Young Veterans Carry Heavy Burden of Physical Illness

[w8liftinglady]

http://www.medscape.com/viewarticle/739142?src=mp&spon=24

March 17, 2011 (San Antonio, Texas) — Despite their young age, returning veterans from the current conflicts in Iraq and Afghanistan carry a heavy burden of physical illness — most predominantly musculoskeletal disorders — and this load is particularly striking in those who develop posttraumatic stress disorder (PTSD), substance use disorders (SUD), or both, new research suggests.

A large cross-sectional study presented here at the American Psychosomatic Society 69th Annual Scientific Meeting shows that compared with their counterparts with no mental health conditions (MHCs), returning female veterans from Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF) with comorbid PTSD and SUD had a more than 2-fold increased risk of having a medical diagnosis, whereas male veterans had a 1.5-fold increased risk.

"Despite their young age, men and women OEF/OIF veterans overall carry a heavy burden of illness. Medical burden was particularly associated with PTSD in both sexes. Further, veterans who had either PTSD only or comorbid PTSD and SUD demonstrated a robust association with medical conditions," said lead investigator Deborah Nazarian, PhD, Veterans Administration (VA) Palo Alto Health Care System, Menlo Park, California.

Dr. Nazarian noted there is a large body of evidence from past conflicts, including the Vietnam War, demonstrating a strong association among PTSD, SUD, and medical disease. Veterans from these wars, she noted, were significantly affected by a heavy burden of late-life medical illness.

However, she added, there is limited research examining this association in returning OEF/OIF veterans.

In addition, she said, research suggests that this population is at increased risk of developing PTSD and alcohol and drug use disorders. Further, she noted, they are less likely to present to specialty mental health clinics because of a concern about potential stigma attached to seeking mental healthcare.

Furthermore, said Dr. Nazarian, the increased numbers of female service members serving in the current conflicts offer a new avenue of research to understand the mental health and medical needs of women veterans.

Unique Opportunity

"The VA has a unique and time-sensitive opportunity to develop interventions that address comorbid mental health and medical disease among OEF and OIF veterans that can prevent the late-life burden of medical illness that we have observed in older vets from previous cohorts," she told Medscape Medical News.

She also noted that although recent research conducted by Judith Andersen, PhD, and colleagues also showed a robust link between mental health conditions, specifically PTSD, and physical disease among returning OEF/OIF veterans in the VA Healthcare Network of Upstate New York, the current study analyzed national administrative data of veterans who use Veterans Health Administrative primary care services.


Dr. Judith Andersen

The study had 2 main aims — to determine the most frequent medical diagnoses in returning men and women with PTSD alone, SUD alone, or comorbid PTSD/SUD in returning OEF/OIF veterans and to determine whether there is an increased likelihood of medical problems among those with mental health problems vs no MHCs.

The cohort included a nationally representative population of 73,720 returning OEF/OIF veterans who used primary care services and 15% were female. Most of the study population was younger than 35 years, and approximately one-third had more than 1 deployment.

Clinician-diagnosed mental health and medical conditions were obtained from International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis codes. The researchers calculated adjusted odds ratios for 10 specific medical condition categories in relation to 4 mutually exclusive groups of veterans — those with a diagnosis of PTSD alone, those with SUD alone, those with comorbid PTSD/SUD, and those with no MHCs.

Musculoskeletal Disorders Most Common

The investigators, who included Rachel Kimerling, PhD, and Susan Frayne, MD, MPH, found that diseases of the musculoskeletal system had the highest frequency across the 4 study groups.

"More generally," said Dr. Nazarian, "we observed high frequencies of diagnoses for several of these medical categories regardless of mental health status."

Adjusted odds ratios (AORs) of having a diagnosis among the 5 most prevalent medical diagnoses among women were statistically significant, she added. Compared with women with no MCHs, women veterans with SUD alone (AOR, 2.20) or PTSD/SUD (AOR, 2.19) were more than twice as likely to have any medical diagnosis.

Male veterans with PTSD or PTSD/SUD had a 1.5 greater odds of having any medical diagnosis relative to their counterparts with no MHC.

The 3 most frequent medical diagnoses among women were disease of the musculoskeletal, nervous, and genitourinary systems. In men they were diseases of the musculoskeletal, nervous, and digestive systems.

Although there were some differences in odds ratios among medical categories, Dr. Nazarian said her team was struck by the significantly high AORs in the injury and poisoning category among women veterans with PTSD/SUD (AOR, 3.80) or PTSD (AOR, 2.54) compared with women with no MHCs.

Dr. Nazarian said the association between musculoskeletal conditions and PTSD/SUD is concerning because musculoskeletal conditions may lead to the development of chronic pain. This comorbidity may make it challenging for primary care physicians to independently manage the care of these patients.

