Beyond service connection: what helps PTSD-disabled veterans get better?

除了服务连接之外：什么可以帮助患有创伤后应激障碍（PTSD）的退伍军人康复？

• 批准号: 8182883
• 负责人: Maureen Murdoch
• 金额: --
• 依托单位: MINNEAPOLIS VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-10-01 至 2014-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8182883
• 关键词: Address; Affect; Characteristics; Clinical; Code; Data; Deterioration; Disability Insurance; Disabled Persons; Educational process of instructing; Enrollment; Food; Fostering; Gender; Homelessness; Insurance Benefits; Intervention; Interview; Learning; Life; Mails; Measures; Mental Health; Mental disorders; Mentally Ill Persons; Methods; Military Personnel; Minority; Observational Study; Personal Satisfaction; Post-Traumatic Stress Disorders; Poverty; Qualitative Methods; Quality of life; Recovery; Recruitment Activity; Reliance; Research; Respondent; Role; Sample Size; Sampling; Self Perception; Services; Severities; Social Functioning; Social Security; Social Welfare; Supplemental Security Income; Surveys; Symptoms; Telephone; Time; Veterans; Vietnam Conflict; Voice; Work; abstracting; beneficiary; clinically relevant; design; disability; falls; improved; insight; meetings; member; prevent; programs; social; treatment program

Project Summary/Abstract Project Background/ Rationale In a small sample of homeless, mentally ill veterans who applied for Supplemental Security Income (SSI) or Social Security Disability Insurance (SSDI) benefits, Rosenheck et al. showed that levels of illness and disability did not differ substantially among those who were and were not approved for benefits. However, once their benefits were approved, SSI/SSDI beneficiaries had substantially better life quality, less homelessness, and less reliance on welfare and food stamps to meet basic needs than veterans who were denied SSI/SSDI benefits. We recently extended this research to examine the long-term impacts of receiving or not receiving VA disability benefits for posttraumatic stress disorder (PTSD). PTSD is a uniquely disabling condition that affects veterans' mental health as well as their physical and social well-being. We estimate that 1.5 million veterans and military troops have been affected by PTSD symptoms. Of these, we estimate that almost 560,000 have applied for VA disability benefits for PTSD. Veterans who receive VA disability benefits are said to be "service connected." Approximately six years after enrolling a longitudinal panel of 3,337 nationally representative veterans who applied for PTSD disability benefits, findings showed that, on average, PTSD service connection reduced poverty and PTSD symptoms. However, the latter effect was small. PTSD service connection did not improve beneficiaries' work, role and social functioning overall. Notably, among both service connected (SC+) and non-service connected (SC-) veterans, substantial minorities had clinically relevant improvements in their PTSD symptoms. A smaller but still substantial minority in each group had clinically relevant deteriorations. Project Objectives 1) To identify factors associated with PTSD-disabled veterans getting clinically better or clinically worse, 2) To identify the strategies and lessons they learned that might help other PTSD-disabled veterans get better or, conversely, prevent them from getting worse, and 3) To use cross-case comparison to see if results differ by PTSD service-connected status, gender, or service era. A secondary aim is to see if objective survey measures of improvement/decrement correspond to veterans' self-perceptions of "being better" or "being worse." Project Methods This 3.5-year, observational study will use qualitative methods to take advantage of our pre-existing, well- characterized panel of former disability applicants. A mailed survey will identify the qualitative sample: veterans with clinically relevant improvements or decrements in PTSD symptom severity and in their work, role and social functioning since their last assessment. Survey respondents will be stratified according to 4 core characteristics: clinical status (got better or worse), PTSD service-connected status (SC+ or SC-), gender, and service era (served during or after the Vietnam Conflict). From eligible, mailed survey respondents, a total of 64 veterans will be randomly selected from these 4 strata for in-depth, qualitative interviews. The sample provides for 32 veterans per group for each planned 2-group, cross-case comparison and falls within usually recommended sample sizes for achieving thematic saturation. Because of the panel's geographic spread, interviews will be conducted by telephone. For the interviews, we will use inductive, open coding content analysis to identify themes across and within cases to address project objectives.

