Psychosocial Barriers to Care Among Operation Enduring Freedom and Operation Iraqi Freedom Veterans
Background and Purpose: US veterans present with complex medical and psychosocial concerns post-deployment. Identification of psychosocial concerns is necessary for appropriate and targeted social work interventions to improve delivery and receipt of health care through the Veterans Administration (VA). Frequently, veterans report that psychosocial concerns are a barrier to that health care. The goal of this paper is to identify specific psychosocial concerns of veterans presenting at the War Related Illness & Injury Center in order to tailor social work intervention to optimize veteran transition to civilian life and utilization of health care services. The WRIISC is a specialized program to address post-deployment healthcare needs of veterans with unexplained illnesses and injuries. Veterans are evaluated by an interdisciplinary team of healthcare providers and recommendations for further care are made; Social Work is part of that team.
Methods: A retrospective chart review of psychosocial concerns from all Operation Enduring Freedom/Operation Iraqi Freedom veterans seen by the WRIISC from June 2008-June 2010 was conducted. Demographic data were collected including age, gender, education, marital status, parenting status, branch of the military, component of military (active duty, reserve, National Guard) and number of deployments. Psychosocial concerns included social support, pain, childcare, substance abuse, sleep, employment, education, anger, relationships, financial, transportation, cognitive, legal, navigating the VA system, insurance and application for disability. Data included posttraumatic stress disorder (PTSD) Checklist (PCL), a validated self-report instrument used by the VA for screening, diagnosing, and monitoring treatment of veterans. A score of over 50 indicates the likelihood of PTSD. Descriptive statistics and bivariate comparisons were made to test for subgroup differences.
Results: The veterans in this sample (N=356) were on average 32 years old with 14 years of education. The majority of the sample was white (58 %) and were in the Army (64 %). Thirty-nine percent of the sample was married and 48% were currently parenting. Eighty-eight percent were male and had an average of 1.4 deployments. The sample had a high prevalence of PTSD with 48.8% scoring over 50 on PCL (average of 47.13, sd 20.59, range 17-85). Veterans reported an average of 4.55 psychosocial concerns (sd 2.28, range 0-11). The majority of the veterans reported concerns with pain (66%) and sleep (58%). The most common concerns reported by the veterans were employment, education, cognitive, relationships, financial, anger, substance abuse, and social support. There were no significant differences between the psychosocial concerns of active duty and reserve components.
Conclusion and Implications: The OEF/OIF veterans in our sample reported a large number of psychosocial concerns as they began to reintegrate back into their home communities. While pain and sleep were most commonly reported; other psychosocial concerns can become barriers to receiving recommended care. Social work intervention to address psychosocial concerns is imperative to maximize veteran adherence to medical recommendations and to optimize veteran functioning in the community.