1
|
Wolfson C, Gauvin DE, Schulz J, Magalhaes S, Tansey CM, Feinstein A, Aiken A, Scarfo B, Middleton J, Raina P, VanTil L, Molnar-Szakacs I. The Canadian Longitudinal Study on Aging: A Vehicle for Research on Aging in Older Veterans. Mil Med 2024; 189:1080-1088. [PMID: 36722191 PMCID: PMC11110616 DOI: 10.1093/milmed/usad012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 12/18/2022] [Accepted: 01/11/2023] [Indexed: 02/02/2023] Open
Abstract
INTRODUCTION Research on the health of older Veterans in Canada is an emerging area. Few population-based studies in Canada have included older Veterans as a specific group of interest. This paper describes a cohort of self-identified Veterans within the Canadian Longitudinal Study on Aging (CLSA). MATERIALS AND METHODS Using data from the CLSA baseline assessment (2011-2015), we describe sociodemographic and health characteristics along with military-related variables in a cohort of Veterans in Canada. We also estimate the number of Canadian and non-Canadian Veterans living in Canada at the time of the CLSA baseline data collection. RESULTS We estimate that at the CLSA baseline, there were 718,893 (95% confidence interval [CI], 680,033-757,110) Canadian Veterans and 185,548 (95% CI, 165,713-205,100) non-Canadian Veterans aged 45-85 years living in Canada. Veterans were older and predominantly male compared to non-Veterans in the CLSA. Following age and sex adjustment, the distribution of sociodemographic and health characteristics was similar across all groups. The majority (> 85%) of participants in each comparison group reported self-rated general and mental health as excellent, very good, or good. Following age and sex adjustment, most characteristics across groups remained similar. One exception was mental health, where a greater proportion of Veterans screened positive for depression and anxiety relative to non-Veterans. CONCLUSIONS Using CLSA baseline data, we estimate the number of older Veterans in Canada and present descriptive data that highlight interesting differences and similarities between Veterans and non-Veterans living in Canada. Canadian and non-Canadian Veterans in the CLSA are presented separately, with the latter group having not been previously studied in Canada. This paper presents a snapshot of a cohort of self-identified Veterans within the CLSA at study baseline and highlights the potential of the CLSA as a vehicle for studying the aging Veteran population in Canada for years to come.
Collapse
Affiliation(s)
- Christina Wolfson
- Department of Epidemiology and Biostatistics and Occupational Health, McGill University, Montreal, QC H3A 1G1, Canada
- Department of Medicine, McGill University, Montreal, QC H4A 3J1, Canada
- Neuroepidemiology Research Unit, Research Institute of the McGill University Health Centre, Montreal, QC H3G 1A4, Canada
| | - Danielle E Gauvin
- Neuroepidemiology Research Unit, Research Institute of the McGill University Health Centre, Montreal, QC H3G 1A4, Canada
| | - Juliana Schulz
- Department of Decision Sciences, HEC Montréal, Montréal, QC H3T 2A7, Canada
| | - Sandra Magalhaes
- New Brunswick Institute for Research, Data and Training and Department of Sociology, University of New Brunswick, Fredericton, NB E3C 1N8, Canada
| | - Catherine M Tansey
- Neuroepidemiology Research Unit, Research Institute of the McGill University Health Centre, Montreal, QC H3G 1A4, Canada
| | - Anthony Feinstein
- Department of Psychiatry, University of Toronto and Sunnybrook Health Sciences Centre, Toronto, ON M4N 3M5, Canada
| | - Alice Aiken
- Faculty of Health, Dalhousie University, Halifax, NS B3H 4R2, Canada
| | - Brittany Scarfo
- Neuroepidemiology Research Unit, Research Institute of the McGill University Health Centre, Montreal, QC H3G 1A4, Canada
| | - Jason Middleton
- Neuroepidemiology Research Unit, Research Institute of the McGill University Health Centre, Montreal, QC H3G 1A4, Canada
| | - Parminder Raina
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON L8S 4K1, Canada
| | - Linda VanTil
- Research Directorate, Veterans Affairs Canada, Charlottetown, PEI C1A 8M9, Canada
| | - Istvan Molnar-Szakacs
- Neuroepidemiology Research Unit, Research Institute of the McGill University Health Centre, Montreal, QC H3G 1A4, Canada
| |
Collapse
|
2
|
Coppel D, Barber J, Temkin NR, Mac Donald CL. Combat Deployed Service Members by Blast TBI and Service Separation Status 5-years Post-deployment: Comparison of Cognitive, Neurobehavioral, and Psychological Profiles of Those Who Left vs. Those Still Serving. Mil Med 2024; 189:e795-e801. [PMID: 37756615 PMCID: PMC10898932 DOI: 10.1093/milmed/usad378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 08/29/2023] [Accepted: 09/20/2023] [Indexed: 09/29/2023] Open
Abstract
