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Levin C, Nenninger S, Freundlich D, Glatt S, Sokol Y. How future self-continuity mediates the impact of job loss on negative mental health outcomes among transitioning veterans. MILITARY PSYCHOLOGY 2024; 36:491-503. [PMID: 37252891 PMCID: PMC11407375 DOI: 10.1080/08995605.2023.2215697] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 05/10/2023] [Indexed: 06/01/2023]
Abstract
Veterans in the transition stage out of the military have an increased risk for negative mental health outcomes and suicide. Previous research has found that finding and retaining employment is the most challenging post-service adjustment for veterans. Job loss may have a greater impact on mental health for veterans than for civilians due to the myriad challenges often faced when transitioning to the civilian workplace, as well as preexisting vulnerabilities that are common among veterans such as trauma exposure or service-related injuries. Previous studies have demonstrated that low Future Self-Continuity (FSC), which refers to the sense of "psychological connectedness" that a person has between their present and future selves, has also been associated with the abovementioned mental health outcomes. 167 U.S. military veterans who exited the military 10 or fewer years prior to their participation in the study, of which 87 experienced subsequent job loss, completed a series of questionnaires to assess future self-continuity (FSC) and mental health outcomes. Results confirmed previous findings in that job loss, as well as low FSC, were individually associated with an increased risk for negative mental health outcomes. Findings suggest that FSC may act as a mediator, where levels of FSC mediate the effects of job loss on negative mental outcomes (depression, anxiety, stress, and suicidality) among veterans during their first 10 years out of the military. These findings may have implications for enhancing current clinical interventions for veterans experiencing job loss and mental health difficulties during the transition period.
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Affiliation(s)
- Chynna Levin
- VISN 2 Mental Illness Research, Education and Clinical Center, James J. Peters VA Medical Center, Bronx, New York
| | | | - Devora Freundlich
- VISN 2 Mental Illness Research, Education and Clinical Center, James J. Peters VA Medical Center, Bronx, New York
| | - Sofie Glatt
- VISN 2 Mental Illness Research, Education and Clinical Center, James J. Peters VA Medical Center, Bronx, New York
| | - Yosef Sokol
- VISN 2 Mental Illness Research, Education and Clinical Center, James J. Peters VA Medical Center, Bronx, New York
- Department of Psychology, School of Health Sciences, Touro University, New York, New York
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Mosalpuria K, Bailey EV, Ko H, Hansen EJ, Wilson FA. Chronic Physical and Mental Health Conditions Associated With Employment Status in Veterans. AJPM FOCUS 2024; 3:100242. [PMID: 38993712 PMCID: PMC11238941 DOI: 10.1016/j.focus.2024.100242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 07/13/2024]
Abstract
Introduction Veterans commonly experience both poor health and employment difficulty. However, the research examining potential relationships between chronic physical and mental health conditions and employment in veterans has important limitations. This study examines those potential relationships using large-scale, nationally representative data. The authors' hypothesis was that veterans experiencing these conditions would be less likely to be employed than veterans without the conditions and, further, that there may be differences in these relationships when comparing male veterans with female veterans. Methods The study team conducted a pooled cross-sectional analysis of nationally representative data from the 2004-2019 administrations of the Medical Expenditures Panel Survey, which had items addressing health conditions, employment, and military experience. The authors assessed the relationship between health conditions and employment using multivariate logistic regression. Control variables included demographics, SES, family size, and survey year. Results Veterans experiencing diabetes, high blood pressure, stroke, emphysema, arthritis, serious hearing loss, poor self-reported mental health, poor self-reported health, depression, or psychological distress were less likely to be employed than veterans without those conditions, even after adjusting for potential confounding factors. Veterans with diabetes had 25% lesser odds of being employed than veterans without the condition (95% CI=0.65, 0.85). Veterans with increased likelihood of depression had 35% lesser odds of being employed than veterans without depression (95% CI=0.52, 0.81). Conclusions This study adds evidence to the understanding of the role of chronic health conditions in employment status of veterans. The results support arguments for programs that aid veterans with both their health and their employment.
