The Effect of Support and Training for Family Members on Access to Outpatient Services for Veterans with Posttraumatic Stress Disorder (PTSD)

BACKGROUND/OBJECTIVES: To describe the caregiving experiences and physical and emotional needs of family members and friends who provide care to veterans with mental, physical, and cognitive comorbidities. DESIGN: Cross-sectional study. SETTING: National telephone surveys administered from 2017 to 2019. PARTICIPANTS: Family caregivers of veterans enrolled in the Veterans Affairs (VA) Program of General Caregiver Support Services between October 2016 and July 2018 who responded to a telephone survey (N = 1,509; response rate = 39%). MEASUREMENTS: We examined caregiver burden, depressive symptoms, financial strain, satisfaction with care, amount and duration of caregiving, life chaos, loneliness, and integration of caregiver with the healthcare team using validated instruments. We also collected caregiver demographic and socioeconomic characteristics and asked caregivers to identify the veteran's condition(s) and provide an assessment of the veteran's functioning. RESULTS: Average caregiver age was 62.2 (standard deviation [SD] = 13.7) and 69.8 (SD = 15.6) for veterans. Among caregivers, 76.7% identified at White, and 79.9% were married to the veteran. Caregivers reported having provided care for an average of 6.4 years and spending on average 9.6 hours per day and 6.6 days per week providing care. Average Zarit Subjective Burden score was 21.8 (SD = 9.4; range = 0-47), which is well above the cutoff for clinically significant burden (>16). Caregivers reported high levels of depressive symptoms; the sample average Center for Epidemiologic Studies Depression 10-item Scale score was 11.5 (SD = 7.1; range = 0-30). Caregivers also reported high levels of loneliness and financial strain. CONCLUSION: Caregivers who care for veterans with trauma-based comorbidities reported intensive caregiving and significant levels of distress, depressive symptoms, and other negative consequences. These caregivers require comprehensive support services including access to health care, financial assistance, and enhanced respite care. Planned expansion of VA caregiver support has the potential to provide positive benefits for this population and serve as a model for caregiver support programs outside the VA health care system.

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“…39 Veterans whose caregivers received financial support through PCAFC had higher rates of outpatient mental and physical health services. 40,41…”

Section: Discussionmentioning

confidence: 99%

“…Caregivers in PCAFC reported feeling more confident in their caregiving skills and more aware of VA resources 39 . Veterans whose caregivers received financial support through PCAFC had higher rates of outpatient mental and physical health services 40,41 …”

Section: Discussionmentioning

confidence: 99%

Family Caregivers of Veterans Experience High Levels of Burden, Distress, and Financial Strain

Shepherd‐Banigan

Sherman

Lindquist

et al. 2020

J American Geriatrics Society

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“…Additionally, given the importance of social support in help-seeking among veterans, support for families caring for veterans represents a potentially high yield target 12 . Future research should evaluate currently offered services, such as VA Program of Comprehensive Assistance for Family Caregivers, to develop improved efforts for educating and supporting veterans and their families 39 .…”

Section: Discussionmentioning

confidence: 99%

US Veterans Who Do and Do Not Utilize Veterans Affairs Health Care Services

Meffert

Morabito

Sawicki

et al. 2019

Prim. Care Companion CNS Disord.

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Objective. To examine sociodemographic and military characteristics of U.S. veterans who do and do not utilize Veterans Affairs (VA) healthcare services as their primary source of healthcare, and examine the relationship between VA utilization and medical and psychosocial characteristics. Methods. Participants were a nationally representative sample of 3,152 military veterans (89.8% male, 83.5% Caucasian, 6.0%, Mage = 62.0, SD = 13.1) who completed a survey assessing healthcare utilization, sociodemographic, military service, medical and psychosocial characteristics. Receiver operator characteristic analyses and logistic and linear regressions were conducted to provide a comprehensive and multivariate examination of factors associated with VA utilization. Results. Veterans who used VA were more likely to be Black, younger, female, unmarried, less educated, and have lower household incomes. They were also more likely to have served longer in the military and in combat. VA users were more likely to screen positive for lifetime psychopathology, endorse current suicidality, and report enduring more traumas. VA users were also more likely to report more medical conditions, endorse a disability, and score lower on measures of functioning. The primary factor differentiating VA users from those that did not use VA was presence of lifetime psychopathology. Conclusion. Results provide a comprehensive profile of veterans who do and do not utilize VA and suggest that veterans who use VA have a substantially elevated health burden compared to other veterans. Results may help inform outreach and engagement initiatives targeting the unique healthcare needs of veterans who do and do not utilize VA services.

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“…Additionally, expanding health insurance coverage or offering other supports to enable people to receive professional, long-term, in-home care for SCD could improve HRQOL. We found veterans with SCD were less likely to report an unmet need for assistance, which could be a result of the VA health care system's Program of General Caregiver Support Services, which includes training, education, peer-support, and respite care for caregivers (Shepherd-Banigan et al, 2018a, 2018b). Although we did not have information about VA service use, these programs and services could be used as a template for other health care systems in the US to address unmet needs for assistance among people with SCD.…”

Section: Discussionmentioning

confidence: 88%

Unmet needs for assistance related to subjective cognitive decline among community-dwelling middle-aged and older adults in the US: prevalence and impact on health-related quality of life

Bouldin

Taylor

Knapp

et al. 2020

Int. Psychogeriatr.

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Objectives: To estimate the prevalence of unmet needs for assistance among middle-aged and older adults with subjective cognitive decline (SCD) in the US and to evaluate whether unmet needs were associated with health-related quality of life (HRQOL). Design: Cross-sectional Setting: US – 50 states, District of Columbia, and Puerto Rico Participants: Community-dwelling adults aged 45 years and older who completed the Cognitive Decline module on the 2015-–2018 Behavioral Risk Factor Surveillance System reported experiencing SCD and always, usually, or sometimes needed assistance with day-to-day activities because of SCD (n = 6,568). Measurements: We defined SCD as confusion or memory loss that was happening more often or getting worse over the past 12 months. Respondents with SCD were considered to have an unmet need for assistance if they sometimes, rarely, or never got the help they needed with day-to-day activities. We measured three domains of HRQOL: (1) mental (frequent mental distress, ≥14 days of poor mental health in the past 30 days), (2) physical (frequent physical distress, ≥14 days of poor physical health in the past 30 days), and (3) social (SCD always, usually, or sometimes interfered with the ability to work, volunteer, or engage in social activities outside the home). We used log-binomial regression models to estimate prevalence ratios (PRs). All estimates were weighted. Results: In total, 40.2% of people who needed SCD-related assistance reported an unmet need. Among respondents without depression, an unmet need was associated with a higher prevalence of frequent mental distress (PR = 1.55, 95% CI: 1.12–2.13, p = 0.007). Frequent physical distress and social limitations did not differ between people with met and unmet needs. Conclusions: Middle-aged and older adults with SCD-related needs for assistance frequently did not have those needs met, which could negatively impact their mental health. Interventions to identify and meet the unmet needs among people with SCD may improve HRQOL.

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The Effect of Support and Training for Family Members on Access to Outpatient Services for Veterans with Posttraumatic Stress Disorder (PTSD)

Cited by 6 publications

References 31 publications

Family Caregivers of Veterans Experience High Levels of Burden, Distress, and Financial Strain

Family Caregivers of Veterans Experience High Levels of Burden, Distress, and Financial Strain

US Veterans Who Do and Do Not Utilize Veterans Affairs Health Care Services

Unmet needs for assistance related to subjective cognitive decline among community-dwelling middle-aged and older adults in the US: prevalence and impact on health-related quality of life

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