Maguen Shira, Hoerster Katherine D, Littman Alyson J, Klingaman Elizabeth A, Evans-Hudnall Gina, Holleman Rob, Kim H Myra, Goodrich David E
San Francisco VA Medical Center, San Francisco, CA, United States; University of California, San Francisco, CA, United States.
VA Puget Sound Healthcare System, Seattle Division, Seattle, WA, United States; University of Washington Department of Psychiatry and Behavioral Sciences, Seattle, WA, United States.
J Affect Disord. 2016 Mar 15;193:289-94. doi: 10.1016/j.jad.2015.12.078. Epub 2016 Jan 6.
Three-quarters of Iraq and Afghanistan veterans enrolled in Veterans Health Administration (VHA) care are overweight or obese. The VHA MOVE!® weight management program can mitigate the risks of obesity-related morbidity. However, many Iraq and Afghanistan veterans experience barriers to VHA services, which may affect participation, especially among those with posttraumatic stress disorder (PTSD) and/or depression. Little is known about MOVE! engagement among recent veterans. We describe a retrospective evaluation of MOVE! participation among Iraq and Afghanistan veterans with and without mental health problems.
As part of a national VHA mental health evaluation study, we accessed VHA patient care databases to identify Iraq and Afghanistan veterans receiving care from 2008-2013 who had ≥1 MOVE! visit(s) and ≥1 weight measurements (N=24,899). We used logistic regression to determine whether mental health conditions were associated with having 12 visits/year (desirable dose of care), adjusting for demographic, health, and utilization factors.
Among Iraq and Afghanistan veterans enrolled in MOVE!, 4% had a desirable dose of participation. In adjusted models, desirable MOVE! participation was more likely among those without PTSD; those who were older, female, and unmarried; and those who had higher baseline weight, more medical comorbidities, no pain, psychotropic medication use, higher disability ratings, and more mental health visits.
We used administrative ICD-9 codes. Sample only included veterans in VHA care.
Iraq and Afghanistan veterans, particularly those with PTSD, had low participation in VHA weight management programming. Correlates of MOVE! participation were identified, highlighting opportunities to tailor MOVE! to improve participation for these veterans.
参加退伍军人健康管理局（VHA）护理的伊拉克和阿富汗退伍军人中有四分之三超重或肥胖。VHA的“行动起来！”（MOVE!®）体重管理计划可以降低肥胖相关发病风险。然而，许多伊拉克和阿富汗退伍军人在接受VHA服务时遇到障碍，这可能会影响参与度，尤其是那些患有创伤后应激障碍（PTSD）和/或抑郁症的退伍军人。对于近期退伍军人参与“行动起来！”计划的情况知之甚少。我们描述了一项对有心理健康问题和无心理健康问题的伊拉克和阿富汗退伍军人参与“行动起来！”计划的回顾性评估。
作为一项全国性VHA心理健康评估研究的一部分，我们访问了VHA患者护理数据库，以识别2008年至2013年期间接受护理且有≥1次“行动起来！”就诊和≥1次体重测量的伊拉克和阿富汗退伍军人（N = 24,899）。我们使用逻辑回归来确定心理健康状况是否与每年进行12次就诊（理想护理剂量）相关，并对人口统计学、健康状况和使用因素进行了调整。
在参加“行动起来！”计划的伊拉克和阿富汗退伍军人中，4%达到了理想参与剂量。在调整后的模型中，无PTSD的退伍军人、年龄较大、女性、未婚的退伍军人、基线体重较高、有更多医疗合并症、无疼痛、使用精神药物、残疾评级较高以及心理健康就诊次数较多的退伍军人更有可能达到理想的“行动起来！”参与度。
我们使用了行政ICD - 9编码。样本仅包括接受VHA护理的退伍军人。
伊拉克和阿富汗退伍军人，特别是那些患有PTSD的退伍军人，参与VHA体重管理计划的比例较低。确定了“行动起来！”计划参与度的相关因素，突出了调整“行动起来！”计划以提高这些退伍军人参与度的机会。