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Affiliation(s)
- Kavita Mosalpuria
- Matheson Center for Health Care Studies, The University of Utah, Salt Lake City, Utah
- Department of Population Health Sciences, School of Medicine, University of Utah, Salt Lake City, Utah
- Department of Public Health, Brody School of Medicine, East Carolina University, Greenville, North Carolina
| | - Elise V. Bailey
- Department of Population Health Sciences, School of Medicine, University of Utah, Salt Lake City, Utah
- College of Social and Behavioral Science, The University of Utah, Salt Lake City, Utah
| | - Hyunkyu Ko
- Department of Orthopedics, School of Medicine, University of Utah, Salt Lake City, Utah
| | - Eric J. Hansen
- Department of Population Health Sciences, School of Medicine, University of Utah, Salt Lake City, Utah
- College of Social and Behavioral Science, The University of Utah, Salt Lake City, Utah
| | - Fernando A. Wilson
- Matheson Center for Health Care Studies, The University of Utah, Salt Lake City, Utah
- Department of Population Health Sciences, School of Medicine, University of Utah, Salt Lake City, Utah
- Department of Economics, College of Social and Behavioral Science, The University of Utah, Salt Lake City, Utah
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Kroll-Desrosiers A, Kinney RL, Marteeny V, Mattocks KM. Exploring the Acceptability of Expanded Perinatal Depression Care Practices Among Women Veterans. J Gen Intern Med 2022; 37:762-769. [PMID: 36042083 PMCID: PMC9427169 DOI: 10.1007/s11606-022-07573-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 04/01/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Veterans receive obstetrical care from community-based providers contracted through the Veterans Health Administration (VA); however, Veterans remain eligible for VA mental healthcare in the perinatal period. To date, few studies have focused specifically on the mental health needs of Veterans during the perinatal period. OBJECTIVE To examine the acceptability of more comprehensive perinatal mental healthcare screening and treatment in VA care, we explored pregnant and postpartum Veteran perspectives of United States Preventive Services Task Force (USPSTF) recommendations that aim to expand mental health counseling for the prevention and treatment of perinatal depression. DESIGN Semi-structured interviews with pregnant and postpartum Veterans enrolled in VA care, integrated with quantitative survey data. PARTICIPANTS Pregnant and postpartum Veterans (n=27) who had delivered infants or were due by February 2020. APPROACH Framework analysis with an inductive approach was utilized to understand our data, interpret and code our transcripts, and develop themes. KEY RESULTS Fewer than half (44%) of the women reported seeing a mental health provider at the beginning of their pregnancy. We found that Veterans support USPSTF recommendations in the VA, consider mental healthcare to be very important during the perinatal period, would like better access to mental healthcare resources and peer support networks, and suggest that perinatal depression screening could be more extensive. CONCLUSIONS These findings support the implementation of more comprehensive perinatal depression prevention policies and practices within VA care. Understanding the real-world feasibility and prevailing barriers to comprehensive perinatal depression care is needed to inform implementation of the USPSTF recommendations or a similar intervention tailored for VA care.
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Affiliation(s)
- Aimee Kroll-Desrosiers
- VA Central Western Massachusetts Healthcare System, Leeds, MA, USA.
- University of Massachusetts Chan Medical School, Worcester, MA, USA.
| | - Rebecca L Kinney
- VA Central Western Massachusetts Healthcare System, Leeds, MA, USA
- University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Valerie Marteeny
- VA Central Western Massachusetts Healthcare System, Leeds, MA, USA
| | - Kristin M Mattocks
- VA Central Western Massachusetts Healthcare System, Leeds, MA, USA
- University of Massachusetts Chan Medical School, Worcester, MA, USA
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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] [MESH Headings] [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.
