Publication year
2014
Citation Title
Iraq and Afghanistan war veterans with reintegration problems: Differences by Veterans Affairs healthcare user status.
Journal Name
Administration Policy in Mental Health
Journal Volume
42
Issue Number
4
Page Numbers
493-503
DOI
10.1007/s10488-014-0564-2
Summary
Veterans from OEF/OIF/OND participated in a clinical trial of expressive writing; Veterans Affairs (VA) users were compared to nonusers in terms of demographic and clinical characteristics. About half of the participants reported reintegration difficulties almost six years after returning from deployment. Military service variables and probable traumatic brain injury predicted use of VA healthcare services.
Key Findings
Fifty-four percent of OEF/OIF/OND Veterans reported at least a little difficulty reintegrating, and report this difficulty almost six years after returning from deployment.
VA user status was not related to minority status, indicators of socioeconomic status, or employment levels; military Service branch (Army), time since discharge, having a service connected mental or physical health condition, and probable traumatic brain injury were all significantly associated with being a VA user.
Veterans from OEF/OIF/OND who had used VA healthcare with perceived reintegration difficulty were more likely to have probable traumatic brain injury and PTSD, and were more likely to report higher levels of psychological distress, physical symptoms, and reintegration difficulty compared to non-users.
Although many of the assessed problems were more prevalent in VA users, nonusers also reported many difficulties; for example, probable PTSD excessed 25% in VA nonusers.
Implications for Program Leaders
Host trainings for service providers to increase awareness of post-deployment concerns and other common health problems in Service members
Develop programming to facilitate routine follow up with Service members and their families over time to minimize reintegration difficulties
Provide workshops to help deployed Service members’ spouses learn about available supportive services to handle increased stress and difficulties
Implications for Policy Makers
Continue to support programs that involve the assessment and treatment of reintergration and deployment-related problems such as traumatic brain injury and PTSD
Encourage collaboration among DoD programs and community-based organizations to support a smooth transition for departing Service members
Continue to support programs that address the challenges deployed Service members and their families face
Methods
Data from the DoD Defense Manpower Data Center (DMDC) roster of all OEF/OIF/OND Veterans were used for the study. Researchers included those who had left Active Duty service, had assessment data from a randomized control trial of expressive writing, and reported perceived reintegration difficulty in the analysis; those with severe depression were excluded.
Demographic and military status variables were included in the analysis; trauma history, distress, anger, physical symptoms, probable PTSD, social support, life satisfaction, health behaviors and health service use were all queried via online survey.
Statistical analyses were used to predict VA user status and examine differences in characteristics.
Participants
Participants included 15,686 Iraq and Afghanistan Veterans, with an average age of 28.9 years and mostly male (89%).
Sixty-six percent of the sample was White, 16% was Latino/Latina, 12% was Black, 14% was not reported.
Among the sample, 66% represented the Army, 18% the Marines, 12% the Navy, and 10% represented the Air Force. Most of the participants were enlisted (89%) and 58% were Active Duty, while 38% were in the Reserves.
Limitations
Differences between responders and non-responders could have impacted the outcomes in unmeasured ways and this wasn't accounted for in the analyses.
Those with severe depression were excluded and this could have resulted in lower estimates of mental and physical health symptoms.
Researchers used a one-item measure of reintegration difficulty which likely didn't capture the construct's fully complexity.
Avenues for Future Research
Examine differences in user status in Service members with a range of reintegration difficulty
Develop a multi-item assessment of reintegration difficulty and consider variables such as how far Veterans live from a VA in comparing users to nonusers
Assess family charactersitics and relationship status that may impact Service members' reintegration difficulties
Focus
Multiple Branches
Target Population
Population Focus
Military Branch
Military Component
Abstract
We studied 1,292 Iraq and Afghanistan War veterans who participated in a clinical trial of expressive writing to estimate the prevalence of perceived reintegration difficulty and compare Veterans Affairs (VA) healthcare users to nonusers in terms of demographic and clinical characteristics. About half of participants perceived reintegration difficulty. VA users and nonusers differed in age and military background. Levels of mental and physical problems were higher in VA users. In multivariate analysis, military service variables and probable traumatic brain injury independently predicted VA use. Findings demonstrate the importance of research comparing VA users to nonusers to understand veteran healthcare needs.
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