INTRODUCTION Longitudinal research regarding the pre- and post-separation experience has been relatively limited, despite its potential as a major life transition. Separating from the military and re-integration to civilian life is noted to be a period of increased risk of significant adjustment challenges, which impacts a service member in a multitude of areas. Active duty service members with combat-related physical or mental health or pre-existing adjustment conditions may be more likely to separate from service and more at risk for post-military service adjustment problems. MATERIALS AND METHODS This is a secondary data analysis from a prospective, observational, longitudinal, multicohort study involving deployed service members originally enrolled between 2008 and 2013 in combat or following medical evacuation to Landstuhl, Germany. Two combat-deployed cohorts were examined: non-head-injured control without blast exposure (n = 109) and combat-related concussion arising from blast (n = 165). Comprehensive clinical evaluations performed at 1 year and 5 year follow-up included identical assessment batteries for neurobehavioral, psychiatric, and cognitive outcomes. In addition to demographics collected at each study visit, the current analysis leveraged the Glasgow Outcome Scale Extended (GOS-E), a measure of overall global disability. For neurobehavioral impairment, the Neurobehavioral Rating Scale-Revised (NRS) was used as well as the Headache Impact Test (HIT-6) to assess headache burden. To compare psychiatric symptom burden between those separated to those still serving, the Clinician-Administered PTSD Scale for DSM-IV (CAPS) and Montgomery-Asberg Depression Rating Scale (MADRS) for depression were used as well as the Michigan Alcohol Screening Test (MAST) to be able to compare alcohol misuse across groups. Overall cognitive function/performance was defined for each service member by aggregating the 19 neuropsychological measures. RESULTS Overall comparisons following adjustment by linear regression and correction for multiple comparisons by separation status subgroup for non-blast control or blast traumatic brain injury (TBI) identified significant differences at 5 years post-enrollment in measures of global disability, neurobehavioral impairment, and psychiatric symptom burden. Those who separated had worse global disability, worse neurobehavioral symptoms, worse Post-Traumatic Stress Disorder symptoms, and worse depression symptoms than active duty service members. While service members who sustain a mild blast TBI during combat are more likely to separate from service within 5 years, there is a proportion of those non-injured who also leave during this time frame. Clinical profiles of both groups suggest service members who separated have elevated psychiatric and neurobehavioral symptoms but not cognitive dysfunction. Interestingly, the symptom load in these same domains is lower for those without blast TBI who separated during this time frame. CONCLUSIONS These results appear to support previous research depicting that, for some service members, transitioning out of the military and re-integrating into civilian life can be a challenging adjustment. Many factors, including personal and social circumstances, prior mental or emotional difficulties, availability of social or community support or resources, can influence the adjustment outcomes of veterans. Service members with prior adjustment difficulties and/or those with blast TBI history (and ongoing neurobehavioral symptoms) may find the transition from military to civilian life even more challenging, given the potential substantial changes in lifestyle, structure, identity, and support.
Collapse
Affiliation(s)
- David Coppel
- Department of Neurological Surgery, University of Washington, Seattle, WA 98104-2499, USA
| | - Jason Barber
- Department of Neurological Surgery, University of Washington, Seattle, WA 98104-2499, USA
| | - Nancy R Temkin
- Department of Neurological Surgery, University of Washington, Seattle, WA 98104-2499, USA
| | - Christine L Mac Donald
- Department of Neurological Surgery, University of Washington, Seattle, WA 98104-2499, USA
| |
Collapse
|
3
|
Misca G, Augustus J, Russell J, Walker J. Meaning(s) of transition(s) from military to civilian life at the intersection with mental health: implications for clinical settings. Front Psychol 2023; 14:1142528. [PMID: 37228334 PMCID: PMC10203708 DOI: 10.3389/fpsyg.2023.1142528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 03/31/2023] [Indexed: 05/27/2023] Open
Abstract
The experiences of military personnel moving into civilian life can be varied for the individual, families and communities. This paper aims to shed light on the various meanings of the multiple and "nested" transitions of military personnel to civilian life in the context of attending a mental health service in the UK. This was achieved through secondary analysis of semi-structured interviews with veterans who were engaging with a mental health service in the UK and a further interview with the mental health service lead. A thematic analysis was employed based on a descriptive phenomenological approach. Results indicate that an appropriate support infrastructure needs to be put in place for veterans prior to, during and after the transition to civilian life. The support appropriateness includes themes specific to connectedness to others, support service accessibility, mental health professionals' military culture awareness and mental health stigma. Although the findings suggest that community services need an awareness of veterans' specific needs, many of the themes are similar to those of the general population. Therefore, the need for an integrated healthcare system is essential in the transition of military service personnel to civilian life. Drawing on international evidence as well as the current findings, implications for policy and practice are highlighted throughout.
