Military Veterans’ Preferences for Incorporating Spirituality in Psychotherapy or Counseling
Abstract: Amassing research findings suggests that religious faith and/or spirituality (R/S) can both help and hinder recovery from mental health conditions that might prompt military veterans to seek psychotherapy or counseling. As such, there is increasing interest among psychologists and other professionals working with military populations in the helpfulness of addressing the R/S domain. However, research has yet to examine veterans’ actual preferences for integrating R/S in their treatment. Drawing on two samples with heterogeneity in R/S backgrounds and military-related experiences, results revealed that veterans generally viewed incorporating R/S in psychotherapy or counseling as “somewhat” important. When compared to more concrete approaches assessed in the study, they also gave greater importance to interventions that assumed an exploratory and affirming approach to R/S. In addition, when focusing on veterans with a probable need for treatment for posttraumatic stress disorder (PTSD) and/or major depressive disorder (MDD) at the time of the study, other results illuminated several factors that might shape these preferences. Namely, veterans from ethnic minority groups and those who were highly religious and/or had a strong belief in God’s existence were more interested in a spiritually integrative treatment. This final set of analyses also revealed that veterans with clinical levels of PTSD/MDD symptoms who were experiencing R/S struggles endorsed stronger preferences, particularly with respect to moral struggles. Overall, these findings support the need for a patient-centered approach with veterans in which clinicians are not ignorant of R/S concerns but also do not assume that this domain should be targeted in every case.
Abstract: Objectives: Increasing numbers of older adults are reentering community following incarceration (i.e., reentry), yet risk of incident neurodegenerative disorders associated with reentry is unknown. Our objective was to determine association between reentry status (reentry vs never-incarcerated) and mild cognitive impairment (MCI) and/or dementia. Methods: This nationwide, longitudinal cohort study used linked Centers for Medicare & Medicaid Services and Veterans Health Administration data. Participants were aged 65 years or older who experienced reentry between October 1, 2012, and December 31, 2018, with no preincarceration MCI/dementia, compared with age-matched/sex-matched never-incarcerated veterans. MCI/dementia was defined by diagnostic codes. Fine-Gray proportional hazards models were used to examine association. Results: This study included 35,520 veterans, mean age of 70 years, and approximately 1% women. The reentry group (N = 5,920) had higher incidence of MCI/dementia compared with the never-incarcerated group (N = 29,600; 10.2% vs 7.2%; fully adjusted hazard ratio [aHR] 1.12; 95% CI 1.00-1.25). On further investigation, reentry was associated with increased risk of dementia with or without prior MCI diagnosis (aHR 1.21; 95% CI 1.06-1.39) but not MCI only. Discussion: Transition from incarceration to community increased risk of neurocognitive diagnosis. Findings indicate health/social services to identify and address significant cognitive deficits on late-life reentry. Limitations include generalizability to nonveterans.