Eradicating Stigma

Finally, she said, the high frequency of genitourinary conditions in women veterans is an area that warrants further research. It may be that this is a problem specific to women veterans that may relate to conditions during deployment, including a lack of access to washrooms, temperature, and hygiene issues.

"Our findings suggest that these veterans have complex and unique mental health and medical needs, which may be challenging for primary care physicians to independently manage their care and suggests a comprehensive interdisciplinary treatment approach may be best," she said.

Dr. Nazarian added that embedding mental health clinicians in primary care clinics may help reduce potential stigma related to seeking mental healthcare services, which has previously been shown to be a barrier to care among OEF/OIF military personnel.

She pointed out that the Veterans Health Administration has embraced this concept of providing a "one-stop" shop where veterans can have all of their physical and mental healthcare needs addressed in a streamlined way.

PTSD Education Needed

Commenting on the study, Judith Andersen, PhD, Center for Integrated Healthcare at the Department of Veterans Affairs Medical Center in Syracuse, New York, said that longitudinal research conducted by her team shows that PTSD and physical illness, including serious medical conditions, are definitely linked.

"We've shown that 30-year-olds are developing cardiovascular conditions 5 years post war. And it's not only cardiovascular disease but respiratory disease, immune suppression, and so forth. So we need to take mental health conditions like PTSD seriously. These are serious predictors of chronic disease at a young age," Dr. Andersen told Medscape Medical News.

She added that there is still a great deal of resistance to the idea that mental illness can be a catalyst for physical illness, and so education of government, policymakers, and the public is essential.

Dr. Nazarian added she hopes this work will lead to a better understanding of the link between chronic medical illness and mental illness and ultimately lead to more effective interventions that will prevent today's veterans from the burden of late-life medical illness that was the fate of many of their predecessors from earlier conflicts.

Dr. Nazarian and Dr. Andersen have disclosed no relevant financial relationships.

[Adsos Letter]

1. K&R.

[L0oniX]

2. Is your life really worth risking by joining the military?

Military men are just dumb stupid animals to be used as pawns in foreign policy. - Henry Kissinger

"Every gun that is made, every warship launched, every rocket fired signifies, in the final sense, a theft from those who hunger and are not fed, those who are cold and are not clothed. This world in arms is not spending money alone. It is spending the sweat of its laborers, the genius of its scientists, the hopes of its children." - Dwight Eisenhower

You measure a democracy by the freedom it gives its dissidents, not the freedom it gives its assimilated conformists.- Abbie Hoffman


Blind obedience to authority is the enemy of the truth. - Albert Einstein

Become an internationalist and learn to respect all life. Make war on machines. And in particular the sterile machines of corporate death and the robots that guard them. -Abbie Hoffman

That worst outcrop of herd life, the military system, which I abhor . . . This plague-spot of civilization ought to be abolished with all possible speed. Heroism on command, senseless violence, and all the loathsome nonsense that goes by the name of patriotism–how passionately I hate them! – Albert Einstein

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Never was a patriot yet, but was a fool. – John Dryden

A patriot is a fool in ev’ry age. – Alexander Pope.

Patriotism is the last refuge of the scoundrel. – Samuel Johnson

In Dr. Johnson’s famous dictionary, patriotism is defined as the last resort of a scoundrel. With all due respect to an enlightened but inferior lexicographer, I beg to submit that it is the first. – Ambrose Bierce

Patriotism is as fierce as a fever, pitiless as the grave, blind as a stone, and irrational as a headless hen. – Ambrose Bierce

That pernicious sentiment, “Our country, right or wrong.” – James Russell Lowell

“My country right or wrong” is a thing that no patriot would think of saying except in a desperate case. It is like saying, “My mother drunk or sober.” – G. K. Chesterton

Patriotism which has the quality of intoxication is a danger not only to its native land but to the world, and “My country never wrong” is an even more dangerous maxim than “My country, right or wrong.” – Bertrand Russell

Patriotism is your conviction that this country is superior to all other countries because you were born in it. – George Bernard Shaw

Patriotism is the virtue of the vicious. – George Bernard Shaw

You’ll never have a quiet world till you knock the patriotism out of the human race. – George Bernard Shaw

Patriotism is a pernicious, psychopathic form of idiocy. – George Bernard Shaw

Patriotism is an ephemeral motive that scarcely ever outlasts the particular threat to society that aroused it. – Denis Diderot

To me, it seems a dreadful indignity to have a soul controlled by geography. – George Santayana

The Athenian democracy suffered much from that narrowness of patriotism which is the ruin of all nations. – H.G. Wells

Nationalism is our form of incest, is our idolatry, is our insanity. “Patriotism” is its cult. . . . Just as love for one individual which excludes the love for others is not love, love for one’s country which is not part of one’s love for humanity is not love, but idolatrous worship. – Erich Fromm

