Deployment-related sequelae and treatment utilization in rural and urban war veterans in Hawaii.

Abstract

This study compared common deployment-related health issues and correlates of mental health service utilization among rural and urban veterans of Operation Enduring Freedom (OEF), Operation Iraqi Freedom (OIF), and Operation New Dawn (OND) living in Hawaii. Frequency of utilization of a broad range of mental health resources, including clergy/spiritual leaders, videoconference/online programs, and traditional/alternative healers, was also characterized. A random sample of 116 rural and 117 urban ethnoracially diverse veterans completed a mail survey. Rural veterans were more likely than urban veterans to meet screening criteria for posttraumatic stress disorder (PTSD), deployment-related concussion with persistent postconcussive symptoms, and alcohol use problems. Over one third of veterans who desired help for a mental health problem reported no current use of any services. Rural veterans were more likely than urban veterans to have accessed Veteran Readjustment Centers, but they did not differ with respect to utilization of other services. Correlates of mental health service utilization included higher education, PTSD, and lower mental-health-related quality of life. Results of this study underscore the need for dissemination efforts to enable OEF/OIF/OND veterans to access mental health resources.

Concussion and Mild-Traumatic Brain Injury in Rural Settings: Epidemiology and Specific Health Care Considerations

“…In a similar population of 116 rural and 117 urban veterans who served in OEF/OIF/OND, Whealin et al found rural veterans were less educated (high school or less: 30 vs. 12%, college degree: 17 vs. 30%), more likely to screen positive for PTSD (43 vs. 30%), have postconcussive (41 vs. 24%), and alcohol use problems (20 vs. 8%). 38 Utilization of VA services including medications and mental health were comparable between rural/urban groups (40%/32%). The authors contend that economic and community resources can buffer the impact of stress-related disorders.…”

“…In OEF/OIF/OND veterans, morbidity rates have been reported at 60% higher rates than from soldiers in cities and suburbs. 38…”

“…Veterans with postconcussive symptoms, PTSD, or a history of mTBI/concussion are also more likely to live in rural areas after return from deployment. 37,38 This presents a clear challenge for access to health care resources. Although reported rates of VA service utilization were comparable between rural and urban groups, discordantly higher morbidity rates highlight a need for increased rural access to community resources 38 and to prevent further decline using maladaptive coping mechanisms, such as alcohol.…”

“…37,38 This presents a clear challenge for access to health care resources. Although reported rates of VA service utilization were comparable between rural and urban groups, discordantly higher morbidity rates highlight a need for increased rural access to community resources 38 and to prevent further decline using maladaptive coping mechanisms, such as alcohol. 19,21,38 Importantly, the services required are "low-tech," primarily encompassing mental health, and community resources.…”

The Deployment Life Study: Longitudinal Analysis of Military Families Across the Deployment Cycle

“…In general, fewer than half of those who have deployed and report symptoms indicating that they could benefit from mental health services actually receive such care (Gorman et al, 2011;Pietrzak et al, 2009;Schell and Tanielian, 2011). There is some evidence that greater symptom severity increases treatment-seeking (Balderrama-Durbin et al, 2013;Cohen, Gima, et al, 2010;Possemato et al, 2010;Whealin et al, 2014). Some of the more commonly endorsed reasons about why those who might benefit from treatment don't get it are: difficulty scheduling an appointment or getting time off, stigma, and treatment costs Elnitsky et al, 2013;Schell and Tanielian, 2011).…”