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SHP 08-161 – HSR&D Study

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SHP 08-161
Gender and Medical Needs of OEF/OIF Veterans with PTSDII
Susan M Frayne MD MPH
VA Palo Alto Health Care System, Palo Alto, CA
Palo Alto, CA
Funding Period: April 2008 - September 2008

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) and those with a Dual Diagnosis of PTSD plus Substance Use Disorder (SUD) 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, those with Dual Diagnosis (PTSD plus SUD), 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. Additional analyses focused on the subset with PTSD, of whom 13% of women and 23% of men had comorbid SUD (Dual Diagnosis). Those with Dual Diagnosis had higher prevalence of diagnosed injuries than did those with PTSD alone. Among women, those with Dual Diagnosis also had higher rates of infections, gastrointestinal disorders, and genitourinary disorders than did those with PTSD alone. Dual Diagnosis was also associated with increased use of emergency department care and acute inpatient stays.

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). For those PTSD patients with comorbid SUD, injury prevention should be an additional clinical focus; efforts to engage this special population in primary care could potentially reduce need for acute care services.

PUBLICATIONS:

Journal Articles

  1. Boden MT, Kimerling R, Jacobs-Lentz J, Bowman D, Weaver C, Carney D, Walser R, Trafton JA. Seeking Safety treatment for male veterans with a substance use disorder and post-traumatic stress disorder symptomatology. Addiction (Abingdon, England). 2012 Mar 1; 107(3):578-86.
  2. Rosen CS, Greenbaum MA, Fitt JE, Laffaye C, Norris VA, Kimerling R. Stigma, help-seeking attitudes, and use of psychotherapy in veterans with diagnoses of posttraumatic stress disorder. The Journal of nervous and mental disease. 2011 Nov 1; 199(11):879-85.
  3. Alvarez J, McLean C, Harris AH, Rosen CS, Ruzek JI, Kimerling R. The comparative effectiveness of cognitive processing therapy for male veterans treated in a VHA posttraumatic stress disorder residential rehabilitation program. Journal of consulting and clinical psychology. 2011 Oct 1; 79(5):590-9.
Conference Presentations

  1. Nazarian D, Kimerling R, Frayne SM. Association between PTSD, substance use disorders, and medical conditions among returning Veterans. Paper presented at: American Psychosomatic Society Annual Scientific Meeting; 2011 Mar 10; San Antonio, TX.
  2. Oliva E, Kulkarni M, Trafton JA, Kimerling R. Veterans with co-morbid posttraumatic stress disorder and alcohol use disorder: Patient- and clinic level predictors of substance use disorder treatment engagement and visits. Poster session presented at: Association for Behavioral and Cognitive Therapies Annual Convention; 2010 Nov 20; San Francisco, CA.
  3. Nazarian D, Kimerling R, Frayne SM. PTSD, substance use disorders, and medical comorbidity among women and men returning Veterans in primary care: A key role for behavioral medicine. Presented at: VA HSR&D Field-Based Women's Health Meeting; 2010 Jul 1; Arlington, VA.
  4. Nazarian D, Kimerling R, Frayne SM. PTSD, Substance Use Disorders, and Medical Comorbidity among OEF/OIF Veterans in Primary Care: Prevalence and Implications for Behavioral Medicine Interventions. Paper presented at: VA HSR&D Field-Based Mental Health and Substance Use Disorders Meeting; 2010 Apr 28; Little Rock, AR.


DRA: Military and Environmental Exposures, Mental, Cognitive and Behavioral Disorders, Substance Abuse and Addiction
DRE: Diagnosis
Keywords: Comorbidity, PTSD, Women - or gender differences
MeSH Terms: none