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BACKGROUND/RATIONALE:
Combat exposure and other traumatic experiences are significant, known risk factors for post-traumatic stress disorder (PTSD), depression, and other psychiatric and substance abuse conditions. Consequently, military service personnel returning from deployment in Iraq and Afghanistan are likely to be vulnerable to these conditions, and recent research indicates that OIF/OEF veterans have higher rates of mental health concerns than veterans from other wars. However, some individuals are particularly resilient following traumatic exposure, and do not develop mental health or substance abuse problems. Thus, both risk and resilience factors interact to determine whether an individual will develop a psychiatric or substance abuse disorder. Resilience factors identified in the literature include social support, self-efficacy, hardiness and positive coping strategies. Thus, identifying these factors through conducting the proposed research study, will help to prevent future clinical disorders such as depression, post-traumatic stress disorder, and substance abuse. The study has been peer-reviewed and VA's Office of Research and Development has determined the study to be unique and not duplicative of any other survey with this population.
OBJECTIVE(S):
The goal of this study is to understand risk and resilience factors that predict development of a psychiatric or substance abuse disorder and associated mental health and/or substance abuse service use. Specific objectives are to:
1) examine the association between baseline pre-deployment risk and resilience factors, deployment experiences and post-deployment factors in a national sample of OEF and OIF veterans up to one year post-deployment; 2) examine change in post-deployment life events, social support, mental health and substance abuse status, functioning and service use over a 6-9 month period following baseline assessment; and 3) identify risk and resilience factors that predict mental health status, functioning, and service use six months after baseline assessment. In addition to testing these hypotheses, we will explore the impact of gender, which has previously been found to show differential effects of pre-war factors on PTSD. Inclusion of risk and resilience factors will expand existing models of service use that are limited to data available from administrative databases (primarily demographic and diagnostic information), allowing for better prediction of mental health status, substance abuse and service use.
METHODS:
A national, stratified random sample of 1,300 veterans enrolled for VA care will serve as the study sample. Women will be oversampled to comprise 50% of the total. A cover letter and baseline survey will be sent to each potential participant, along with a pre-addressed stamped envelope for returning completed surveys. The survey will include standardized and validated measures of risk, resilience, mental health, substance abuse and service use, as well as demographic and descriptive characteristics including employment, insurance eligibility and self-reports of medical conditions. Surveys will be re-administered after six months to allow for longitudinal analysis of predictors of mental health substance abuse and service use. To address the research questions, data analysis will use regression and structural equation models with mental health/substance abuse status and service use as outcomes, and risk and resilience measures as independent variables.
FINDINGS/RESULTS:
No new findings as of yet.
IMPACT:
The disease burden and financial costs of treating serious mental illness and substance abuse are enormous. Understanding resilience factors that protect veterans from adverse effects of combat exposure has the potential to reduce these costs and burdens in the highly vulnerable population of returning OIF/OEF veterans. Effective interventions have been developed to promote and enhance resilience. Examination of risk and resilience factors will help identify individuals who could benefit from such interventions, and help guide implementation of appropriate interventions designed to counteract the negative effects of trauma, and develop and enhance resilience characteristics that promote positive community readjustment.
PUBLICATIONS:
None at this time.
DRA:
Mental Illness, Military and Environmental Exposures
DRE:
Prevention
Keywords:
PTSD, Deployment Related
MeSH Terms:
none
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