Collapse
Affiliation(s)
- Gabriela Misca
- School of Psychology, University of Worcester, Worcester, United Kingdom
| | - Jo Augustus
- Institute of Health, University of Cumbria, Cumbria, United Kingdom
| | - Jade Russell
- School of Psychology, University of Worcester, Worcester, United Kingdom
| | - Janet Walker
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, United Kingdom
| |
Collapse
|
4
|
Emotional Dysregulation and Craving in Patients with Substance Use Disorder: the Mediating Role of Psychological Distress. Int J Ment Health Addict 2023. [DOI: 10.1007/s11469-023-01031-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/26/2023] Open
|
5
|
Matsegora Y, Kolesnichenko O, Prykhodko I, Kravchenkо O, Kуslyi V, Bayda M, Kryvokon N, Rumiantse Y, Marushchenko K, Pashchenko A. Social and psychological predictors of alcohol-related incidents involving servicemen. ROMANIAN JOURNAL OF MILITARY MEDICINE 2022. [DOI: 10.55453/rjmm.2022.125.4.20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
"The aim of the research was to determine the social and psychological predictors of alcohol-related incidents involving servicemen. The research involved 310 servicemen, who were subjected to disciplinary and administrative penalties within 2016-2021 years for the offence commitment under the influence of alcohol. The control group included 650 servicemen who joined the service within this period. The analysis of psychological features of servicemen was carried out with the help of the following methods: “Determination of Type Accentuation of Character Traits and Temper” Questionnaire, “Self-Esteem Structures of Temper Questionnaire”, “Multilevel Personality ‘Adaptability’ Questionnaire”, “Progressive Matrix”, “16 PF Questionnaire”, and “Self-Esteem Structures of Temper Questionnaire”. Cluster analysis was used to differentiate servicemen who committed incidents under the influence of alcohol. The determined typology was valuable for the organization of preventive works, events dedicated to the improvement of socialization by recruits, adequate formation of servicemen image as well as their identification in accordance with it, and events dedicated to the prevention of suicidal behaviour."
Collapse
|
6
|
Bond GR, Al-Abdulmunem M, Drake RE, Davis LL, Meyer T, Gade DM, Frueh BC, Dickman RB, Ressler DR. Transition from Military Service: Mental Health and Well-being Among Service Members and Veterans with Service-connected Disabilities. J Behav Health Serv Res 2022; 49:282-298. [PMID: 35083657 PMCID: PMC9160081 DOI: 10.1007/s11414-021-09778-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/12/2021] [Indexed: 01/07/2023]
Abstract
Transitioning from military service is stressful for veterans with service-connected disabilities seeking civilian employment. This descriptive study examined self-assessed mental health, well-being, and substance use of men and women shortly before or after transition from US military service, compared to norms from community and military samples. As part of a prospective study evaluating an innovative employment program, researchers interviewed 229 current and former service members with service-connected disabilities transitioning from U.S. military service. Compared to published norms, respondents reported significantly poorer outcomes on 5 of 6 standardized measures, indicating less life satisfaction, poorer mental health, more symptoms of depression and posttraumatic stress disorder, and greater financial distress. In the previous year, 42% were prescribed opioid medications, over twice the annual opioid prescription rate of 19% in the general US population. Systematic strategies are needed to ensure access for transitioning veterans with serious behavioral health issues to appropriate evidence-based practices.
