Andersen et al. (1992) Cross-sectional survey (national – 3 US states only reported) US US veterans within National Institute of Mental Health (NIMH) Epidemiologic Catchment (ECA) program. N = 834 Age range: 18–60 years Sex: 100% men Male non-veterans in National Institute of Mental Health (NIMH) Epidemiologic Catchment Areas (ECA) program N = 2,255 Age range: 18–60 years Self-reported mental health status Alcohol abuse Drug abuse Depression Other Findings: Alcohol abuse rate was 28% in veterans and 25% in non-veterans, while drug abuse was 11% in veterans and 13% in non-veterans (both significant at p < .05). Barrera et al. (2013) Cross-sectional survey (single site) US US veterans with primary diagnosis of disorder, recruited via physician referrals and advertisements posted in clinic waiting areas. N = 21 Mean age: 46.3 [SD 9.1] (31–58 years) Sex: 86% men Civilians with panic disorder N = 213 Age and sex: no information provided U.S. population norms N=2,474 Age and sex: no information SF-36 – all component measures. Health utility scores Findings: Veterans reported significantly greater impairment on all eight (physical functioning, role physical, bodily pain, general health, vitality, social functioning, role emotional and mental health) of the SF-36 subscales. Becerra & Becerra (2015) Cross-sectional survey US California Behavioural Risk Factor Surveillance System (BRFSS) California Health Interview Survey (CHIS) 2009 and 2011/2012 data N = 9,993 Mean age: 60.0 SD [0.40] Sex: 100% men Male civilians within California Behavioural Risk Factor Surveillance System (BRFSS)) N = 26,999 Mean age: 41.4 [SD 0.06] Kessler 6-scale measure of psychological distress. Asthma Findings: More civilians reported past year serious psychological distress (SPD) (6.34%) than veterans (4.67%). Bergman et al. (2017) Cross-sectional UK Scottish Veterans Health Study. N = 56,570 (56,205 included in the analysis) Non-veterans Tuberculosis (TB)
survey (national) Age range: 37–77 years (Veterans born registered with NHS Scotland) Sex: 90.7% men N = 172,753 (172,741 included in the analysis (National Health Service [NHS] Scotland) Age and sex: no information Compared to NHS Scotland Findings: Prevalence of tuberculosis was similar in veterans (0.12%) and general population (0.15%). The 1945–1949 veterans’ cohort was at higher risk of tuberculosis, although the difference in risk did not achieve significance. Veterans born from 1950 were at significantly reduced risk of tuberculosis compared with non-veterans after adjusting for deprivation. Bergman et al. (2016a) survey (national) UK Scottish (UK) veterans within Scottish Veteran Health Study. 56,570 (56,205 included in the analysis) Age range: 37–77 years (Veterans born who were registered with NHS Scotland) Sex: 90.7% men Non-veterans N = 172,753 (172,741 included in the analysis (non-veteran population within UK National Health Service administrative data with no record of service matched 3:1 for age, sex and postcode sector residence) Age and sex: No information provided Mental health disorders based on ICD-10 codes for anxiety disorders Findings: There was a rate of 4.97% episodes of any mental health disorder in veterans compared with 4.5% in non-veterans, and this difference was statistically significant for all veterans (adjusted HR: 1.21, 95% CI: 1.16–1.27, p < 0.001). Bergman et al. survey (national) UK Scottish Veterans Health Study. 56,570 (56,205 included in the analysis) Age range: 37–77 years (Veterans born who were registered with NHS Scotland) Non-veterans N = 172,753 (172,741 included in the analysis (National Health Service (NHS) Scotland - people with no record of military service, resident in Alcoholic Liver Disease (ALD)
