Maureen Murdoch

A Qualitative Study of Determinants of PTSD Treatment Initiation in Veterans

Although there are effective treatments for Posttraumatic Stress Disorder (PTSD), many PTSD sufferers wait years to decades before seeking professional help, if they seek it at all. An understanding of factors affecting treatment initiation for PTSD can inform strategies to promote help-seeking. We conducted a qualitative study to identify determinants of PTSD treatment initiation among 44 U.S. military veterans from the Vietnam and Afghanistan/Iraq wars; half were and half were not receiving treatment. Participants described barriers to and facilitators of treatment initiation within themselves, the post-trauma socio-cultural environment, the health care and disability systems, and their social networks. Lack of knowledge about PTSD was a barrier that occurred at both the societal and individual levels. Another important barrier theme was the enduring effect of experiencing an invalidating socio-cultural environment following trauma exposure. In some cases, system and social network facilitation led to treatment initiation despite individual-level barriers, such as beliefs and values that conflicted with help-seeking. Our findings expand the dominant model of service utilization by explicit incorporation of factors outside the individual into a conceptual framework of PTSD treatment initiation. Finally, we offer suggestions regarding the direction of future research and the development of interventions to promote timely help-seeking for PTSD.

Women and war. What physicians should know.

Most of today’s 1.7 million women veterans obtain all or most of their medical care outside the VA health care system, where their veteran status is rarely recognized or acknowledged. Several aspects of women’s military service have been associated with adverse psychologic and physical outcomes, and failure to assess women’s veteran status, their deployment status, and military trauma history could delay identifying or treating such conditions. Yet few clinicians know of women’s military history—or of military service’s impact on women’s subsequent health and well being. Because an individual’s military service may be best understood within the historical context in which it occurred, we provide a focused historical overview of women’s military contributions and their steady integration into the Armed Forces since the War for Independence. We then describe some of the medical and psychiatric conditions associated with military service.

Prevalence and consequences of adult sexual assault of men: Review of empirical findings and state of the literature

Male victims of adult sexual assault (ASA) are understudied as compared with female victims. Further, commonly-held myths about sexual assault suggest that men cannot be victims or that, if men are victims, they are relatively physically and emotionally unharmed by sexual assault. The goal of this paper was to systematically review the empirical literature on ASA among men to evaluate the veracity of these myths. This paper also sought to examine the methodological quality of the body of research in this area, identify limitations and gaps in the current literature, and suggest directions for future research. Eighty-seven relevant studies were identified through a systematic review of the literature. The reported prevalence of mens sexual aggression varied widely depending on the methods used and the population studied; some populations (e.g., veterans, prison inmates, and gay and bisexual men) reported higher rates of ASA than men in the general population. Few studies have systematically examined the consequences of male ASA; however, those that have suggest that ASA can have notable adverse physical and psychological consequences for some men.

Early Mental Health Treatment-Seeking Among U.S. National Guard Soldiers Deployed to Iraq

The authors examined rates of and factors associated with postdeployment treatment-seeking in a panel of 424 National Guard soldiers who spent 16 months in Iraq. Soldiers completed a self-report, mailed survey 3- to 6-months after returning home. Approximately one third of respondents reported postdeployment mental health treatment. Those who screened positive for mental health problems were more likely to indicate that they had received treatment compared to those who screened negative, but over one half of those who screened positive were not engaged with mental health treatment. Variables related to reported treatment receipt included positive attitudes about mental health therapies, having been injured in-theater, illness-based need, and having received mental health treatment while in-theater. Implications and future research directions are discussed.

Health‐Related Quality of Life, Functional Impairment, and Healthcare Utilization by Veterans: Veterans' Quality of Life Study

Objectives: To describe the health status of veterans receiving care in a veterans integrated service network (VISN).

Acute GI Bleeding in the Setting of Supratherapeutic International Normalized Ratio in Patients Taking Warfarin: Endoscopic Diagnosis, Clinical Management, and Outcomes