Collapse
Affiliation(s)
- Gary R Bond
- Westat, Rivermill Commercial Center, 85 Mechanic Street, Lebanon, NH, 03766, USA.
| | | | - Robert E Drake
- Westat, Rivermill Commercial Center, 85 Mechanic Street, Lebanon, NH, 03766, USA
| | - Lori L Davis
- Research Service, Tuscaloosa VA Medical Center, Tuscaloosa, AL, USA.,Department of Psychiatry, University of Alabama School of Medicine, Birmingham, AL, USA
| | - Thomas Meyer
- Sloan School of Management, Massachusetts Institute of Technology, Cambridge, USA
| | - Daniel M Gade
- Department of Public Administration and Policy, American University, Washington, DC, USA
| | - B Christopher Frueh
- Department of Psychology, University of Hawaii, Hilo, HI, USA.,Department of Neurosurgery, Houston Methodist Academic Institute, Houston, TX, USA
| | | | - Daniel R Ressler
- Westat, Rivermill Commercial Center, 85 Mechanic Street, Lebanon, NH, 03766, USA
| |
Collapse
|
7
|
Harwood-Gross A, Weltman A, Kanat-Maymon Y, Pat-Horenczyk R, Brom D. Peace of mind: Promoting psychological growth and reducing the suffering of combat veterans. MILITARY PSYCHOLOGY 2022. [DOI: 10.1080/08995605.2022.2044119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Anna Harwood-Gross
- The Paul Baerwald School of Social Work and Social Welfare, Hebrew University of Jerusalem, Jerusalem, Israel
- METIV, The Israel Psychotrauma Center, Jerusalem, Israel
| | - Alon Weltman
- METIV, The Israel Psychotrauma Center, Jerusalem, Israel
| | - Yaniv Kanat-Maymon
- Baruch Ivcher School of Psychology, Interdisciplinary Center (IDC), Herzliya, Israel
| | - Ruth Pat-Horenczyk
- The Paul Baerwald School of Social Work and Social Welfare, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Danny Brom
- METIV, The Israel Psychotrauma Center, Jerusalem, Israel
| |
Collapse
|
8
|
Davis JP, Prindle J, Castro CC, Saba S, Fitzke RE, Pedersen ER. Changes in alcohol use during the COVID-19 pandemic among American veterans. Addict Behav 2021; 122:107052. [PMID: 34284311 DOI: 10.1016/j.addbeh.2021.107052] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 06/18/2021] [Accepted: 07/12/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND The COVID-19 pandemic has had considerable behavioral health implications globally. One subgroup that may be of particular concern is U.S. veterans, who are susceptible to mental health and substance use concerns. The current study aimed to investigate changes in alcohol use and binge drinking before and during the first year of the pandemic among U.S. veterans, and how pre-pandemic mental health disorders, namely posttraumatic stress disorder (PTSD), and COVID-19-related factors like loneliness, negative reactions to COVID-19, and economic hardship influenced alcohol use trends. METHODS 1230 veterans were recruited in February 2020 as part of a larger survey study on veteran health behaviors. Veterans were asked to complete follow-up assessments throughout the pandemic at 6, 9, and 12- months. RESULTS Overall, veterans reported a significant decrease in alcohol use (IRR = 0.98) and binge drinking (IRR = 0.11) However, women, racial/ethnic minority veterans, and those with pre-existing PTSD exhibited smaller decreases in alcohol use and binge drinking and overall higher rates of use compared to men, White veterans, and those without PTSD. Both economic hardship and negative reactions to COVID-19 were associated with greater alcohol and binge drinking whereas loneliness showed a negative association with alcohol use and binge drinking. CONCLUSIONS Veterans reported decreases in alcohol use and binge drinking throughout the pandemic, with heterogeneity in these outcomes noted for higher risk groups. Special research and clinical attention should be given to the behavioral health care needs of veterans in the post-pandemic period.
Collapse
|
9
|
Pedersen ER, Davis JP, Fitzke RE, Lee DS, Saba S. American Veterans in the Era of COVID-19: Reactions to the Pandemic, Posttraumatic Stress Disorder, and Substance Use Behaviors. Int J Ment Health Addict 2021; 21:767-782. [PMID: 34466132 PMCID: PMC8390086 DOI: 10.1007/s11469-021-00620-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/12/2021] [Indexed: 02/06/2023] Open
Abstract
The COVID-19 pandemic may have a compounding effect on the substance use of American veterans with posttraumatic stress disorder (PTSD). This study investigated the relationship between PTSD and current reactions to COVID-19 on alcohol and cannabis use among veterans who completed a survey 1 month prior to the pandemic in the USA and a 6-month follow-up survey. We hypothesized that veterans with PTSD would experience more negative reactions to COVID-19 and increased alcohol and cannabis use behaviors over those without PTSD. Veterans with PTSD prior to the pandemic, relative to those without, endorsed poorer reactions, greater frequency of alcohol use, and greater cannabis initiation and use during the pandemic. Veterans with PTSD may use substances to manage COVID-related stress. Clinicians may see an increase in substance use among this group during and after the pandemic and may need to implement specific behavioral interventions to mitigate the negative effects of COVID-19.