项目摘要/摘要 项目背景/基本原理 在一小部分申请补充安全收入(SSI)或 社会保障残疾保险(SSDI)福利，Roseneck等人。表明疾病的程度和 残疾在那些获得和没有获得福利批准的人中没有实质性的区别。然而，一旦 他们的福利得到批准，SSI/SSDI受益者的生活质量大大提高，无家可归者减少， 对福利和食品券来满足基本需求的依赖比被剥夺了SSI/SSDI的退伍军人要少 福利。我们最近扩展了这项研究，以检查接受或不接受退伍军人管理局的长期影响 创伤后应激障碍(PTSD)的伤残津贴。创伤后应激障碍是一种独特的致残情况，它会影响 退伍军人的心理健康以及他们的身体和社会福祉。我们估计有150万退伍军人 军队也受到创伤后应激障碍症状的影响。其中，我们估计有近56万人 为创伤后应激障碍申请退伍军人伤残津贴。 领取退伍军人伤残津贴的退伍军人被称为“与服务有关的人”。大约六年 在登记了3337名申请创伤后应激障碍残疾的全国代表性退伍军人的纵向小组后 关于创伤后应激障碍的益处，调查结果显示，平均而言，创伤后应激障碍服务连接减少了贫困和创伤后应激障碍症状。 然而，后一种影响很小。创伤后应激障碍服务连接没有改善受益人的工作、角色和 整体的社会功能。值得注意的是，在连接的服务(SC+)和非连接的服务(SC-)中 退伍军人、相当大的少数族裔在他们的创伤后应激障碍症状方面有临床相关的改善。一辆较小的但 尽管如此，每组中仍有相当数量的少数患者出现了与临床相关的恶化。 项目目标 1)确定与创伤后应激障碍伤残退伍军人临床好转或恶化相关的因素，2) 为了找出他们学到的策略和教训，可能会帮助其他患有创伤后应激障碍的退伍军人变得更好，或者， 相反，防止它们变得更糟，以及3)使用跨案例比较来查看结果是否不同 与创伤后应激障碍服务相关的身份、性别或服务时代。第二个目标是看看客观调查是否 改进/减少的措施与退伍军人自我感觉的“变好”或“变得更好”相对应 更糟的是。“ 项目方法 这项为期3.5年的观察性研究将使用定性的方法来利用我们先前存在的、良好的 特色化的前残疾申请者小组。邮寄的调查将确定定性样本：退伍军人 与临床相关的创伤后应激障碍症状严重性的改善或减少，以及他们的工作、角色和 自上次评估以来的社会功能。调查对象将根据4个核心进行分层 特征：临床状态(好转或恶化)，创伤后应激障碍服务相关状态(SC+或SC-)，性别，以及 服役时代(在越南冲突期间或之后服役)。从合格的邮寄调查受访者中，总共有 老兵将从这4个阶层中随机抽取进行深入、定性的访谈。样本 为每个计划的两组提供每组32名退伍军人，跨案例比较，通常属于 达到主题饱和所需的推荐样本量。由于太阳能电池板的地理分布， 面试将通过电话进行。对于采访，我们将使用归纳的、开放的编码内容 分析以确定跨案例和案例内的主题，以解决项目目标。

项目成果

Changes in Post-traumatic Stress Disorder Service Connection Among Veterans Under Age 55: An 18-Year Ecological Cohort Study.

55 岁以下退伍军人中创伤后应激障碍服务联系的变化：一项 18 年生态队列研究。

• DOI: 10.1093/milmed/usz052
• 发表时间: 2019
• 期刊: Military medicine
• 影响因子: 1.2
• 作者: Murdoch,Maureen;Kehle-Forbes,Shannon;Spoont,Michele;Sayer,NinaA;Noorbaloochi,Siamak;Arbisi,Paul
• 通讯作者: Arbisi,Paul

Reversals in initially denied Department of Veterans Affairs' PTSD disability claims after 17 years: a cohort study of gender differences.

• DOI: 10.1186/s12905-021-01214-7
• 发表时间: 2021-02-16
• 期刊: BMC women's health
• 作者: Murdoch M;Spoont MR;Sayer NA;Kehle-Forbes SM;Noorbaloochi S
• 通讯作者: Noorbaloochi S