Gender Differences in Use of Complementary and Integrative Health by U.S. Military Veterans with Chronic Musculoskeletal Pain

Evans, Elizabeth; Herman, Patricia M.; Washington, Donna L.; Lorenz, Karl; Yuan, Anita H.; Upchurch, Dawn M.; Marshall, Nell; Hamilton, Alison B.; Taylor, Stephanie L.

doi:10.1016/j.whi.2018.07.003

Cited by 31 publications

(17 citation statements)

References 43 publications

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“…In addition to the research gaps regarding gender-specific results for chronic disease, there is also a paucity in the literature when it comes specifically to Gulf War women veterans. Although more than 40,000 women deployed in support of the 1990-1991 Gulf War, there have been no published data from large-scale epidemiologic studies reporting prevalence estimates of chronic disease solely in this population (Arout, Sofuoglu, Bastian, & Rosenheck, 2018;Breland et al, 2017;Evans et al, 2018;Higgins et al, 2017;Ziobrowski, Sartor, Tsai, & Pietrzak, 2017). The experience of women Gulf War veterans is unique compared with women veterans of other eras, largely owing to the multiple, concurrent, toxic exposures that were present during the war and cleanup operations (Chao & Zhang, 2018;Kang et al, 2000;O'Callaghan, Kelly, Locker, Miller, & Lasley, 2015;Ojo et al, 2014;Phillips & Deshpande, 2016;Proctor et al, 1998;White et al, 2016).…”

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confidence: 99%

Health Status of Female and Male Gulf War and Gulf Era Veterans: A Population-Based Study

Dursa

Barth

Porter

et al. 2019

Women's Health Issues

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Background: The health of women Gulf War (deployed) and Gulf Era (nondeployed) veterans is understudied; although most studies examining the health effects of deployment to the Gulf War adjust for gender in multivariate analyses, gender-specific prevalence and effect measures are not routinely reported. The National Academy of Medicine recommended that the Department of Veterans Affairs assess gender-specific health conditions in large cohort studies of Gulf War veterans. Methods: Data from this study come from the follow-up study of a national cohort of Gulf War and Gulf Era veterans. This study was conducted between 2012 and 2014, and was the second follow-up of a population-based cohort of Gulf War and Gulf Era veterans that began in 1995. Measures included self-reported medical conditions and frequency of doctor visits as well as validated screening instruments for mental health conditions. Results: Overall, female veterans (both Gulf War and Era) reported poorer health than their male counterparts as measured by the prevalence of self-reported disease. The top five prevalent conditions in both Gulf War and Gulf Era veterans were migraine, hypertension, major depressive disorder, arthritis, and dermatitis. Female Gulf War veterans were found to have a higher prevalence of disease than male Gulf Era veterans. Conclusions: Women veterans, particularly deployed veterans, from this era have significant medical needs that may justify increased outreach from the Department of Veterans Affairs. Our findings highlight the importance of asking about military service, particularly for women veterans, in the clinical setting, both in the Department of Veterans Affairs and in the private sector. Published by Elsevier Inc. on behalf of Jacobs Institute of Women's Health.

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confidence: 99%

Health Status of Female and Male Gulf War and Gulf Era Veterans: A Population-Based Study

Dursa

Barth

Porter

et al. 2019

Women's Health Issues

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“…Compared with male veterans, female veterans may be at greater risk for chronic pain conditions, because women veterans are more likely to experience physical injuries during military training exercises and are more prone to some types of injury, such as stress fractures (Bell, Mangione, Hemenway, Amoroso, & Jones, 2000;Niva, Mattila, Kiuru, & Pihlajamaki, 2009). Gender differences in pain perception (Haskell et al, 2011;Higgins et al, 2014;Nahin, 2017;Runnals et al, 2013) and pain coping strategies (Evans et al, 2018;Kaur, Stechuchak, Coffman, Allen, & Bastian, 2007) have also been identified in veteran samples, although these findings are mixed.…”

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confidence: 99%

Pain Intensity and Pain Interference in Male and Female Iraq/Afghanistan-era Veterans