Collapse
Affiliation(s)
- Eric R. Pedersen
- Department of Psychiatry and Behavioral Sciences, Keck School of Medicine, University of Southern California, CA 90033 Los Angeles, USA
| | - Jordan P. Davis
- Suzanne Dworak-Peck School of Social Work, USC Center for Artificial Intelligence in Society, USC Center for Mindfulness Science, USC Institute for Addiction Science, University of Southern California, CA 90089 Los Angeles, USA
| | - Reagan E. Fitzke
- Department of Psychiatry and Behavioral Sciences, Keck School of Medicine, University of Southern California, CA 90033 Los Angeles, USA
| | - Daniel S. Lee
- Suzanne Dworak-Peck School of Social Work, University of Southern California, CA 90089 Los Angeles, USA
| | - Shaddy Saba
- Suzanne Dworak-Peck School of Social Work, University of Southern California, CA 90089 Los Angeles, USA
| |
Collapse
|
10
|
Longitudinal Investigation of Military-specific Factors Associated With Continued Unhealthy Alcohol Use Among a Large US Military Cohort. J Addict Med 2021; 14:e53-e63. [PMID: 31821191 PMCID: PMC7280069 DOI: 10.1097/adm.0000000000000596] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
To examine whether military separation (Veteran), service component (active duty, Reserve/National Guard), and combat deployment are prospectively associated with continuing unhealthy alcohol use among US military service members.
Collapse
|
11
|
Leave no one behind? Transitioning from the military to civilian life in New Zealand. JOURNAL OF MANAGEMENT & ORGANIZATION 2021. [DOI: 10.1017/jmo.2021.20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Abstract
Transition from the military environment into a civilian environment is a topic that has seen increasing attention within the last two decades. There is, in the literature, a clearly articulated issue that transition from the military to the civilian world is somewhat different to transitioning from school to work, or from career to career, or from work to retirement. Many, but not all, of the extant examples regarding military transition are case studies, focus groups or small-scale qualitative surveys. The following article details a large-scale survey that took place in New Zealand in 2019. From just over 1400 responses, a wide range of information was gathered. The aim of the survey was to uncover the experiences of military who had undergone transition within New Zealand. In this respect, the survey was exploratory. We report here the qualitative results that expand the existing body of knowledge of military transition. Our results are in line with international results and demonstrate that a large majority of respondents had a less than desirable transition experience. The contribution made therefore is a reinforcement that current practice in this area is needing a great deal of attention. The following outlines the experiences our New Zealand-based respondents had and how this mirrors the extant international literature. As this was the first survey of its kind to attract large numbers of respondents within New Zealand, the results and discussion that follow present aspects of transition that the Ministry of Defence and the New Zealand Defence Force may wish to consider when planning future transition programmes.
Collapse
|
12
|
Bigelow A, Fausone CA. Service Impact on Veteran Health: Case Examples From Recent Eras. J Nurse Pract 2021. [DOI: 10.1016/j.nurpra.2020.12.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
|
13
|
Turna J, MacKillop J. Cannabis use among military veterans: A great deal to gain or lose? Clin Psychol Rev 2021; 84:101958. [PMID: 33486280 DOI: 10.1016/j.cpr.2021.101958] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 06/11/2020] [Accepted: 01/06/2021] [Indexed: 12/16/2022]
Abstract
Policy changes have resulted in dramatic increases in access to cannabis for medical purposes. Veterans are disproportionately affected by conditions for which medical cannabis is often pursued, making an evidence-based perspective on risks versus benefits of high priority. The current review sought to examine the state of the evidence on the correlates and consequences of cannabis use among veterans. Using a comprehensive search strategy, 501 articles were identified and 86 studies met criteria for inclusion. The literature was predominated by cross-sectional studies (67%) of male veterans (71.4%-100% male) from the United States (93.0%). Three overarching themes emerged, comprising cannabis associations with other substance use, mental health, and physical health outcomes. The balance of the evidence associated cannabis use with negative health outcomes, with consistent positive associations with other substance use, psychiatric disorders, and self-harm/suicidality. Few studies examined the therapeutic effects of cannabis, thus limiting the potential to evaluate evidence of efficacy. Priority areas for future research are studies using designs that can examine the directionality of links between cannabis and health in veterans more conclusively, and studies directly examining therapeutic efficacy of cannabis-based therapies in veterans. Methodologically rigorous design will be essential to inform clinical recommendations and practices guidelines in an era of burgeoning access to cannabis.
