Lisa Lind

Military Sexual Trauma A Review of Prevalence and Associated Health Consequences in Veterans

This article reviews the literature documenting the prevalence of military sexual trauma (MST) and its associated mental and physical health consequences. Existing research indicates that prevalence rates of MST vary depending on method of assessment, definition of MST used, and type of sample. Risk factors for MST have been identified as including age, enlisted rank, negative home life, and previous assault history. MST has been associated with increased screening rates of depression and alcohol abuse, in addition to significantly increased odds of meeting criteria for post-traumatic stress disorder. In addition, MST has been associated with reporting increased number of current physical symptoms, impaired health status, and more chronic health problems in veterans. Available research on health care utilization and MST is also discussed. Researchers are encouraged to utilize standardized definitions of MST, employ standardized assessment methodology, and utilize more male veterans in future research. Policy and practice implications are discussed.

Sexual assault in women veterans: An examination of PTSD risk, health care utilization, and cost of care

Objective: This study examines the differential impact of military, civilian adult, and childhood sexual assault on the likelihood of developing posttraumatic stress disorder (PTSD). It also examines the relationship of military sexual assault (MSA) to service utilization and health care costs among women who access services through Veterans Affairs (VA). Methods: A convenience sample of 270 veteran women receiving medical and/or mental health treatment at the VA North Texas Healthcare System participated in the study. Participants were interviewed using the Clinician Administered PTSD Scale (CAPS) and categorized into a sexual assault group using the Interview of Sexual Experiences (ISE). A chart review was also conducted to determine the frequency of diagnoses among the women. Data regarding health care utilization was obtained from self-report using the Utilization and Cost Patient Questionnaire (UAC-PQ) and VA administrative records. Results: Compared with those without a history of sexual assault, women veterans were 9 times more likely to have PTSD if they had a history of MSA, 7 times more likely if they had childhood sexual assault (CSA) histories, and 5 times more likely if they had civilian sexual assault histories. An investigation of medical charts revealed that PTSD is diagnosed more often for women with a history of MSA than CSA. CSA was associated with a significant increase in health care utilization and cost for services, but there was no related increase in use or cost associated with MSA. Conclusion: Women veterans have differential rates of PTSD due to sexual assault, with higher rates found among those assaulted while on active duty. Although women with MSA are more likely to have PTSD, results suggest that they are receiving fewer health care services. PTSD = posttraumatic stress disorder; MSA = military sexual assault; CSA = civilian sexual assault; ChSA = childhood sexual assault; VA = Veterans Affairs; UAC-PQ = Utilization and Cost Patient Questionnaire; ISE = Interview of Sexual Experiences; CAPS = Clinician Administered PTSD Scale; NSA = no sexual assault; SD = standard deviation; ER = emergency room; SE = standard error.

Mental Health, Quality of Life, and Health Functioning in Women Veterans Differential Outcomes Associated with Military and Civilian Sexual Assault

The present study examined psychiatric, physical, and quality-of-life functioning in a sample of 270 women veterans receiving outpatient treatment at a Veterans Affairs medical center. Participants were interviewed regarding their civilian (CSA) and military sexual assault (MSA) histories, and data regarding quality of life and health outcomes were obtained through structured interviews and questionnaires. Women veterans with CSA histories reported significantly poorer physical, psychiatric, and quality-of-life functioning compared to those without a history of sexual assault. Furthermore, women veterans with an MSA history demonstrated additional negative consequences above and beyond the effects of CSA. The study sample was comparable to a national random sample of women veterans who access care in the Veterans Affairs healthcare system, increasing the generalizibility of the results.

Measures of aggressive behavior: overview of clinical and research instruments

This overview of current aggressive measures is offered as an aid for selection of task-appropriate instruments to meet the needs of both clinicians and researchers. The article provides a general overview of selected aggression instruments and is intended to provide readers with information, such as intended purpose of the instrument, general descriptive information, characteristics of the samples used, and psychometric properties, to assist in identifying instruments that may best suit their clinical and/or research needs. It is also offered as a tool to assist clinicians in selecting such measurement instruments for use in their practice and in understanding results of research studies. Selected instruments have also been categorized to differentiate between those that reflect state or trait characteristics and based on method of administration. Measures were included or not included in this article primarily based on frequency of usage in research and/or clinical settings and potential clinical utility.