Sex: 100% women Findings: Among heterosexual women, veterans reported lower mean social support scores than nonveterans (34.8 vs. 36.1), but they also reported slightly lower levels of social strain (6.4 vs. 6.5). Liu et al. (2006) Cross-sectional survey (national) US Asset and Health Dynamics among the Oldest Old (AHEAD) survey Sample: n=1492 Age: 70+ years Sex: No information N = 5,579 in same national survey Age and sex: No information Health behaviours (e.g. smoking, alcohol) Health status Functional status Findings: Veteran status significantly impacts age-dependent transitions from functional dependence to other statuses. At age 85, functionally dependent veterans were much less likely to resolve from functional dependence and much more likely to die than their non-veteran counterparts. O’Donnell (2000) Cross-sectional survey (national) US US veterans identified within the Household Component of the Medical Expenditure Panel Survey (MEPS) (Round 1) (1996). N = 660 (61.8% of 1068) Mean age: 72.3 [SD 0.22] (range 65–90 years) Sex: 100% men Non-veterans (within MEPS data aged 65+ years.) N = 408 (38.2% of 1068) Mean age: 75.0 [SD 0.37] (range 65–90 years) Sex: 100% men Health status Mental health Findings: Veterans were more likely to be a college graduate (23.8% vs. 13.2%, p < 0.0001) and less likely to be Medicaid eligible (3.9 vs. 12.1%, p < 0.0001). Poorer self-rated mental health was associated with lower educational attainment, lower socioeconomic status, and limitation in walking and cognition. Sim et al. (2005) Survey questionnaire) Australia Korean War veterans residing in Australia (Some participants by proxy) Population sample of 2,964 Australian men aged 65 and over drawn from the Electoral Roll N = 6,122 (from a sample frame of 7,525 Korean war veterans) Age 66–99 Sex: 100% men N = 1,893 (from a sample frame of 2,964) Age range: 66–99 Sex: 100% men Life satisfaction Depression Anxiety PTSD Smoking Alcohol consumption (AUDIT) Quality of life Medical conditions Korean war service characteristics
Shen et al. (2012) survey (national) US Female veterans within 2009 Behavioural Risk Factor Surveillance System (BRFSS). N = 3747 (matched) Age range: 21–49 years 56.7%, 50–64 years 25.9%, ≥65 years 17.3% Sex: 100% women Non-veterans in 2009 BRFSS N = 3747 (matched) Age range: 21–49 years 56.3%, 50–64 years 26.9%, ≥65 years 16.8% Sex: 100% Health related quality of life (HRQOL) Financial barriers to health care access. Findings: Both veterans (14%) and non-veterans (14.5%) indicated financial barriers to receiving care; and, 40.4% of the non-veterans and 34.1% of the veterans who reported poor mental health also reported having financial barriers to receiving care; whereas 8.3% of the non-veterans and 7.8% of the veterans who reported excellent mental health also reported financial barriers to care. Thorp et al. (2012) Cross-sectional survey (national) (Secondary data analysis) US Schizophrenia among older US veterans N = 373 Mean age: 57.13 SD [6.25] Sex: 100% men Non-veterans (matched within same national survey) N = 373 Mean age: 54.39 SD [9.16] Sex: 100% men Schizophrenia diagnosis confirmation Pre-morbid adjustment scale American National Adult Reading Test Psychopathology Health related quality of life (SF-36) Everyday functioning Cognitive performance Findings: Veterans had higher likelihood of being married (9% vs. 5%) and lower likelihood of living in a board-and-care facility (44% vs. 58%) than Fewer veterans endorsed current use of substances than non-veterans. Ullrich et al. (2008) Cross-sectional survey sites in 2 US states) US Pain among US veterans with spinal cord injury N = 132 Mean age: 56.5 SD [12.8] Sex: No information provided Non-veterans (with SCI involved in a separate and ongoing study of pain (reference provided) N = 289 Mean age: 46.9 SD [13.7] Primary diagnoses Place of residence
Employment supported employment (SE) vs. treatment as usual (TAU) Findings: Subjects in the supported employment (SE) group were 2.5 times more likely than the treatment as usual interventional site (TAU-IS) group and 11.4 times more likely than the treatment as usual observation site (TAU-OS) group to obtain competitive employment. Ottomanelli et al. (2013) US Employment RCT with 1 –year follow-up Veterans with spinal cord injury Participants assigned to supported employment (SE) or treatment as usual (TAU) Primary outcome: competitive employment Secondary outcomes: health related quality of life (HRQOL), handicap and disability Findings: There were no significant differences in outcomes between veterans who participated in