Collapse
Affiliation(s)
- Jasmine Turna
- Michael G. DeGroote Centre for Medicinal Cannabis Research, McMaster University & St. Joseph's Healthcare Hamilton, 100 West 5(th) St, Hamilton, ON L9C 0E3, Canada; Peter Boris Centre for Addictions Research, McMaster University & St. Joseph's Healthcare Hamilton, 100 West 5(th) St, Hamilton, ON L9C 0E3, Canada
| | - James MacKillop
- Michael G. DeGroote Centre for Medicinal Cannabis Research, McMaster University & St. Joseph's Healthcare Hamilton, 100 West 5(th) St, Hamilton, ON L9C 0E3, Canada; Peter Boris Centre for Addictions Research, McMaster University & St. Joseph's Healthcare Hamilton, 100 West 5(th) St, Hamilton, ON L9C 0E3, Canada; Homewood Research Institute, 150 Delhi St. Riverslea Building, Guelph, ON N1E 6K9, Canada.
| |
Collapse
|
14
|
Lindberg M, Sloley S, Ivins B, Marion D, Moy Martin E. Military TBI—What civilian primary care providers should know. J Family Med Prim Care 2021; 10:4391-4397. [PMID: 35280636 PMCID: PMC8884302 DOI: 10.4103/jfmpc.jfmpc_98_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 07/27/2021] [Accepted: 07/31/2021] [Indexed: 11/13/2022] Open
Abstract
In June 2019, the Department of Veterans Affairs (VA) launched the VA Mission Act, which expanded veterans’ health-care access to the private sector. Since civilian primary care providers may see more veterans in their practice, it will be important to understand the unique experiences, comorbidities, and culture of this population in order to provide optimal care. Military service members (SMs) are at an increased risk for traumatic brain injury (TBI), and comorbidities, such as post traumatic stress disorder (PTSD), increasing the likelihood of prolonged symptoms. Military training and repetitive low-level blast exposure may cause symptoms similar to TBI or increase long-term negative effects in SMs. Military culture often has a strong influence in this population. Those who serve in the military identify with military values and have a strong team mentality, which places emphasis on the mission above all else, not accepting defeat, and not ever leaving a fellow SM behind. These values can impact the way a SM/veteran seeks care and/or communicates with his or her health-care provider. Taking a detailed history to understand how these factors apply, as well as screening for mental health comorbidities, are recommended. Understanding the military cultural influences can assist in promoting a stronger therapeutic alliance and encourage more open communication. Ultimately, it is the trusting and respectful relationship between the SM/veteran and the provider that will determine the most effective treatment and result in the most effective resolution of TBI and comorbid symptoms.
Collapse
|
15
|
Serebro M, Sobol-Goldberg S, Feingold D. From Enchantment to Disillusion: A Narrative Exploration of Cannabis Use Disorder Among Young Israeli Combat Veterans. Front Psychiatry 2021; 12:643618. [PMID: 34220568 PMCID: PMC8249726 DOI: 10.3389/fpsyt.2021.643618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 05/24/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction: Substance use is common among military personnel and war veterans, especially combat veterans. Despite substantially high prevalence of cannabis use and Cannabis Use Disorder (CUD) consistently reported among veterans, little is known about psychological factors which may underlie CUD among this population. Methods: In this study, we used narrative analysis in order to interpret retrospective in-depth interviews of combat veterans (N = 12) who were released from mandatory military duty during the past 5 years and currently qualified for a diagnosis of CUD. Participants were recruited from a larger quantitative study were eligible for participation if they screened positive for a diagnosis of CUD according to the Cannabis Use Disorder Identification Test- Revised (CUDIT-R) questionnaire. CUD diagnosis was validated in-person using the cannabis section of the Alcohol Use Disorder and Associated Disabilities Interview Schedule-5 (AUDADIS-5) interview protocol. All interviews were transcribed and coded using the content analysis procedure. Findings: Five main themes were extracted: (a) Traumatic events (b) Attitudes toward cannabis use (c) Combatant identity (d) The role of authority/father figures, and (e) Moral crisis. A meta-theme has been identified, "from enchantment to disillusion," representing a gradual psychological shift from a hopeful, highly motivated stance into the current state of mental rupture and moral injury, which are unsuccessfully compensated by excessive use of cannabis. Conclusions: This study shed light on the etiology of CUD among young combat veterans, highlighting the role of supposed self-medication for trauma and sense of betrayal.
