Suchergebnisse

BACKGROUND: Transgender individuals are overrepresented among Veterans. However, little is known regarding their satisfaction with Veterans Administration (VA) care and unmet health needs. OBJECTIVES: This study examined transgender Veterans' satisfaction with VA medical and mental health care, prevalence of delaying care, and correlates of these outcomes. RESEARCH DESIGN: We used data from transgender Veterans collected in 2014 through an online, national survey. SUBJECTS: In total, 298 transgender Veterans living in the United States. MEASURES: We assessed patient satisfaction with VA medical and mental health care and self-reported delays in seeking medical and mental health care in the past year. Potential correlates associated with these 4 outcomes included demographic, health, and health care variables. RESULTS: Over half of the sample used VA (56%) since their military discharge. Among transgender Veterans who had used VA, 79% were satisfied with medical care and 69% with mental health care. Lower income was associated with dissatisfaction with VA medical care, and being a transgender man was associated with dissatisfaction with VA mental health care. A substantial proportion reported delays in seeking medical (46%) or mental (38%) health care in the past year (not specific to VA). Screening positive for depression and/or posttraumatic stress disorder was associated with delays in seeking both types of care. CONCLUSIONS: Although the majority of transgender Veterans are satisfied with VA health care, certain subgroups are less likely to be satisfied with care. Further, many report delaying accessing care, particularly those with depression and/or posttraumatic stress disorder symptoms. Adapting health care settings to better engage these vulnerable Veterans may be necessary.

Food and housing insecurity may contribute to poorer mental and physical health. It is unclear as to whether those with prior military service, compared to those without, are more vulnerable to these current stressors. The objective of this study was to use U.S. population-based data to determine whether prior military service moderates the association of food and housing insecurity with poor mental and physical health. We analyzed data from nine states administering the Social Context module from the 2011 and 2012 Behavioral Risk Factor Surveillance System. Multivariable logistic regression was used to examine the associations of housing and food insecurity with poor mental and physical health and potential modification by military service. Compared with those with a history of military service, those without had higher prevalence of food insecurity (23.1% versus 13.7%) and housing insecurity (36.0% versus 22.5%). Food insecurity was associated with poor mental and physical health (mental health: odds ratio (OR)=3.47, 95% confidence interval (CI)=[3.18-3.77]; physical health: OR=3.21, 95% CI=[2.92-3.53]). Similar associations were observed between housing insecurity and poor mental and physical health. Prior military service was significantly associated with poor physical health. Interaction terms of prior military service with food and housing were not statistically significant. Food and housing insecurity does not appear to differentially impact mental and physical health among those with and without military service. ; VA Puget Sound Health Care System, Seattle, WA; VA Postdoctoral Fellowship (TPP 61-028); VA Career Development Award (CDA 13-024)

Food and housing insecurity may contribute to poorer mental and physical health. It is unclear as to whether those with prior military service, compared to those without, are more vulnerable to these current stressors. The objective of this study was to use U.S. population-based data to determine whether prior military service moderates the association of food and housing insecurity with poor mental and physical health.

OBJECTIVE: To compare delay of treatment for posttraumatic stress disorder (PTSD), major depressive disorder, and/or alcohol-use disorder among post-9/11 veterans relative to pre-9/11 veterans and civilians. METHOD: The 2012-2013 National Epidemiologic Survey on Alcohol and Related Conditions III (NESARC-III), a nationally representative survey of US non-institutionalized adults was used. Participants included 13,528 civilians, 1,130 pre-9/11 veterans, and 258 post-9/11 veterans with lifetime diagnoses of PTSD, major depression, and/or alcohol-use disorder. Cox proportional hazard models, controlling for relevant demographics, were used to estimate differences in treatment delay (i.e., time between diagnosis and treatment). RESULTS: Post-9/11 veterans were less likely to delay treatment for PTSD and depression than pre-9/11 veterans (AHRs=0.69 95% CI=0.49-0.96, 0.74 95% CI=0.56-0.98, for PTSD and depression, respectively) and civilians (AHRs=0.60 95% CI=0.47-0.76, 0.67 95% CI=0.53-0.85, for PTSD and depression, respectively). No differences in treatment delay were observed between post-9/11 veterans and pre-9/11 veterans or civilians for alcohol-use disorder. Pre-9/11 veterans did not differ from civilians in delay of treatment for any of the three disorders. In an exploratory analysis, post-9/11 veterans with past year military health care coverage (e.g., Veterans Health Administration) showed the shortest delay for depression treatment, although past year coverage did not predict treatment delay for PTSD or alcohol-use disorder. CONCLUSIONS: Post-9/11 veterans delay treatment for some common psychiatric conditions less than pre-9/11 veterans or civilians, which may reflect efforts to engage recent veterans in mental health care. All groups exhibited low initiation of treatment for alcohol-use disorder, highlighting the need for further engagement efforts.