Effectiveness of Supported Employment for Veterans With Spinal Cord Injuries: Results From a Randomized Multisite Study

OBJECTIVE To examine whether supported employment (SE) is more effective than treatment as usual (TAU) in returning veterans to competitive employment after spinal cord injury (SCI). DESIGN Prospective, randomized, controlled, multisite trial of SE versus TAU for vocational issues with 12 months of follow-up data. SETTING SCI centers in the Veterans Health Administration. PARTICIPANTS Subjects (N=201) were enrolled and completed baseline interviews. In interventional sites, subjects were randomly assigned to the SE condition (n=81) or the TAU condition (treatment as usual-interventional site [TAU-IS], n=76). In observational sites where the SE program was not available, 44 subjects were enrolled in a nonrandomized TAU condition (treatment as usual-observational site [TAU-OS]). INTERVENTIONS The intervention consisted of an SE vocational rehabilitation program called the Spinal Cord Injury Vocational Integration Program, which adhered as closely as possible to principles of SE as developed and described in the individual placement and support model of SE for persons with mental illness. MAIN OUTCOME MEASURES The primary study outcome measurement was competitive employment in the community. RESULTS Subjects in the SE group were 2.5 times more likely than the TAU-IS group and 11.4 times more likely than the TAU-OS group to obtain competitive employment. CONCLUSIONS To the best of our knowledge, this is the first and only controlled study of a specific vocational rehabilitation program to report improved employment outcomes for persons with SCI. SE, a well-prescribed method of integrated vocational care, was superior to usual practices in improving employment outcomes for veterans with SCI.

Aggression, impulsivity, and health functioning in a veteran population: equivalency and test–retest reliability of computerized and paper-and-pencil administrations ☆

Abstract The present study examined the equivalency and test–retest reliability of two administration methods (paper-and-pencil and computerized) of the Aggression Questionnaire (AQ), Barratt Impulsiveness Scale-11 (BIS-11), and SF-36 Health Survey (SF-36) in a sample of 97 veterans. The two-week test–retest reliability for the conventional paper-and-pencil administrations of the AQ, BIS-11, and the SF-36 in the veteran population were generally reliable and comparable to the test–retest reliability of these measures noted in the research for other populations. Equivalence of the computer vs. paper-and-pencil administrations were examined and results indicated that for the AQ, ICCs for all four subscales and total score were substantially lower for the PC administration. For the BIS-11, ICCs were comparable with the exception of the Motor subscale, which was lower in the PC condition. For the SF-36, two of the domains were higher in the PC condition, with four more being comparable. Overall, the computerized administration of the BIS-11 and SF-36 was found to be equivalent to the “gold standard” paper-and-pencil administration of these measures and can be utilized successfully among veterans. The computerized administration of the AQ, however, was not found to be equivalent to the paper-and-pencil administration of the measure.

Aggression and impulsivity instruments: an examination in veterans

To gather useful and meaningful information concerning behavioral traits, instruments must be determined to be reliable and valid for the specific population in which they will be used. The objective of this study was to examine the psychometric properties and validity of the Aggression Questionnaire (AQ; Buss & Perry, 1992), the Overt Aggression Scale–Modified (OAS–M; Coccaro, Harvey, Kupsaw-Lawrence, Herbert, & Bernstein, 1991), and the Barratt Impulsiveness Scale–11 (BIS–11; Barratt, 1994) in a sample of veterans. Participants included 474 veterans seeking outpatient care from 4 Veterans Affairs medical facilities in the southwestern United States. Results suggest that the AQ, BIS–11, and OAS–M can be reliably used with veterans. However, subscale scores of the BIS and AQ did not provide any additional information over the total score of these instruments. Although total scores of the OAS–M were found to be reliable, subscale scores were not. Nonetheless, information obtained from the OAS–M appeared to be qualitatively different than that from the self-report questionnaires. In summary, the overall results of this study indicate that these aggression and impulsivity instruments may be reliably used in a veteran sample.

Measuring use and cost of care for patients with mood disorders: the utilization and cost inventory.

Background:Researchers conducting cost-outcome studies must account for all materially relevant care that subjects receive from their care providers. However, access to provider records is often limited. This article describes and tests the Utilization and Cost Inventory (UAC-I), a structured patient interview designed to measure costs of care when access to provider records is limited. Methods:UAC-I was tested on 212 consenting adult veterans with mood disorder attending a VA medical center. Counts (inpatient days and outpatient encounters) and costs (dollars) computed from survey responses were compared with estimates from medical records and an alternative structured questionnaire. Results:The agreement between inpatient costs computed from provider records and from UAC-I responses, assessed using the intraclass correlation coefficient (ICC), was 0.66, 95% confidence interval (CI), 0.30–0.84; the bias was −3.7%, 95% CI, −48 to 41. The ICC for the service data (inpatient days) was 0.97, 95% CI, 0.95–0.99; the bias was <1%, 95% CI, −14 to 15. The ICC for outpatient costs computed from provider records and from UAC-I responses was 0.53 95% CI, 0.38–0.65; the bias was <1%, 95% CI, −27 to 27. The ICC for outpatient encounters was 0.74, 95% CI, 0.65–0.80; the bias was <1%, 95% CI, −16 to 18. Conclusions:These results indicate that it may be feasible for cost-outcome studies to compare patient groups for inpatient and outpatient costs computed from patient self-reports.

A Data Accounting System for Clinical Investigators

Clinical investigators often preprocess, process, and analyze their data without benefit of formally organized research centers to oversee data management. This article outlines a practical three-file structure to help guide these investigators track and document their data through processing and analyses. The proposed process can be implemented without additional training or specialized software. Thus, it is particularly well suited for research projects with small budgets or limited access to viable research/data coordinating centers.