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SDR 07-331 – HSR&D Study

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SDR 07-331
Gender and Medical Needs of OIF/OEF Veterans with PTSD
Susan M Frayne MD MPH
VA Palo Alto Health Care System, Palo Alto, CA
Palo Alto, CA
Funding Period: July 2007 - October 2007

BACKGROUND/RATIONALE:
In response to recent attention to the high rates of post-traumatic stress disorder (PTSD) in returning Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF) veterans, there have been considerable efforts to characterize their mental health services needs. However, the general medical care needs of women and men OEF/OIF veterans with post-traumatic stress disorder (PTSD) have not been characterized.

OBJECTIVE(S):
This project characterizes the burden of medical illness associated with PTSD in women (and men) OEF/OIF returnees.

METHODS:
This supplemental project capitalized on a database created for VA HSR&D IAE 05-291, drawn from existing data sources: VA's National Patient Care Database, the MST Data Archive, and the OEF/OIF Roster. For all OEF/OIF roster members who received VA outpatient care during FY 2006 and during FY 2007, we used VA administrative records to identify those with PTSD and those with specific medical conditions (the latter derived using the Agency for Healthcare Research and Quality's Clinical Classifications Software framework, supplemented with expert clinical opinion).


FINDINGS/RESULTS:
A total of 90,558 (12,723 women, 77,461 men) OEF/OIF veteran VA patients with confirmed veteran status were identified; 27% of women and 35% of men had a diagnosis of PTSD. Women and men with PTSD had more medical conditions than did those with no mental health conditions (MHC). The most frequent medical conditions among women with PTSD were lumbosacral spine disorders, headache, lower extremity joint disorders, skin disorders, tendonitis/myalgia, dental disorders, allergies, vision defects, acute upper respiratory tract infections, and overweight/obesity. The most frequent medical conditions among men with PTSD were lumbosacral spine disorders, lower extremity joint disorders, hearing problems, tobacco use disorder, hyperlipidemia, tendonitis/myalgia, skin disorders, dental disorders, hypertension and sleep disturbance. After age adjustment, all of these conditions were significantly more likely among veterans with PTSD as compared to those with no mental health conditions.

IMPACT:
VA's efforts to meet the needs of the newest generation of returning veterans with PTSD need to take into account not only their increased mental health services needs, but also their increased medical services needs. These findings support VA's recent efforts to optimize integration of medical and mental health services. To fully meet the health care needs of the newest generation of veterans with PTSD, VA should assure availability of services relevant to their most prevalent health problems, e.g., chronic low back and joint problems (e.g., with pain clinics or rehabilitation care), hearing problems (e.g., with audiology services), and behaviorally related conditions like tobacco use and obesity (e.g., with behavioral medicine and the MOVE! program).

PUBLICATIONS:

Journal Articles

  1. Frayne SM, Chiu VY, Iqbal S, Berg EA, Laungani KJ, Cronkite RC, Pavao J, Kimerling R. Medical care needs of returning veterans with PTSD: their other burden. Journal of general internal medicine. 2011 Jan 1; 26(1):33-9.
  2. Smith MW, Chow A, Kimerling R. Estimating lost revenue from a free-care mandate in the U.S. Department of Veterans Affairs. Psychiatric services (Washington, D.C.). 2010 Nov 1; 61(11):1150-2.
  3. Kimerling R, Street AE, Pavao J, Smith MW, Cronkite RC, Holmes TH, Frayne SM. Military-related sexual trauma among Veterans Health Administration patients returning from Afghanistan and Iraq. American journal of public health. 2010 Aug 1; 100(8):1409-12.
Conference Presentations

  1. Pavao JR, Kimerling R, Street A, Gima K, Smith MW, Cronkite RC, Frayne SM. Burden of mental illness associated with military sexual trauma among veterans deployed to Iraq and Afghanistan. Poster session presented at: American Public Health Association Annual Meeting and Exposition; 2008 Oct 28; San Diego, CA.


DRA: Military and Environmental Exposures, Mental, Cognitive and Behavioral Disorders
DRE: Diagnosis, Treatment - Observational
Keywords: Operation Enduring Freedom, Operation Iraqi Freedom, PTSD
MeSH Terms: none