BACKGROUND/RATIONALE:
Nearly 1.7 million US service members have been deployed to Iraq or Afghanistan since the beginning of America's engagement in the Global War on Terror. Service members returning from these deployments carry a high burden of mental disorders. High-profile cases of suicide and homicide among veterans of the wars in Iraq/Afghanistan provide further evidence of the reintegration problems these veterans face. Although Federal and state agencies have implemented programs to assist veterans with readjustment to civilian life, to our knowledge there has been no systematic study of the types of functional problems these new veterans face or the types of interventions they prefer as they reenter their communities. We know even less about the treatment preferences of this new generation of veterans which differs from earlier cohorts of veterans in terms of age, education, and comfort with technology.and community re-integration among new veterans.

OBJECTIVE(S):
The primary objectives of this study were to describe the prevalence and types of community re-integration problems faced by Iraq and Afghanistan war veterans and to assess preferences for interventions to promote adaptation to civilian life. Secondarily, we explored variation in community reintegration problems and treatment interests by probable Posttraumatic Stress Disorder (PTSD), race and gender.

METHODS:
We surveyed a national, stratified sample of Iraq/Afghanistan combat veterans enrolled in the Department of Veterans Affairs (VA) health care system. Survey questions assessed reintegration problems, treatment preferences, and physical and mental health using screening measures with strong psychometric properties. Prevalence and proportions were weighted to represent the population of Iraq/Afghanistan combat veterans surveyed. We used stratified logistic regression models to construct odds ratios and 95% confidence intervals for community reintegration problems by probable PTSD status, gender and race adjusting for demographic characteristics that preceded deployment. Stratified Poisson regression was used to determine whether the number of community reintegration problems and the number of services of interest were associated with the presence of probable PTSD, gender or race. All analyses were first performed on responders and then were adjusted for potential non-response bias based on administrative data by constructing response propensities and producing a weighted combination of within-propensity class estimates.

FINDINGS/RESULTS:
Of 1,226 veterans surveyed, 754 (62%) responded. An estimated 25% to 56% of the population had some to extreme difficulty in social functioning, productivity, community involvement, and self-care domains. At least one third reported divorce, dangerous driving, increased substance use and anger control problems since returning from deployment. Difficulty getting along with one's spouse was more common among nonWhite compared with White veterans. An estimated 41% had probable posttraumatic stress disorder (PTSD) and each type of reintegration problem was more prevalent among veterans with probable PTSD. The vast majority (96%) of Iraq/Afghanistan veterans expressed interest in services to help them readjust to civilian life. The most commonly preferred ways to receive reintegration service or information was at a VA facility, through the mail, and over the internet. Veterans with probable PTSD and female veterans expressed interest in more types of services than other veterans. Interest in self-help techniques and yoga/meditation was particularly common among women.

IMPACT:
Iraq/Afghanistan war veterans reported multiple functional and reintegration problems, which were particularly prevalent among those with probable PTSD. The types of services these veterans most frequently wanted are typically not provided in health care settings. New strategies are needed to deliver readjustment services.

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External Links for this Project

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PUBLICATIONS:

Journal Articles

1. Bangerter A, Gravely A, Cutting A, Clothier B, Spoont M, Sayer N. Brief report: Comparison of methods to identify Iraq and Afghanistan war veterans using Department of Veterans Affairs administrative data. Journal of rehabilitation research and development. 2010 Nov 9; 47(8):815-21. [view]
2. Sayer NA, Frazier P, Orazem RJ, Murdoch M, Gravely A, Carlson KF, Hintz S, Noorbaloochi S. Military to civilian questionnaire: a measure of postdeployment community reintegration difficulty among veterans using Department of Veterans Affairs medical care. Journal of traumatic stress. 2011 Dec 7; 24(6):660-70. [view]
3. Carlson KF, Gravely AA, Noorbaloochi S, Simon AB, Bangerter AK, Sayer NA. Post-deployment injury among new combat veterans enrolled in Veterans Affairs (VA) healthcare. Injury Prevention : Journal of The International Society For Child and Adolescent Injury Prevention. 2011 Oct 1; 17(5):343-7. [view]
4. Sayer NA, Noorbaloochi S, Frazier P, Carlson K, Gravely A, Murdoch M. Reintegration problems and treatment interests among Iraq and Afghanistan combat veterans receiving VA medical care. Psychiatric services (Washington, D.C.). 2010 Jun 1; 61(6):589-97. [view]

Conference Presentations

1. Carlson KF, Sayer NA, Gravely AA, Noorbaloochi S. Potential Risk Factors for Post-Deployment Injury among Combat Veterans. Poster session presented at: Society for Epidemiologic Research Annual Meeting; 2009 Jun 25; Anaheim, CA. [view]
2. Sayer NA, Frazier P, Orazem R, Murdoch M, Abel MD, Carlson KF, Gravely AA, Noorbaloochi S. Psychometric Properties of a Measure of Post-Deployment Community Reintegration Difficulty. Paper presented at: VA HSR&D National Meeting; 2011 Feb 17; National Harbor, MD. [view]
3. Sayer NA, Noorbaloochi S, Frazier P, Carlson KF, Gravely A, Murdoch M. Reintegration Problems and Treatment Preferences among Recent Veterans - New Directions for Trauma Research. Paper presented at: American Psychological Association Annual Convention; 2009 Aug 7; Toronto, Canada. [view]
4. Sayer NA, Noorbaloochi S, Frazier P, Murdoch M, Carlson K, Gravely A, Baines A. Reintegration Problems and Treatment Preferences among Veterans Returning from Iraq and Afghanistan with and without Probable PTSD. Paper presented at: VA HSR&D National Meeting; 2009 Feb 12; Baltimore, MD. [view]
5. Sayer NA. Reintegration problems and treatment preferences among Veterans returning from Iraq and Afghanistan with and without probable PTSD. Paper presented at: Trauma Spectrum Disorders Annual Conference; 2010 Dec 7; Bethesda, MD. [view]
6. Carlson KF, Sayer NA, Gravely AA, Noorbaloochi S. Risk of medically-treated injuries among Iraq and Afghanistan combat Veterans. Paper presented at: American Public Health Association Annual Meeting and Exposition; 2009 Nov 9; Philadelphia, PA. [view]
7. Carlson KF, Pogoda TK, Resnick SG, O'Neil ME, Sayer NA. Supported Employment for Veterans with Traumatic Brain Injury: Needs and Interests. Poster session presented at: VA HSR&D / QUERI National Meeting; 2015 Jul 8; Philadelphia, PA. [view]

DRA: Military and Environmental Exposures
DRE: Treatment - Observational, Prevention
Keywords: Caregivers – not professionals, Patient preferences, PTSD
MeSH Terms: none