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

项目总结/摘要 项目背景/理由 在一小部分无家可归的精神病退伍军人中，他们申请了补充保障收入（SSI）， 社会保障残疾保险（SSDI）福利，Rosenheck等人。 残疾在被批准和未被批准享受福利的人之间没有实质性差异。然而一旦 他们的福利获得批准，SSI/SSDI受益人的生活质量大幅提高，无家可归者减少， 与那些被拒绝SSI/SSDI的退伍军人相比， 效益我们最近扩展了这项研究，以检查接受或不接受VA的长期影响 创伤后应激障碍（PTSD）的残疾福利。创伤后应激障碍是一种独特的致残性疾病， 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 和军队都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 因创伤后应激障碍申请退伍军人伤残补助 领取退伍军人事务部残疾福利金的退伍军人被称为“服务连接”。“大约六年 在招募了一个由3,337名申请PTSD残疾的全国代表性退伍军人组成的纵向小组后， 研究结果表明，平均而言，PTSD服务连接减少了贫困和PTSD症状。 然而，后者的影响很小。PTSD服务连接并没有改善受益人的工作，角色和 整体社会功能。值得注意的是，在服务连接（SC+）和非服务连接（SC-）两者中， 退伍军人中，相当多的少数民族在他们的PTSD症状中有临床相关的改善。更小但 各组中仍有相当多的少数患者出现临床相关的恶化。 项目目标 1)确定与PTSD残疾退伍军人临床好转或临床恶化相关的因素，2） 为了确定他们学到的策略和教训，可能有助于其他PTSD残疾退伍军人变得更好， 相反，防止它们变得更糟，3）使用跨案例比较，看看结果是否不同， PTSD服务连接状态，性别或服务时代。第二个目的是看看客观的调查 改善/减少的措施对应于退伍军人的自我知觉“更好”或“是 糟了" 项目方法 这项为期3.5年的观察性研究将使用定性方法，以利用我们预先存在的，良好的- 前残疾申请人的特点小组。一份邮寄的调查将确定定性样本：退伍军人 PTSD症状严重程度和他们的工作、角色和 自上次评估以来的社会功能。调查受访者将根据4个核心 特征：临床状态（好转或恶化），PTSD服务连接状态（SC+或SC-），性别， 服务时代（在越南冲突期间或之后服务）。从符合条件的邮寄调查受访者中， 64名退伍军人将从这4个阶层中随机选择进行深入的定性访谈。样品 为每个计划的2组提供每组32名退伍军人，跨病例比较和福尔斯通常在 为达到专题饱和度建议的样本大小。由于小组的地理分布， 面试将以电话方式进行。对于采访，我们将使用归纳，开放编码内容 分析以确定跨案例和案例内的主题，以实现项目目标。

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.