Naylor

Wagner

Johnston

et al. 2019

Women's Health Issues

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Background: Chronic pain conditions are common among both male and female Iraq/Afghanistan-era veterans and can have substantial negative impacts on quality of life and function. Although in general women tend to report higher levels of pain intensity than men, findings remain mixed on whether gender differences in pain exist in Iraq/ Afghanistan-era veterans. Additionally, the relationships between functional impairment, pain intensity, and gender remain unknown. Methods: This project examined gender differences in pain intensity and pain interference in 875 male and female Iraq/Afghanistan-era veterans. Nonparametric Wilcoxon rank-tests examined gender differences in pain scores. Multivariable generalized linear regression modeling was used to evaluate the magnitude of pain intensity and interference across levels of chronicity and gender, and to evaluate the role of chronicity in gender effects in measures of pain and function. Results: Pain intensity and interference scores were significantly greater among both male and female veterans reporting chronic pain relative to acute pain. Women veterans endorsed higher levels of pain intensity and pain interference compared with men. Results derived from multivariable analyses implicated pain intensity as a factor underlying gender differences in functional impairment among chronic pain sufferers, indicating that gender differences in functional measures were eliminated after controlling statistically for pain intensity. Conclusions: Results demonstrate that the effects of functional impairment are impacted by pain intensity, and not by gender.Published by Elsevier Inc. on behalf of Jacobs Institute of Women's Health.

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“…Given patients' and veterans' preference to receive CIH therapies, 27 , 122 , 123 especially among female veterans, 124 the RWC provides a non-stigmatizing environment that appears to appeal to female veterans (31% female participants vs. 8% VA wide 125 ), of whom the majority (65%) experienced MST. This potentially offers a novel avenue of care for the vulnerable female veterans, particularly those with MST exposure.…”

Section: Discussionmentioning

confidence: 99%

Effectiveness of Complementary and Integrative Approaches in Promoting Engagement and Overall Wellness Toward Suicide Prevention in Veterans

Vitale

Byma

Sun

et al. 2021

The Journal of Alternative and Complementary Medicine

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Objective: Suicide is a major public health problem, specifically among U.S. veterans, who do not consistently engage in mental health services, often citing stigma as a barrier. Complementary and Integrative Health (CIH) interventions are promising alternatives in promoting patient engagement and further, they may play a critical role in transitioning people into mental health care. Toward this goal, the Resilience and Wellness Center (RWC) was developed to break through the stigma barrier by addressing risk factors of suicide through multimodal CIH interventions via cohort design, promoting social connectedness and accountability among participants. Design: This is a program evaluation study at a large urban VA medical center, where assessments were evaluated from pre- to post-program completion to determine the effectiveness of an intensive multimodal CIH 4-week group outpatient intervention for suicide prevention. Outcome measures: Primary outcomes measured included group connectedness, severity of depression and hopelessness symptoms, suicidal ideation, sleep quality, and diet. Secondary outcomes included measures of post-traumatic stress disorder (PTSD), generalized anxiety severity stress/coping skills, pain, and fatigue. Results: The RWC showed high participant engagement, with an 84%–95% attendance engagement rate depending on suicide risk history. Data from 15 cohorts ( N = 126) demonstrate favorable outcomes associated with participation in this comprehensive program, as evidenced by a reduction in suicidal ideation, depression, and hopelessness, but not sleep quality and diet. In addition, in a subset of veterans with a history of suicidal ideation or attempt, significant improvements were noted in pain, PTSD/anxiety symptoms, and stress coping measures. Conclusions: The RWC shows that an intensive complement of CIH interventions is associated with a significant improvement with high veteran engagement. Findings from this program evaluation study can be used to aid health care systems and their providers in determining whether or not to utilize such multimodal CIH integrated interventions as an effective treatment for at-risk populations as a part of suicide prevention efforts.

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Gender Differences in Use of Complementary and Integrative Health by U.S. Military Veterans with Chronic Musculoskeletal Pain

Cited by 31 publications

References 43 publications

Health Status of Female and Male Gulf War and Gulf Era Veterans: A Population-Based Study

Health Status of Female and Male Gulf War and Gulf Era Veterans: A Population-Based Study

Pain Intensity and Pain Interference in Male and Female Iraq/Afghanistan-era Veterans

Effectiveness of Complementary and Integrative Approaches in Promoting Engagement and Overall Wellness Toward Suicide Prevention in Veterans

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