BACKGROUND Acute GI bleeding is a life-threatening complication of warfarin therapy. Acute GI bleeding in patients with an international normalized ratio of 4.0 or greater (supratherapeutic) is often attributed to trivial mucosal lesions. The aim of the study was to determine the frequency of potentially significant lesions that would warrant endoscopy in this setting. METHODS A retrospective review was conducted of patients treated with warfarin who were admitted to a single Veterans Affairs hospital from 1996 to 2000 with acute GI bleeding. Endoscopic findings, clinical management, and outcomes are reviewed for patients with a supratherapeutic international normalized ratio (>or=4.0) and compared with patients with an international normalized ratio in the therapeutic range (2.0-3.9). RESULTS Fifty-five patients with an international normalized ratio of 4.0 or greater (mean 8.4 [3.9]) and 43 patients with an international normalized ratio between 2.0 and 3.9 (mean 2.9 [0.6]) were hospitalized with acute GI bleeding. Thirty-seven patients (67%) with a supratherapeutic international normalized ratio and GI bleeding underwent upper endoscopy. Of these, 81.1% had positive findings, 18.9% had peptic ulcer disease, and 7.2% required endoscopic treatment. Thirty-eight percent of the patients with a supratherapeutic international normalized ratio underwent lower endoscopy; of these, 57.1% had abnormal findings and 9.5% required endoscopic treatment. Four patients (7.3%) in the supratherapeutic international normalized ratio group died during the index hospitalization. When patients with GI bleeding and a therapeutic international normalized ratio were compared with those with a supratherapeutic international normalized ratio, there were no significant differences between the two groups with regard to days of hospitalization, units of blood transfused, frequency of recurrent bleeding, need for surgery, or in-hospital deaths. CONCLUSIONS The high frequency of clinically significant lesions in patients taking warfarin with an international normalized ratio in the supratherapeutic range and acute GI bleeding supports a role for endoscopic evaluation.

Military to civilian questionnaire: A measure of postdeployment community reintegration difficulty among veterans using Department of Veterans Affairs medical care

The primary objective of this study was to describe the development, reliability, and construct validity of scores on the Military to Civilian Questionnaire (M2C-Q), a 16-item self-report measure of postdeployment community reintegration difficulty. We surveyed a national, stratified sample of 1,226 Iraq and Afghanistan veterans who used U.S. Department of Veterans Affairs (VA) medical care; 745 completed the M2C-Q and validated mental health screening measures. All analyses were based on weighted estimates. The internal consistency of the M2C-Q was .95 in this sample. Factor analyses indicated a single total score was the best-fitting model. Total scores were associated with measures theoretically related to reintegration difficulties including perception of overall difficulty readjusting back into civilian life (R(2) = .49), probable PTSD (d = 1.07), probable problem drug or alcohol use (d = 0.34), and overall mental health (r = -.83). Subgroup analyses revealed a similar pattern of findings in those who screened negative for PTSD. Nonwhite and unemployed veterans reported greater community reintegration difficulty (d = 0.20 and 0.45, respectively). Findings offer preliminary support for the reliability and construct validity of M2C-Q scores.

Functioning and Psychiatric Symptoms among Military Men and Women Exposed to Sexual Stressors

OBJECTIVE The goal was to describe military mens and womens functioning and psychiatric symptoms according to their military sexual stressor exposure. METHOD A cross-sectional survey of 204 Army soldiers and 611 other active duty troops (487 men and 327 women) was performed. RESULTS Forty-five percent of men and 80% of women reported at least one sexual stressor type (i.e., sexual identity challenges, sexual harassment, or sexual assault). After adjustment, subjects reporting more types of sexual stressors had poorer physical, work, role, and social functioning; more-severe post-traumatic stress disorder, depression, and anxiety symptoms; and more somatic concerns, compared with subjects reporting fewer or no sexual stressor types (all p < or = 0.004). Interactions by gender were insignificant (all p > 0.11). Within sexual stressor category, men and women reported similar mean adjusted functioning and psychiatric symptoms. CONCLUSIONS For both men and women, impaired functioning and more severe psychiatric symptoms were more common among those reporting more types of sexual stressors.

Racial disparities in VA service connection for posttraumatic stress disorder disability.

Background. “Service connected” veterans are those with documented, compensative conditions related to or aggravated by military service, and they receive priority for enrollment into the Veterans Affairs (VA) health care system. For some veterans, service connection represents the difference between access to VA health care facilities and no access. Objectives. To determine whether there are racial discrepancies in the granting of service connection for posttraumatic stress disorder (PTSD) by the Department of Veterans Affairs and, if so, to determine whether these discrepancies could be attributed to appropriate subject characteristics, such as differences in PTSD symptom severity or functional status. Research Design. Mailed survey linked to administrative data. Claims audits were conducted on 11% of the sample. Setting and Subjects. The study comprised 2700 men and 2700 women randomly selected from all veterans filing PTSD disability claims between January 1, 1994 and December 31, 1998. Results. A total of 3337 veterans returned useable surveys, of which 17% were black. Only 16% of respondents carried private health insurance, and 44% reported incomes of

Long-term Outcomes of Disability Benefits in US Veterans With Posttraumatic Stress Disorder

20,000 or less. After adjusting for respondents’ sociodemographic characteristics, symptom severity, functional status, and trauma histories, black persons’ rate of service connection for PTSD was 43% compared with 56% for other respondents (P = 0.003). Conclusion. Black persons’ rates of service connection for PTSD were substantially lower than other veterans even after adjusting for differences in PTSD severity and functional status.