SE and those who received TAU. Participants obtaining competitive employment demonstrated significantly higher scores on the Social Integration, Mobility, and Occupation dimensions of the CHART. Partin et al. (2006) US Physical wellbeing (health behaviours) RCT, trial, follow-up period Veterans aged ≥19 years with a prescription for nicotine replacement or bupropion for smoking cessation/Zyban. Age: Overall: mean age 55 ± 10.59. Usual care: 55 ± 11.00 Patients received a phone call to assess smoking status, quit challenges, and treatment preferences, and computerised progress note to providers communicating this information 2) care: 949 participants. Proportion of patients receiving repeat pharmacologic or behavioural treatment in the 6-month follow-up period 7-day point prevalence abstinence and satisfaction assessed by patient survey. Findings: The intervention significantly increased repeat treatment rates and satisfaction with services; but, did not have a significant effect on abstinence rates. Salyers et al. (2014) US Schizophrenia RCT with 18-month follow-up Patients currently receiving (or newly admitted to) mental health services with diagnosis of schizophrenia or schizoaffective disorder IMR group (n=60) PS control (n=58) Mean age: 47.76 +/- 8.9. Illness management and recovery (IMR) group: Trained facilitators ran group sessions using the IMR curriculum, incorporating psychoeducation, approaches, relapse prevention, social skills training, and coping skills training. Diagnoses were assessed with the psychosis modules of the Structured Clinical Interview for DSM-IV Psychiatric (PANSS) Quality of life Illness self-management Patient Activation Measure Medication adherence Recovery Assessment Scale (RAS)
PS control: Participants were encouraged to discuss current concerns and receive group support for solving problems. State Hope Scale Service utilisation Findings: - No significant differences were found between IMR and problem-solving groups. - Participants in both groups improved significantly over time in symptom severity, illness management, and quality of life and had emergency department visits. Participation rates in both interventions were low. Only 28% of consumers assigned to IMR and 17% of those assigned to the problem-solving group participated in more than half the scheduled groups, and 23% and 34%, respectively, attended no sessions. Saxon et al. (2006) US Addiction RCT, follow-up Veterans in additions treatment Onsite group: N = 358, Average age: 45.4 [SD 7.7], Sex: 98% men Offsite group: N = 362, Average age: 46.5 [SD 7.1], Sex: 98% men IG: randomised to medical centre CG: randomised to SUD clinic among VA pts who receive medical care within the substance use disorder clinic and those referred to a general medicine clinic at the same facility Primary: medical service use Health related quality of life Substance use disorder treatment engagement SUD treatment outcomes VA costs Findings: Over the year, patients assigned to on-site care were more likely to attend primary care (adjusted odds ratio [AOR] = 2.20; 95% CI 1.53–3.15) and to remain engaged in SUD treatment for at least 3-months (OR 1.36, 1.00–1.84). Overall, outcomes on the Mental Component Summary (but not the Physical Component Summary) and the Addiction Severity Index improved significantly over time, but did not differ by treatment condition. Total VA costs did not differ reliably across conditions. Shahnazari et al. (2013) US Physical wellbeing (health behaviours, eating) RCT, follow up Veterans responsible for their own food selection, preparation, and consumption IG: Wellness coaching: Both IG and CG receive initial individualised nutrition education session from dietetics students. IG received individualised wellness coaching weekly either face-to-face or telephone Primary: reduction in BMI Secondary: changes in nutrition behaviours trial