Collapse
Affiliation(s)
- Miri Serebro
- MA Program, Psychology Department, Ariel University, Ariel, Israel
| | | | | |
Collapse
|
16
|
Vest BM, Brady LA, Brimmer MJ, Homish GG. Variations in Risk and Motivations for Substance Use over the Course of Military Service. Subst Use Misuse 2021; 56:559-566. [PMID: 33616468 PMCID: PMC8108137 DOI: 10.1080/10826084.2021.1887257] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Epidemiological data identify risk factors related to substance use among military service members to inform prevention and treatment. Less is known about how motivations and risks for substance use vary over a military service career. The study goal was to explore substance use patterns and motivations among a sample of United States undergraduate student veterans in order to identify periods of risk. Methods: Qualitative interviews were conducted (n = 31) between December 2018 and April 2019. Transcripts were coded in ATLAS.ti using thematic content analysis. Results: Interviews revealed complex motivations around substance use and identified key periods of risk. 1) Pre-service: Participants reported using alcohol and marijuana, primarily during social activities. 2) During service: Participants described a culture of heavy alcohol and tobacco use in social contexts, but little use of other substances. Post-deployment was a notable exception, when some reported heavier alcohol use and use of other drugs, including opiates, cocaine, and ecstasy. 3) Post-service: Transitioning out of the military was described as difficult; some participants reported heavier use of substances during this period. Some participants quit smoking after military service, or switched to vaping. Others reported use of alcohol and/or marijuana to calm themselves, relieve stress, and enable sleep. Conclusions: These data indicate that the periods immediately following deployment and transition out of the military may be especially high-risk for heavy substance use and use of a broader range of substances. This highlights the need for tailored interventions and messaging at different points of military service, particularly during periods of greatest risk.
Collapse
Affiliation(s)
- Bonnie M Vest
- Primary Care Research Institute, Department of Family Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
| | - Laura A Brady
- Primary Care Research Institute, Department of Family Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
| | - Maximilian J Brimmer
- Primary Care Research Institute, Department of Family Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
| | - Gregory G Homish
- Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo, Buffalo, New York, USA
| |
Collapse
|
17
|
Meca A, Park H, Higgins J, Hamrick H, Webb T, Davies R, Golembiewski L, Bravo AJ, Kelley ML. The role of United States identity in adjustment among Veterans. MILITARY PSYCHOLOGY 2020; 32:408-416. [PMID: 38536242 PMCID: PMC10013209 DOI: 10.1080/08995605.2020.1802400] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 07/23/2020] [Indexed: 01/06/2023]
Abstract
Given over 2.77 million US service members have been deployed in the past 20 years and the intense process of reintegration to civilian life, understanding factors that contribute to Veterans' mental health and substance use is critical. This study sought to understand the effects of US identity exploration, US identity commitment, US identity affirmation, and US identity centrality on substance use and symptoms of depression and anxiety. The sample consisted of 195 US military Veterans (n = 184, 53.3% women; 73.3% White; Mage = 35.12 years, SD = 9.60 years). Bivariate correlations indicated US identity affirmation was negatively associated with substance use and symptoms of depression and anxiety whereas US identity centrality was positively correlated with alcohol use. Utilizing structural equation model, US identity affirmation and US identity centrality were, respectively, negatively and positively associated with alcohol use, substance use, and symptoms of depression and anxiety. Partially consistent with our hypothesis, US identity exploration was positively associated with symptoms of anxiety. In contrast to our hypothesis, US identity commitment was not significantly associated with any outcome. Results are discussed in terms of important directions for identity research in the transition to civilian life.
Collapse
Affiliation(s)
- Alan Meca
- Department of Psychology, Old Dominion University, Norfolk, Virginia
| | - HyeJung Park
- Department of Psychology, Arizona State University, Tempe, Arizona
| | - Jennise Higgins
- Department of Psychology, Old Dominion University, Norfolk, Virginia
| | - Hannah Hamrick
- Department of Psychology, Old Dominion University, Norfolk, Virginia
| | - Taylor Webb
- Department of Psychology, Old Dominion University, Norfolk, Virginia
| | - Rachel Davies
- Department of Psychology, Old Dominion University, Norfolk, Virginia
| | | | - Adrian J. Bravo
- Psychological Sciences, William & Mary, Williamsburg, Virginia
| | | |
Collapse
|
18
|
Abraham TH, Cheney AM, Curran GM, Drummond KL. Drinking as routine practice among re-integrating National Guard and Reservists from Arkansas. QUALITATIVE RESEARCH IN MEDICINE & HEALTHCARE 2020. [DOI: 10.4081/qrmh.2020.9001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Active duty enlisted military personnel are more likely to misuse alcohol than civilians – a pattern which persists even after the transition to civilian life. We used in-depth, substance use history interviews to elicit drinking trajectories from 54 re-integrating Army National Guard, Air Force Reserve and Army Reserve personnel from Arkansas with a history of problematic substance use. A hybrid inductive-deductive analytic approach revealed institutional norms, shared beliefs about drinking, and social values and expectations among military peers present in the context of military service that Veterans described as having shaped their drinking trajectories. Framing Veterans’ narratives vis-à-vis practice theory revealed the complex processes by which excessive drinking was embodied as routine practice during military service and subsequently reproduced in a very different post-deployment context, often with deleterious results. Elucidating these implicit processes suggested pro-active strategies for preventing problematic drinking by active duty personnel and improving the re-integration experiences of Veterans.