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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
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Umucu E, Reyes A, Nay A, Elbogen E, Tsai J. Associations between mental health and job loss among middle‐ and low‐income veterans and civilians during the COVID‐19 pandemic: An exploratory study. Stress Health 2022; 38:410-416. [PMID: 34541784 PMCID: PMC8646322 DOI: 10.1002/smi.3099] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 08/02/2021] [Accepted: 08/30/2021] [Indexed: 12/21/2022]
Abstract
This study examined the relationship between job loss and mental health during the pandemic among a nationally representative sample of middle- and low-income military veterans and civilians. Participants were recruited from Amazon Mechanical Turk in May-June 2020. Our sample was comparable to the U.S. population with respect to key demographics (i.e., sex, race, ethnicity, and geographic region). More veterans were male (36.9% civilians vs. 74.1% veterans), and on average they were older than civilians (Mcivilians = 47.86 vs. Mveterans = 52.64). After controlling for sociodemographic factors, probable anxiety (adjusted odds ratio for veterans = 1.96, 95% [1.22-3.15]) was significantly associated with job loss among veterans, whereas among civilians, probable anxiety (adjusted odds ratio for civilians [AORc ] = 1.48, 95% [1.21-1.81]), probable COVID-19 era-related stress (AORc = 1.73, 95% [1.45-2.07]), and loneliness (AORc = 1.09, 95% [1.04-1.13]) were associated with job loss. Results demonstrated that veteran sample's effect sizes were larger than civilian sample's effect sizes; however, our moderation analyses results revealed that veteran status did not moderate the relationships between mental health and job loss. The findings in this study support a relationship between job loss and poorer mental health, suggesting that increased mental health services may be important to address ongoing effects of the COVID-19 pandemic.
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Affiliation(s)
- Emre Umucu
- Department of Counseling, Educational Psychology & Special EducationMichigan State UniversityEast LansingMichiganUSA
| | - Antonio Reyes
- Division of Special Education and CounselingCalifornia State UniversityLos AngelesCaliforniaUSA
| | - Andrew Nay
- Department of Counseling, Educational Psychology & Special EducationMichigan State UniversityEast LansingMichiganUSA
| | - Eric Elbogen
- U.S. Department of Veterans AffairsNational Center on Homelessness Among VeteransWashingtonDCUSA,Department of PsychiatryDuke University School of MedicineDurhamNorth CarolinaUSA
| | - Jack Tsai
- U.S. Department of Veterans AffairsNational Center on Homelessness Among VeteransWashingtonDCUSA,School of Public HealthUniversity of Texas Health Science Center at HoustonHoustonTexasUSA,Department of PsychiatryYale UniversitySchool of MedicineNew HavenConnecticutUSA
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Rhead R, MacManus D, Jones M, Greenberg N, Fear NT, Goodwin L. Mental health disorders and alcohol misuse among UK military veterans and the general population: a comparison study. Psychol Med 2022; 52:292-302. [PMID: 32777197 DOI: 10.1017/s0033291720001944] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
BACKGROUND For a small minority of personnel, military service can have a negative impact on their mental health. Yet no studies have assessed how the mental health of UK veterans (who served during the recent operations in Afghanistan or Iraq) compares to non-veterans, to determine if they are at a disadvantage. We examine the prevalence of mental disorders and alcohol misuse in UK veterans compared to non-veterans. METHODS Veteran data were taken from the third phase of the King's Centre for Military Health Research cohort study (n = 2917). These data were compared with data on non-veterans taken from two large general population surveys: 2014 Adult Psychiatric Morbidity Survey (n = 5871) and wave 6 of the UK Household Longitudinal Study (UKHLS, n = 22 760). RESULTS We found that, overall, UK veterans who served at the time of recent military operations were more likely to report a significantly higher prevalence of common mental disorders (CMD) (23% v. 16%), post-traumatic stress disorder (PTSD) (8% v. 5%) and alcohol misuse (11% v. 6%) than non-veterans. Stratifying by gender showed that the negative impact of being a veteran on mental health and alcohol misuse was restricted to male veterans. Being ill or disabled was associated with a higher prevalence of CMD and PTSD for both veterans and non-veterans. CONCLUSION Whilst the same sociodemographic groups within the veteran and non-veteran populations seemed to have an increased risk of mental health problems (e.g. those who were unemployed), male veterans, in particular, appear to be at a distinct disadvantage compared to those who have never served.