Aburizik et al. (2013) US Pain Depression RCT Veterans with documented diagnosis of uncontrolled hypertension or chronic pain Combined: Mean age: 66.4 [SD 7.9], Sex: 100% men Illness Management Only: Mean age: 62.7 [SD 9.1], Sex: 90% men Care: Mean age: 64.1 [SD 10.5], Sex: 91% men Usual care vs. illness management only vs. combined psychotherapy and illness management A multidimensional telehealth intervention designed to focus on access barriers to care Beck Depression Inventory-II Health related quality-of-life Medical Outcomes Study Medical Adherence Questionnaire Pain (Brief Pain Inventory) Findings: The combined intervention yielded a significant decline in depressive symptoms compared with usual care. was no time X group effect for pain management. There was no significant difference between the combined and illness management only groups. All three groups showed little change over the course of the 10-week on the measures of chronic disease self-management and health-related quality-of-life. Neither the combined nor the illness management only was effective in improving chronic disease self-management outcomes. Allen et al. (2016) US Physical performance RCT with 24-week follow-up Veterans with knee osteoarthritis Group physiotherapy: N = 159, Mean age: 59.2 [SD 9.6], Sex: 88.7% men Individual physiotherapy: N = 161, Mean age: 60.8 [SD 10.0], Sex: 87.6% men Group versus individual physical therapy Osteoarthritis Index (WOMAC) Short Physical Performance Battery (SPPB) Findings: No difference between groups on change in WOMAC scores-at 12 weeks or 24 weeks. No difference between groups on change in physical performance at 12 weeks. Group physical therapy was not more effective than individual physical therapy for primary and secondary outcomes. Either group physical therapy or individual physical therapy may be a reasonable delivery model for health care systems to consider. Battersby et al. (1993) Australia Mental wellbeing RCT Psychiatric and non-psychiatric patients of a Veterans’ hospital and general hospital patients 3 Groups: 1. Veteran psychiatric patients (n=81) Video (educational material) Attitudes to Electroconvulsive therapy Measure: Questionnaire 1. Knowledge (cognition) 2. Behavioural intent 3. Fear (affective)
Disease management reduced hospitalisations for cardiac or pulmonary conditions other than COPD by 49%, hospitalisations for all causes by 28%, and ED visits for all causes by 27% (p < 0.05 for all). Oslin et al. (2003) US Mental wellbeing RCT, follow-up Veterans with depression and/or drinking Mean age: 61.1 Telephone-based disease management (TDM) program for the acute management of depression and/or at-risk drinking TDM comprised regular contacts by a behavioural health specialist to assist in assessment, education, support, and treatment planning. Primary outcome: response to treatment Secondary outcome: severity of depressive symptoms Findings: Overall response to treatment favoured those assigned to TDM compared with those assigned to usual care (39.1% responded vs. 17.6%, p = 0.022). Comparing depression severity using the HDRS, the patients treated using TDM had significantly greater improvement in symptoms compared with those randomised to usual care. Response rates within the separate diagnostic groups also favoured TDM, but this was only significant for those with depressive disorders. At-risk drinking did not improve. Oslin et al. (2004) US Alcohol use Mental wellbeing RCT Significant anxiety symptoms, significant depressive symptoms, and/or at-risk drinking Age: Intervention: x̅ = 69.72 [SD 6.56] Usual care: x̅ = 69.74 [SD 6.70] Psychogeriatric Biopsychosocial Evaluation and Treatment (UPBEAT) Program, an interdisciplinary mental health care management program Mental Health Inventory (MHI) and for at risk drinking the Alcohol Use Disorders Identification Test (AUDIT) SF-36 Findings: Participant nonadherence to the protocol was common and is a major limitation. There were no differences between UPBEAT and usual care patients on symptom or functional outcomes at any follow-up point. Exploratory analyses suggested that among participants with more physical health problems, there were greater improvements in depressive symptoms in those assigned to UPBEAT care. Despite a theoretical and practically sound intervention, participation was low and treatment outcomes, while generally good, appeared unaffected by the addition of the program. trial