Patterns and correlates of racial/ethnic disparities in posttraumatic stress disorder screening among recently separated veterans.
Abstract: Despite the high prevalence of posttraumatic stress disorder (PTSD) among military veterans, there is a lack of knowledge about racial/ethnic differences. The current study describes patterns and correlates of PTSD screening across race/ethnicity and gender in a sample of 9420 veterans recently separated from the military. Veterans who identified as White (n = 6222), Hispanic/Latinx (n = 1313), Black (n = 1027), Asian/Hawaiian/Pacific Islander (n = 420) and multiracial (n = 438) were included. Trauma exposure and PTSD were assessed with the Primary Care PTSD Screen for DSM-5. Contextual factors examined included the intensity of ongoing stressful events, perceived social support, and sociodemographic variables (e.g., income). Weighted analyses were conducted to account for differential sample response rates. Regression analyses examining correlates of racial/ethnic differences in PTSD screening were stratified by gender. Among men and women, positive PTSD screening rates were significantly elevated among Black, multiracial, and Hispanic/Latinx veterans compared with White veterans. Sociodemographics, trauma exposure, stress and social support accounted for elevated positive screening rates among all racial/ethnic groups except Black men and multiracial women. Findings suggest that Black, Hispanic/Latinx and multiracial veterans may be at higher risk for PTSD shortly following separation from the military. Contextual factors examined explain the excess risk among some, but not all, subgroups. Further specifying disparities in PTSD diagnostic rates and risk factors will enable targeted and tailored intervention among veteran subgroups.
Abstract: Introduction: Persistent inequities exist in obstetric and neonatal outcomes in military families despite universal health care coverage. Though the exact underlying cause has not been identified, social determinants of health may uniquely impact military families. The purpose of this study was to qualitatively investigate the potential impact of social determinants of health and the lived experiences of military individuals seeking maternity care in the Military Health System. Materials and methods: This was an Institutional Review Board-approved protocol. Nine providers conducted 31 semi-structured interviews with individuals who delivered within the last 5 years in the direct or purchased care market. Participants were recruited through social media blasts and clinic flyers with both maximum variation and homogenous sampling to ensure participation of diverse individuals. Data were coded and themes were identified using inductive qualitative research methods. Results: Three main themes were identified: Requirements of Military Life (with subthemes of pregnancy notification and privacy during care, role of pregnancy instructions and policies, and role of command support), Sociocultural Aspects of the Military Experience (with subthemes of pregnancy as a burden on colleagues and a career detractor, postpartum adjustment, balancing personal and professional requirements, pregnancy timing and parenting challenges, and importance of friendship and camaraderie in pregnancy), and Navigating the Healthcare Experience (including subthemes of transfer between military and civilian care and TRICARE challenges, perception of military care as inferior to civilian, and remote duty stations and international care). Conclusions: The unique stressors of military life act synergistically with the existing health care challenges, presenting opportunities for improvements in care. Such opportunities may include increased consistency of policies across services and commands. Increased access to group prenatal care and support groups, and increased assistance with navigating the health care system to improve care transitions were frequently requested changes by participants.