Collapse
|
19
|
Hansen C, McFarlane A, Iannos M, Sadler N, Benassi H, Lawrence-Wood E, Hodson S, Searle A, Van Hooff M. Psychosocial factors associated with psychological distress and functional difficulties in recently transitioned and current serving regular Australian Defence Force members. Psychiatry Res 2020; 286:112860. [PMID: 32065981 DOI: 10.1016/j.psychres.2020.112860] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 02/07/2020] [Accepted: 02/08/2020] [Indexed: 11/19/2022]
Abstract
The transition period from military-to-civilian life can be one of the most significant and stressful periods in the military life cycle. We explore the psychosocial factors associated with psychological distress and functional impairment among those who recently transitioned from the Australian Defence Force (ADF) and those currently serving in 2015. Using data from the Transition and Wellbeing Research Programme, multinomial logistic regression models were used to analyze the associations between a combined measure of psychological distress and functional impairment (K10/SDS) with various psychosocial, lifestyle, and physical health factors. There were 10,210 in the final analytic cohort (Transitioned=3,254; Regular 2015 ADF=6,956). Overall, the odds of belonging to the highly distressed/impaired group were greatest among those with insomnia (Odds Ratio 18.53), low resilience (OR 7.67), physical health symptoms (OR 7.16), and alcohol risk (OR 4.67). Other factors included pain (OR 3.36), financial issues (OR 2.38), and social strain (OR 1.98). The associations with insomnia and physical health symptoms were stronger among the Transitioned compared to the Regular 2015 ADF. Results of this research highlights the importance of taking a multi-dimensional perspective of symptoms in military populations, particularly in those recently transitioned from permanent service, as predictors of future risk of disorder.
Collapse
Affiliation(s)
- Craig Hansen
- Centre for Traumatic Stress Studies, University of Adelaide, South Australia, Australia.
| | - Alexander McFarlane
- Centre for Traumatic Stress Studies, University of Adelaide, South Australia, Australia
| | - Marie Iannos
- Centre for Traumatic Stress Studies, University of Adelaide, South Australia, Australia
| | - Nicole Sadler
- Department of Defence, Canberra, Australia; Phoenix Australia, Centre for Posttraumatic Mental Health, Melbourne, Australia
| | - Helen Benassi
- Department of Defence, Canberra, Australia; Australian National University, Canberra, Australia
| | - Ellie Lawrence-Wood
- Centre for Traumatic Stress Studies, University of Adelaide, South Australia, Australia
| | | | - Amelia Searle
- Centre for Traumatic Stress Studies, University of Adelaide, South Australia, Australia
| | - Miranda Van Hooff
- Centre for Traumatic Stress Studies, University of Adelaide, South Australia, Australia
| |
Collapse
|
20
|
Evans EA, Tennenbaum DL, Washington DL, Hamilton AB. Why Women Veterans Do Not Use VA-Provided Health and Social Services: Implications for Health Care Design and Delivery. JOURNAL OF HUMANISTIC PSYCHOLOGY 2019. [DOI: 10.1177/0022167819847328] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Elizabeth A. Evans
- University of Massachusetts Amherst, Amherst, MA, USA
- VA Center for the Study of Healthcare Innovation, Implementation, and Policy, Los Angeles, CA, USA
| | - Dawn L. Tennenbaum
- VA Center for the Study of Healthcare Innovation, Implementation, and Policy, Los Angeles, CA, USA
| | - Donna L. Washington
- VA Center for the Study of Healthcare Innovation, Implementation, and Policy, Los Angeles, CA, USA
- University of California Los Angeles, Los Angeles, CA, USA
| | - Alison B. Hamilton
- VA Center for the Study of Healthcare Innovation, Implementation, and Policy, Los Angeles, CA, USA
- University of California Los Angeles, Los Angeles, CA, USA
| |
Collapse
|