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Affiliation(s)
- Rebecca Rhead
- Department of Forensic and Neurodevelopmental Science, King's College London, London, UK
- King's Centre for Military Health Research, Department of Psychological Medicine, King's College London, London, UK
| | - Deirdre MacManus
- Department of Forensic and Neurodevelopmental Science, King's College London, London, UK
- King's Centre for Military Health Research, Department of Psychological Medicine, King's College London, London, UK
| | - Margaret Jones
- King's Centre for Military Health Research, Department of Psychological Medicine, King's College London, London, UK
| | - Neil Greenberg
- King's Centre for Military Health Research, Department of Psychological Medicine, King's College London, London, UK
| | - Nicola T Fear
- King's Centre for Military Health Research, Department of Psychological Medicine, King's College London, London, UK
- Academic Department of Military Mental Health, Department of Psychological Medicine, King's College London, London, UK
| | - Laura Goodwin
- King's Centre for Military Health Research, Department of Psychological Medicine, King's College London, London, UK
- Department of Psychological Sciences, University of Liverpool, Liverpool, UK
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Cazares PT, Caporaso E, Rumsey D, Segovia F, Yablonsky A, Anderson L, Weits G. Women's Mental Health in the U.S. Military - Where Are We Now? A Review of Recent Research. Curr Psychiatry Rep 2021; 23:67. [PMID: 34586518 DOI: 10.1007/s11920-021-01276-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/06/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE OF REVIEW The field of women's mental health has grown in the military healthcare system, which has begun to acknowledge and address the sex-specific differences in mental health for service women. The purpose of this review is to examine recent research in active duty populations addressing perinatal mental health, post-traumatic stress disorder (PTSD), depression, and gender isolation. RECENT FINDINGS Within the examined literature focused on active duty populations, analyses by sex and gender continue to exist as notable gaps, and a majority of studies reviewed either do not aim to examine sex or gender-based differences, and/or do not analyze data with an eye towards these paradigms. Within perinatal mental health, the lack of studies led to an inability to make any notable conclusions. PTSD was the area with the most robust publications focused on active duty women, studies of major depression showed significant occupational impact, and the area of gender isolation continues to grow as a promising field with practical implications. We discuss current promising research and advance ideas for future research trajectories that will provide clinicians, policy makers, and scientists with more data to support improved mental healthcare for both military women and men.
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Affiliation(s)
- Paulette T Cazares
- Naval Medical Readiness and Training Center (NMRTC), PSC 482, Box 1600 FPO AP 96362, Okinawa, Japan.
| | - Evan Caporaso
- 3rd Marine Regiment, 3rd Marine Division, Hawaii, USA
| | - Danielle Rumsey
- Naval Medical Readiness and Training Center San Diego, San Diego, USA
| | - Francine Segovia
- Naval Medical Readiness and Training Center Pearl Harbor, Pearl Harbor, USA
| | | | - Lyndse Anderson
- Naval Medical Readiness and Training Center San Diego, San Diego, USA
| | - Genelle Weits
- Naval Medical Readiness and Training Center San Diego, San Diego, USA
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Sienkiewicz ME, Iverson KM, Smith BN, Mitchell KS. Associations between eating disorder symptoms, employment status, and occupational functioning among female veterans. Eat Behav 2021; 42:101536. [PMID: 34182295 DOI: 10.1016/j.eatbeh.2021.101536] [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] [Received: 09/17/2020] [Revised: 06/07/2021] [Accepted: 06/18/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Eating disorders (EDs) have been shown to negatively impact occupational functioning and may be associated with employment status. Findings have been inconsistent, and depression may mediate this relation. Further, prior research focuses mainly on binge eating disorder's (BED) impact on occupational functioning. We assessed the association between transdiagnostic ED symptoms and occupational functioning and employment status among female veterans, who tend to have high rates of EDs and unemployment but who remain understudied. METHOD Participants were 198 female veterans (Mage = 54.09) in the New England region who participated in a larger study. They completed a mailed survey including the Eating Disorder Diagnostic Scale, Center for Epidemiologic Studies-Depression Scale, employment status (employed vs. unemployed and out of the workforce), and the Inventory of Psychosocial Functioning to assess occupational functioning. RESULTS ED symptoms were not significantly related to employment status but were negatively associated with occupational functioning when controlling for body mass index. Depressive symptoms mediated the associations between ED symptoms and both being out of the workforce and occupational functioning, respectively. DISCUSSION Higher levels of ED symptoms were associated with worse occupational functioning in a female veteran sample. Further, comorbid depressive symptoms may be an important treatment target when addressing occupational health in women experiencing ED symptoms.
