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: 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.