Mental Health Diagnoses and Utilization of VA Non-Mental Health Medical Services Among Returning Iraq and Afghanistan Veterans

Over 35% of returned Iraq and Afghanistan veterans in VA care have received mental health diagnoses; the most prevalent is post-traumatic stress disorder (PTSD). Little is known about these patients’ use of non-mental health medical services and the impact of mental disorders on utilization. To compare utilization across three groups of Iraq and Afghanistan veterans: those without mental disorders, those with mental disorders other than PTSD, and those with PTSD. National, descriptive study of 249,440 veterans newly utilizing VA healthcare between October 7, 2001 and March 31, 2007, followed until March 31, 2008. We used ICD9-CM diagnostic codes to classify mental health status. We compared utilization of outpatient non-mental health services, primary care, medical subspecialty, ancillary services, laboratory tests/diagnostic procedures, emergency services, and hospitalizations during veterans’ first year in VA care. Results were adjusted for demographics and military service and VA facility characteristics. Veterans with mental disorders had 42–146% greater utilization than those without mental disorders, depending on the service category (all P < 0.001). Those with PTSD had the highest utilization in all categories: 71–170% greater utilization than those without mental disorders (all P < 0.001). In adjusted analyses, compared with veterans without mental disorders, those with mental disorders other than PTSD had 55% higher utilization of all non-mental health outpatient services; those with PTSD had 91% higher utilization. Female sex and lower rank were also independently associated with greater utilization. Veterans with mental health diagnoses, particularly PTSD, utilize significantly more VA non-mental health medical services. As more veterans return home, we must ensure resources are allocated to meet their outpatient, inpatient, and emergency needs

The biopsychosocial benefits and shortfalls for armed forces veterans engaged in archaeological activities

Background Organised outdoor activates are advocated as promoting multiple benefits for a veteran's wellbeing, of whom up to 50% have suffered either/both physical and mental health (MH) problems. This has resulted in significant investment in a growing number of outdoor events, one of which is the Defence Archaeology Group (DAG) which utilise the technical and social aspects of field archaeology in the recovery and skill development of injured veterans. Objective To advance knowledge within veterans MH and wellbeing through an understanding of the potential long term psychological benefits and shortfalls for veterans undertaking DAG activities. Design A constructivist grounded theory approach was used to enable identification of the issues from the participant veteran's perspective. Setting: DAG archaeological excavations in April and August 2015. Method Semi-structured interviews with 14 veterans. Results The qualitative coding resulted in the indication of 18 categories subsumed within four clusters: motivation and access; mental health; veteran and teamwork; therapeutic environment and leadership. Discussion The psychological benefits were improved self-esteem, confidence, a reduction in stigma and motivation to seek help. The reduction in situational stressors associated with difficult life conditions also appeared to improve mood, and there was a clear benefit in being in a caring environment where other people actively paid an interest. There were extended social benefits associated with being accepted as part of a team within a familiar military environment, which presented an opportunity to establish friendships and utilise military skill sets. Conclusion Organised outdoor activities offer multi-factorial hope for veterans searching for ways to ease the transition to civilian life and recover from military stress and trauma. The relaxing and reflective environment within a military setting appears to construct a sense of personal safety and thereby offers therapeutic value

A log-linear modelling approach to assessing the consistency of ego reports of dyadic outcomes with applications to fertility and sexual partnerships

We propose a log-linear model to assess the consistency of ego reports of dyadic outcomes. We do so specifically in the context where males and females report on shared events, and we demonstrate how inconsistencies can be assessed by using a log-linear model that estimates separate mixing totals for each set of reports. This modelling approach immediately allows us to determine where inconsistencies in reports occur. To demonstrate how our method can be easily implemented for survey data, we apply it to both the 1992 National Health and Social Life Survey and the 2002 National Survey of Family Growth. Our analysis identifies inconsistencies in male and female reports of concurrent partnerships and the number of biological children