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Publication Briefs

Study Shows High Prevalence of Reintegration Difficulty among OEF/OIF/OND Veterans, Particularly among VA Healthcare Users

Taken together, combat operations in Iraq, Afghanistan, and neighboring countries comprise the longest war the U.S. has fought since Vietnam. Returning service members carry a high burden of mental health disorders, with PTSD being especially common (10% to 17%). In a national survey of OEF/OIF Veterans who use VA healthcare, findings showed that at least 25% were having some to extreme difficulty in major life domains after their deployments. Although these problems were more common in those with probable PTSD, high proportions of Veterans faced challenges regardless of their mental health status. This study focused on 1,292 OEF/OIF/OND Veterans who had participated in a clinical trial of expressive writing, reported "at least a little difficulty readjusting back into civilian life", and did not report major depressive symptoms in order to estimate the prevalence of perceived reintegration difficulty in the entire population of OEF/OIF/OND Veterans. Then, focusing only on Veterans with reintegration difficulty, investigators compared those who used VA healthcare to non-users in terms of demographics and clinical characteristics. Measures included: trauma history, psychological distress, anger, physical symptoms, probable PTSD, probable traumatic brain injury (TBI), reintegration difficulty, social support, life satisfaction, binge drinking and tobacco use, and health services utilization.


  • The estimated prevalence of at least a little reintegration difficulty among the entire OEF/OIF/OND population was 54% and was higher among VA healthcare users than among non-users (62% vs. 45%).
  • Among those with at least a little reintegration difficulty, VA healthcare users reported higher levels of combat exposure and were more likely to meet criteria for probable TBI and PTSD compared to non-users. [Veterans with probable TBI were more than twice as likely to be VA healthcare users.] VA users also reported higher levels of psychological distress, physical symptoms, and reintegration difficulty, and were much more likely to report having sought medical care for physical or mental health problems over the past three months.
  • Veterans with reintegration difficulty who also had service-connected mental and physical health conditions were two to four times more likely to be VA healthcare users. And as time since deployment increased, the likelihood of being a VA user also increased.


  • This study did not assess the level and types of impairments represented by those who reported "at least a little" reintegration difficulty compared to those who reported no reintegration difficulty.
  • Investigators examined differences by VA user status among Veterans with perceived reintegration difficulty rather than among the entire population of OEF/OIF/OND Veterans. Thus, findings regarding differences by VA user status probably do not generalize to OEF/OIF/OND Veterans who do not believe they have any reintegration problems.

PubMed Logo Sayer N, Orazem R, Noorbaloochi S, et al. Iraq and Afghanistan War Veterans with Reintegration Problems: Differences by Veterans Affairs Healthcare User Status. Administration and Policy in Mental Health and Mental Health Services Research. June 11, 2014;e-pub ahead of print.

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HSR requires notification by HSR-funded investigators about all articles accepted for publication. These journal articles are reviewed by HSR and publication briefs or summaries are written for a select number of articles that are then forwarded to VHA Central Office leadership to keep them informed about important findings or information. Articles to be summarized are selected by HSR based on timeliness of the findings, interest of leadership, or potential impact on the organization. Publication briefs are written for only a small number of HSR published articles. Visit the HSR citations database for a complete listing of HSR articles and presentations.

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