Intimate Partner Violence and Use of Welfare Services Among California Women

The current study is a population-based investigation of the association between past-year exposure to intimate partner violence (IPV) and current welfare use, while also accounting for the effects of other violence experienced in adulthood and symptoms of posttraumatic stress disorder (PTSD). These data indicate that acute exposure to intimate partner violence is significantly over-represented among women currently on welfare. However, it appears to be a woman\u27s cumulative exposure to interpersonal violence and associated symptoms of PTSD that are uniquely associated with welfare participation. These data highlight the prevalence of violence against women and its consequences for this population. Results suggest that the prevention and detection of violence is an important welfare issue, and highlight the need for more research in this area

Diagnostic Accuracy and Acceptability of the Primary Care Posttraumatic Stress Disorder Screen for the Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) among US Veterans

Importance: Posttraumatic stress disorder (PTSD) is a serious mental health disorder that can be effectively treated with empirically based practices. PTSD screening is essential for identifying undetected cases and providing patients with appropriate care. Objective: To determine whether the Primary Care PTSD screen for the Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) (PC-PTSD-5) is a diagnostically accurate and acceptable measure for use in Veterans Affairs (VA) primary care clinics. Design, Setting, and Participants: This cross-sectional, diagnostic accuracy study enrolled participants from May 19, 2017, to September 26, 2018. Participants were recruited from primary care clinics across 2 VA Medical Centers. Session 1 was conducted in person, and session 2 was completed within 30 days via telephone. A consecutive sample of 1594 veterans, aged 18 years or older, who were scheduled for a primary care visit was recruited. Data analysis was performed from March 2019 to August 2020. Exposures: In session 1, participants completed a battery of questionnaires. In session 2, a research assistant administered the PC-PTSD-5 to participants, and then a clinician assessor blind to PC-PTSD-5 results conducted a structured diagnostic interview for PTSD. Main Outcomes and Measures: The range of PC-PTSD-5 cut points overall and across gender was assessed, and diagnostic performance was evaluated by calculating weighted κ values. Results: In total, 495 of 1594 veterans (31%) participated, and 396 completed all measures and were included in the analyses. Participants were demographically similar to the VA primary care population (mean [SD] age, 61.4 [15.5] years; age range, 21-93 years) and were predominantly male (333 participants [84.1%]) and White (296 of 394 participants [75.1%]). The PC-PTSD-5 had high levels of diagnostic accuracy for the overall sample (area under the receiver operating characteristic curve [AUC], 0.927; 95% CI, 0.896-0.959), men (AUC, 0.932; 95% CI, 0.894-0.969), and women (AUC, 0.899, 95% CI, 0.824-0.974). A cut point of 4 ideally balanced false negatives and false positives for the overall sample and for men. However, for women, this cut point resulted in high numbers of false negatives (6 veterans [33.3%]). A cut point of 3 fit better for women, despite increasing the number of false positives. Participants rated the PC-PTSD-5 as highly acceptable. Conclusions and Relevance: The PC-PTSD-5 is an accurate and acceptable screening tool for use in VA primary care settings. Because performance parameters will change according to sample, clinicians should consider sample characteristics and screening purposes when selecting a cut point

The Veterans Health Administration and Military Sexual Trauma.

The persistence of sexual violence within the US armed forces is a fact long recognized by military officials, policymakers, health care professionals, and the media. The risk of exposure to sexual violence within the military is high. The annual incidence of experiencing sexual assault is 3% among active duty women and 1% among active duty men. Sexual coercion (e.g., quid pro quo promises of job benefits or threats of job loss) and unwanted sexual attention (e.g., touching, fondling, or threatening attempts to initiate a sexual relationship) occur at an annual rate of 8% and 27%, respectively, among women and 1 % and 5% among men.' Research on deployment stress finds that such experiences constitute important duty-related hazcirds.T he Veterans Health Administration (VHA) has adopted the term military sexual trauma (MST) to refer to severe or threatening forms of sexual harassment and sexual assault sustained in military service. In response to such widespread exposure in the military and the lasting deleterious consequences of sexual violence, the VHA has implemented a universal screening program for MST. For patients that screen positive, treatment for any MST-related injury, illness, or psychological condition is provided free of charge regardless of eligibility or co-pay status. These policies may represent the most comprehensive health policy response to sexual violence of any major US health care system. To our knowledge, we are the first to study the VHA's MST program, which provides an unparalleled opportunity to investigate the feasibility and clinical utility of screening for sexual violence and provides unique data to characterize the burden of illness associated with MST. US epidemiological data indicate significant deleterious health and mental health correlates for sexual trauma. Among traumatic events, rape holds the highest conditional risk for posttraumatic stress disorder (PTSD); these data and data specific to military samples confirm that sexual trauma poses a risk for Objectives. We examined the utility ofthe Veterans Health Administration (VHA) universal screening program for military sexual violence. Methods. We analyzed VHA administrative data for 185 880 women and 4139888 men who were veteran outpatients and were treated in VHA health care settings nationwide during 2003. Results. Screening was completed for 70% of patients. Positive screens were associated with greater odds of virtually all categories of mental health comorbidities, including posttraumatic stress disorder (adjusted odds ratio [AOR] = 8.83; 99% confidence interval [Cl] = 8.34, 9.35 for women; AOR = 3.00; 99% Cl = 2.89, 3.12 for men). Associations with medical comorbidities (e.g., chronic pulmonary disease, liver disease, and for women, weight conditions) were also observed. Significant gender differences emerged. Conclusions. The VHA policies regarding military sexual trauma represent a uniquely comprehensive health care response to sexual trauma. Results attest to the feasibility of universal screening, which yields clinically significant information with particular relevance to mental health and behavioral health treatment. Women's health literature regarding sexual trauma will be particularly important to inform health care services for both male and female veterans. {Am J Public Health

Estimating the cost of care

Chapter 13, Part 4. "Estimating the Costs of Care" from PTSD and Mild Traumatic Brain Injury, Edited by Jennifer J. Vasterling, Richard A. Bryant, Terence M. Keane (2012)Traumatic brain injury (TBI) is an important public health concern in the United States, particularly as service members return home from the combat operations in Afghanistan, Iraq, and other locations in service of Operations Enduring Freedom and Iraqi Freedom (OEF/OIF) and Operation New Dawn (OND). According to the U.S. House Committee on Veterans' Affairs, more than 2 million service members have served at least one tour of duty (U.S. House Committee on Veterans' Affairs, March 18, 2010). Longer deployments and more redeployments place considerable strain on health care systems in terms of care for military personnel with mild TBI (mTBI), as well as posttraumatic stress disorder (PTSD)

The Veterans Health Administration and Military Sexual Trauma

Objectives. We examined the utility of the Veterans Health Administration (VHA) universal screening program for military sexual violence