One of the great attractions of patriotism–it fulfills our worst wishes. In the person of our nation we are able, vicariously, to bully and cheat, Bully and cheat, what’s more, with a feeling that we are profoundly virtuous. – Aldous Huxley

Many studies have discovered a close link between prejudice and “patriotism” . . . Extreme bigots are almost always super-patriots – Gordon Allport

It seems like the less a statesman amounts to, the more he loves the flag. – Elbert Hubband

Patriotism varies, from a noble devotion to a moral lunacy. – William Inge

Every miserable fool who has nothing at all of which he can be proud, adopts, as a last resource, pride in the nation to which he belongs; he is ready and glad to defend all its faults and follies tooth and nail, thus reimbursing himself for his own inferiority. – Arthur Schopenhauer

Patriotism is the passion of fools and the most foolish of passions. – Arthur Schopenhauer

Patriotism corrupts history. – Goethe

Into the cultural and technological system of the modern world, the patriotic spirit fits like dust in the eyes and sand in the bearings. Its net contribution to the outcome is obscuration, distrust, and retardation at every point where it touches the fortunes of modern mankind. – Thorstein Veblen

The standardization of mass-production carries with it a tendency to standardize a mass-mind, producing a willing conformity, not merely to common ways of living, but to common ways of thinking and common valuations. The worst defect of patriotism is its tendency to foster and impose this common mind, and so to stifle the innumerable germs of liberty. – J.A. Hobson

2. Patriotism and War:

At the bottom of all patriotism is war: that is why I am no patriot. – Jules Renard

No other factor in history, not even religion, has produced so many wars as has the clash of national egotisms sanctified by the name of patriotism. – Preserved Smith

Naturally the common people don’t want war . . . Voice or no voice, the people can always be brought to the bidding of the leaders . . . All you have to do is to tell them they are being attacked and denounce the pacifists for lack of patriotism. – Hermann Goering.


3. Patriotism and Religion:

Patriotism is a kind of religion; it is the egg from which wars are hatched. – Guy de Maupassant

God and Country are an unbeatable team; they break all records for oppression and bloodshed. – Luis Buñuel

To be patriotic, hate all nations but your own; to be religious, all sects but your own; to be moral, all pretenses but your own. – Lionel Strachey

When a dog barks at the moon, then it is religion; but when he barks at strangers, it is patriotism! – David Starr Jordan

4. The American Syndrome:

If you have a weak candidate and a weak platform, wrap yourself up in the American flag and talk about the Constitution. – Matt Quay

How much longer are we going to think it necessary to be “American” before (or in contradistinction to) being cultivated, being enlightened, being humane, & having the same intellectual discipline as other civilized countries? It is really too easy a disguise for our shortcomings to dress them up as a form of patriotism. – Edith Wharton

The 100 percent American is 99 percent an idiot. – George Bernard Shaw

Treason is in the air around us everywhere. It goes by the name of patriotism. – Thomas Corwin

[Solly Mack]

3. K&R

[sad sally]

4. Senator Patty Murray is good about recognizing the needs of veterans.

Getting the funding they need hasn't been easy though.

Senator Murray’s Statement on the President’s Budget Request for Veterans Programs

February 14, 2011
(Washington, D.C.) – Today, Senate Veterans’ Affairs Committee Chairman, Senator Patty Murray, released the following statement on the President's 2012 budget request for veterans programs. The President’s budget requests an increase of approximately $2.7 billion for VA health care over current year VA funding in a very difficult budget year.

"When we send servicemembers into harm’s way, it is our non-negotiable duty to take care of them when they come home. I know that the President understands that veterans’ health care cannot be jeopardized, that mental health concerns must be treated with the same seriousness as physical wounds, and that our benefits process needs to be improved. His overall request for increased funding for VA health care during an exceedingly difficult budget year appears to reflect that understanding.

“But I will want to hear directly from Secretary Shinseki and others at the VA about their specific plans to care for our veterans and make the VA into a 21st century agency capable of meeting the needs of all of our veterans. On first glance, it looks like the President’s request is a fair place to start, but the truth will be in the details.

"As we move forward I will be reviewing many of the specifics in this budget proposal, including how the VA can better use technology to address a benefits claims backlog that has gone on too long and must be a top priority for the Committee and the Congress.

“I will also pay close attention to a number of other concerns, including helping homeless veterans get off the streets, helping unemployed veterans find job training resources and meaningful careers, and ensuring that VA is addressing the growing needs of women veterans.

“Providing the best possible care and benefits to veterans is a cost of war, a cost that must be paid in full. As Chairman of the Veterans’ Affairs Committee, I will continue to work diligently to ensure that veterans’ needs are met.”

[leftstreet]

5. K&R