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Affiliation(s)
- Megan E Sienkiewicz
- National Center for PTSD, VA Boston Healthcare System, 150 South Huntington Avenue, Boston, MA 02130, USA
| | - Katherine M Iverson
- National Center for PTSD, VA Boston Healthcare System, 150 South Huntington Avenue, Boston, MA 02130, USA; Department of Psychiatry, Boston University School of Medicine, 715 Albany St, Boston, MA 02118, USA
| | - Brian N Smith
- National Center for PTSD, VA Boston Healthcare System, 150 South Huntington Avenue, Boston, MA 02130, USA; Department of Psychiatry, Boston University School of Medicine, 715 Albany St, Boston, MA 02118, USA
| | - Karen S Mitchell
- National Center for PTSD, VA Boston Healthcare System, 150 South Huntington Avenue, Boston, MA 02130, USA; Department of Psychiatry, Boston University School of Medicine, 715 Albany St, Boston, MA 02118, USA.
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Shepherd-Banigan M, Pogoda TK, McKenna K, Sperber N, Van Houtven CH. Experiences of VA vocational and education training and assistance services: Facilitators and barriers reported by veterans with disabilities. Psychiatr Rehabil J 2021; 44:148-156. [PMID: 32597666 PMCID: PMC9677616 DOI: 10.1037/prj0000437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To understand the experiences of veterans with disabilities and caregiving needs who use Department of Veterans Affairs (VA) vocational and education services, including Supported Employment, the Post-9/11 GI Bill, and Vocational Rehabilitation and Employment. METHOD We conducted 26 joint semistructured interviews with post-9/11 veterans who had used at least one of three vocational and education services, and their family members who were enrolled in a VA Caregiver Support Program. RESULTS VA vocational and education services helped veterans with disabilities transition from the military into civilian life by providing skills and incremental exposure to engaging in everyday life tasks. Veteran motivation, caregiver support, and engaged staff at VA and academic institutions were key drivers of veteran success. Veterans who experienced challenges cited the following barriers: health problems, concerns about benefits loss if they became employed, and VA and academic programs that did not accommodate the needs of nontraditional veteran learners. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE There is a need to bolster VA vocational and educational services for veterans with disabilities in several domains, including modifying the roles of frontline staff and increasing communication between vocational counselors and health care teams to better accommodate the veteran's health-related limitations. Providing a vocational rehabilitation navigator to help veterans identify opportunities within VA and work/educational settings that are a good match for the veteran's goals and abilities could also be beneficial across vocational and educational services. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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Affiliation(s)
- Megan Shepherd-Banigan
- Durham Veterans Affairs Health Services Research and Development (HSR&D), Center of Innovation to Accelerate Discovery and Practice Transformation(ADAPT),VA Durham Healthcare System
| | - Terri K Pogoda
- Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System
| | - Kevin McKenna
- Department of Population Health Sciences, Duke School of Medicine
| | - Nina Sperber
- Durham Veterans Affairs Health Services Research and Development (HSR&D), Center of Innovation to Accelerate Discovery and Practice Transformation(ADAPT),VA Durham Healthcare System
| | - Courtney H Van Houtven
- Durham Veterans Affairs Health Services Research and Development (HSR&D), Center of Innovation to Accelerate Discovery and Practice Transformation(ADAPT),VA Durham Healthcare System
