Military Service and Military Health Care Coverage are Associated with Reduced Racial Disparities in Time to Mental Health Treatment Initiation
Abstract: We aimed to evaluate whether military service and access to veteran heath care coverage attenuates racial/ethnic disparities in time to mental health treatment initiation for posttraumatic stress disorder (PTSD), major depressive disorder, and/or alcohol-use disorder. Results are based on 13,528 civilians and 1392 veterans from NESARC-III. Among civilians, racial/ethnic minorities reported longer time to PTSD and depression treatment initiation than non-Hispanic whites. Among veterans, racial/ethnic minorities did not difer from whites in time to PTSD and depression treatment initiation, and showed shorter time to treatment initiation for alcohol-use disorder treatment. Racial/ethnic minorities with past year veteran healthcare coverage showed the strongest evidence for attenuated disparities.
Abstract: Disordered eating is a prevalent and relevant health concern that remains understudied among U.S. military veterans. Avoidant/restrictive food intake disorder (ARFID) is a newly recognized feeding and eating disorder characterized by overly restrictive eating due to (a) picky eating, (b) lack of appetite, and (c) fear of aversive consequences related to eating. The Nine-Item ARFID Screen (NIAS) is a recently developed ARFID screening tool with initial validation studies demonstrating psychometric support. However, the psychometric properties of the NIAS have not been investigated in a veteran sample. To advance our understanding of ARFID screening tools that may be appropriate for use in veterans, the present study examined the factor structure of the NIAS using survey data from a large national sample of recently separated veterans (N = 1,486). Measurement invariance across key subgroups was tested in addition to exploring differential associations between the NIAS and related constructs. Results suggested that a three-factor model provided an excellent fit of the data and demonstrated scalar invariance across self-identified men and women, race and ethnicity, and sexual and gender minority (SGM) identity. Some subgroups had higher latent means on the picky eating (women, SGM, non-Hispanic Black), appetite (women, SGM), and fear (women) factors. The NIAS had some overlap with another measure of disordered eating and was moderately correlated with psychosocial impairment and mental health. Overall, the NIAS may be a useful screening tool for ARFID in veterans, given support for the three proposed subscales and equivalence across diverse identities.