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Elrond AF, Conway PM, Andersen SB, Karstoft KI, Vedtofte MS, Pedersen J. Deployment experiences and mental health problems as predictors of post-deployment unemployment length: a prospective, register-based study among Danish soldiers. BMJ Open 2020; 10:e040625. [PMID: 33293314 PMCID: PMC7722823 DOI: 10.1136/bmjopen-2020-040625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES To test responses of formerly deployed soldiers (FDS) to a questionnaire on deployment experiences in combination with screening levels of post-traumatic stress disorder (PTSD) and depression approximately 6 months after homecoming as predictors of the subsequent probability of gaining employment when unemployed within 5 years post-deployment. DESIGN, SETTING AND PARTICIPANTS Danish FDS responders (n=3935) and non-responders (n=3046) to a 6-month post-deployment screening questionnaire after returning from a first-ever deployment to Kosovo, Iraq or Afghanistan (2002 to 2012) were included in the study and followed in public registers from 6 months to 5 years post-deployment. PRIMARY AND SECONDARY OUTCOME MEASURES We tested Cox regression models including deployment experiences (1a), screening levels of PTSD and depressive symptoms (1b), and their combination (2) for FDS responders. For all FDS, a secondary model included a measure on whether they responded to the questionnaire (3). RESULTS Neither the deployment experiences (1a) of exposure to danger and combat (HR=1.00, 95% CI=0.97 to 1.03) and witnessing consequences of war (HR=1.01, 95% CI=0.96 to 1.06), or the screening levels (1b) of PTSD (HR=1.06, 95% CI=0.84 to 1.33) and depressive symptoms (HR=0.82, 95% CI=0.64 to 1.06) were significant predictors of transitioning from unemployment to employment. Similar results were found for the combined model (2). A tendency among non-respondents (3) to have a lower probability of transitioning from unemployment to employment was found (HR=0.90, 95% CI=0.81 to 1.00). CONCLUSION Deployment experiences, PTSD and depressive symptoms, as measured at 6-month screening questionnaire, did not predict differences in the probability of gaining employment when unemployed within 5 years post-deployment. However, the findings suggest that those with the least probability of transitioning from unemployment to employment can be found among the non-responders to the post-deployment screening questionnaire.
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Affiliation(s)
- Andreas Friis Elrond
- Research and Knowledge Centre, Danish Veteran Centre, Ringsted, Denmark
- Department of Psychology, University of Copenhagen, Faculty of Social Sciences, Copenhagen, Denmark
| | - Paul Maurice Conway
- Department of Psychology, University of Copenhagen, Faculty of Social Sciences, Copenhagen, Denmark
| | - Søren Bo Andersen
- Research and Knowledge Centre, Danish Veteran Centre, Ringsted, Denmark
| | - Karen-Inge Karstoft
- Research and Knowledge Centre, Danish Veteran Centre, Ringsted, Denmark
- Department of Psychology, University of Copenhagen, Faculty of Social Sciences, Copenhagen, Denmark
| | | | - Jacob Pedersen
- National Research Centre for the Working Environment, Copenhagen, Denmark
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11
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Merritt VC, Jurick SM, Crocker LD, Keller AV, Hoffman SN, Jak AJ. Factors associated with employment and work perception in combat-exposed veterans. Rehabil Psychol 2020; 65:279-290. [PMID: 32297778 PMCID: PMC8409174 DOI: 10.1037/rep0000323] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
PURPOSE/OBJECTIVE The purpose of this study was 2-fold: (a) to evaluate whether perception of work ability is associated with employment status in a sample of combat-exposed veterans, and (b) to determine whether the same sets of variables that are associated with employment status are also associated with perception of work ability. Research Method/Design: In this cross-sectional study, veterans (N = 83) underwent a neuropsychological assessment and completed questionnaires assessing demographic characteristics, combat-related experiences, and psychiatric and neurobehavioral/health-related symptoms. Primary outcomes of interest were employment status (unemployed vs. employed) and veterans' perception of whether their ability to work has declined due to an ongoing condition (yes vs. no). RESULTS A chi-square analysis revealed a significant relationship between perception of work ability and employment status. Additionally, psychiatric and neurobehavioral/health-related symptoms were associated with employment status and perception of work ability, whereas demographic characteristics (i.e., service-connected disability rating) and combat-related experiences (i.e., mTBI history) were only associated with perception of work ability. Objective cognitive functioning was not associated with employment status or perception of work ability. CONCLUSIONS/IMPLICATIONS Although preliminary, results suggest that perception of work ability is an important factor to consider when evaluating employment-related outcomes in veterans. Moreover, results indicate that while there is some overlap among the variables associated with employment status and perception of work ability, additional variables are linked with perception of work ability. Taken together, these findings suggest that perception of one's ability to work and factors that influence it may be particularly important treatment targets in the veteran population. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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Affiliation(s)
| | - Sarah M. Jurick
- VA San Diego Healthcare System (VASDHS), San Diego, CA, USA
- Center of Excellence for Stress and Mental Health, VASDHS, San Diego, CA, USA
| | - Laura D. Crocker
- VA San Diego Healthcare System (VASDHS), San Diego, CA, USA
- Center of Excellence for Stress and Mental Health, VASDHS, San Diego, CA, USA
| | | | | | - Amy J. Jak
- VA San Diego Healthcare System (VASDHS), San Diego, CA, USA
- Center of Excellence for Stress and Mental Health, VASDHS, San Diego, CA, USA
- Department of Psychiatry, School of Medicine, University of California San Diego, La Jolla, CA, USA
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12
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Examining the Association between Trauma Exposure and Work-Related Outcomes in Women Veterans. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17124585. [PMID: 32630579 PMCID: PMC7344422 DOI: 10.3390/ijerph17124585] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 06/18/2020] [Accepted: 06/19/2020] [Indexed: 11/23/2022]
Abstract
Women veterans have high rates of trauma exposure, including military sexual trauma (MST), which are associated with numerous health and psychosocial consequences. However, associations between trauma history and work-related outcomes are less well-characterized. We examined whether military-related and non-military trauma types were associated with work-related outcomes and whether posttraumatic stress disorder (PTSD) and depression symptoms mediated these associations. A total of 369 women veterans completed up to two mailed surveys, 12 months apart, assessing trauma exposure, depression and PTSD symptoms, occupational functioning, and employment status (unemployed, out of the workforce, employed). Participants reported high rates of trauma exposure. Nearly half (47.5%) were out of the workforce. Military-related trauma, military sexual assault, and adult sexual assault were associated with worse occupational functioning. Only PTSD symptoms mediated associations between trauma types and occupational functioning. No trauma types were significantly directly associated with employment status; however, PTSD and depression symptoms mediated associations between trauma types and being out of the workforce. Findings can inform screening for military trauma exposures, mental health, and work-related needs among women veterans.
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Albright DL, Hendricks Thomas K, McDaniel J, Fletcher KL, Godfrey K, Bertram J, Angel C. When women veterans return: The role of postsecondary education in transition in their civilian lives. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2019; 67:479-485. [PMID: 30724680 DOI: 10.1080/07448481.2018.1494599] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Revised: 05/05/2018] [Accepted: 06/04/2018] [Indexed: 06/09/2023]
Abstract
Objective: The purpose of this study was to assess the current state of postsecondary educational settings' outreach to military women who become students postservice. Participants: Data for the present cross-sectional study were obtained from the American College Health Association's (ACHA) 2011-2014 National College Health Assessment II (NCHA). Methods: Demographic characteristics of the study sample were explored by calculating frequencies and percentages by military service status. Research questions were explored with Fisher's exact test, maximum likelihood multiple logistic regression, as appropriate. Results: Women service member and veteran students received health information from their university/college less often than women students with no military experience on the following topics: alcohol and other drug use, depression and anxiety, sexual assault and relationship violence prevention, and stress reduction. Conclusions: The findings of this research identified clear gaps in service provision for women student veterans on college campuses and provided some possible models for intervention development.
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Affiliation(s)
| | | | - Justin McDaniel
- c Department of Public Health , Southern Illinois University , Carbondale , Illinois , USA
| | - Kari Lynne Fletcher
- d St. Catherine University - University of St. Thomas School of Social Work , St Paul , Minnesota , USA
| | - Kelli Godfrey
- e University of Alabama , Tuscaloosa , Alabama , USA
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Clearing Away Past Wreckage: A Constructivist Grounded Theory of Identity and Mental Health Access by Female Veterans. ANS Adv Nurs Sci 2018; 41:327-339. [PMID: 30383561 DOI: 10.1097/ans.0000000000000219] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Women Veterans are the largest veteran population yet have significant mental health disparities, greater than both civilian women and veteran men. This article used constructivist grounded theory methods to explore the experiences of women Veterans that led to mental health outpatient service use. Twelve women Veterans revealed meaningful stories on their experiences of trauma and their use of mental health services. A broader grounded theory process model emerged, linking the categories of Trauma, Transitions, Identity, and Structure. This research provides key insight into how women Veterans make health care-related choices and process traumatic events such as military sexual trauma.
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Keeling ME, Ozuna SM, Kintzle S, Castro CA. Veterans’ Civilian Employment Experiences: Lessons Learnt From Focus Groups. JOURNAL OF CAREER DEVELOPMENT 2018. [DOI: 10.1177/0894845318776785] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Emerging evidence highlights employment as a key factor influencing the success of transition from military to civilian life. Historically, employment programs have focused on improving skills such as resume writing and interview skills. However, it is likely that employment challenges are more than these practical barriers. Four focus groups with employed and unemployed Gulf War Era II veterans were conducted aimed at moving past a practical perspective by gaining experiential understandings of veterans’ employment. Thematic analysis indicated that the veterans’ employment experiences were best understood temporally in two master themes: pretransition and the divergent experiences of veterans who did and did not plan ahead and living the transition and the veterans’ experiences of employment barriers and facilitators. Further to the two master themes, an underlying thread of the need for self-determination was evident. Interpretation of the results led to the development of recommendations for policy, service provision, and future research.
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Affiliation(s)
- Mary Elizabeth Keeling
- Center for Innovation and Research in Veterans and Military Families, University of Southern California, Los Angeles, CA, USA
| | - Sara M. Ozuna
- Center for Innovation and Research in Veterans and Military Families, University of Southern California, Los Angeles, CA, USA
| | - Sara Kintzle
- Center for Innovation and Research in Veterans and Military Families, University of Southern California, Los Angeles, CA, USA
| | - Carl A. Castro
- Center for Innovation and Research in Veterans and Military Families, University of Southern California, Los Angeles, CA, USA
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Conard PL, Armstrong ML. Nursing Care of Women Veterans of the Iraq and Afghanistan Wars. Nurs Womens Health 2018; 22:158-173. [PMID: 29628055 DOI: 10.1016/j.nwh.2018.02.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Revised: 10/24/2017] [Indexed: 06/08/2023]
Abstract
The Iraq and Afghanistan wars are unlike earlier wars, and the women veterans who have served in them are unlike veterans of earlier wars. Now these veterans are presenting with distinctive general, genitourinary, reproductive, and behavioral health issues. When seeking health care after deployment, they may be accessing multiple health care providers across numerous sites, including the Veterans Health Administration and civilian facilities. Enhanced levels of understanding, respect, and concern for the many combat-related health challenges experienced by these veterans will help civilian nurses and other clinicians provide optimum care. Provision of health care to women veterans should be multidisciplinary and effectively coordinated among various health care providers and facilities to ensure that their post-deployment health and wellness needs are met.
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Eichler M, Smith-Evans K. Gender in Veteran reintegration and transition: a scoping review. JOURNAL OF MILITARY VETERAN AND FAMILY HEALTH 2018. [DOI: 10.3138/jmvfh.2017-0004] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Maya Eichler
- Department of Political and Canadian Studies and Department of Women's Studies, Mount Saint Vincent University, Halifax, Nova Scotia, Canada
| | - Kimberley Smith-Evans
- Department of Family Studies and Gerontology, Mount Saint Vincent University, Halifax, Nova Scotia, Canada
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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: 55] [Impact Index Per Article: 7.9] [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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