Suicide is a significant public health concern and ranks as the 10th leading cause of death in the U.S. Veterans are at a disproportionately higher risk for suicide, due to risk factors such as exposure to trauma and its negative cognitive-emotional sequalae, such as PTSD, shame, and guilt. However, not all veterans exposed to traumatic events, or who experience shame and guilt, die by suicide, perhaps as a result of the presence of individual-level protective factors such as self-compassion. Conceptualized as self-kindness, mindfulness and common humanity, self-compassion is beneficially associated with mental and physical health, including reduced suicide risk. We examined the potential serial mediating effects of shame/guilt, separated into two models, and PTSD in the relation between self-compassion and suicide risk in a sample of U.S. veterans (N = 317). Participants in our IRB-approved study provided informed consent and completed the Self-Compassion Scale - Short Form, Differential Emotions Scale-IV, PTSD Checklist-Military Version (PCL-M) for DSM-IV, and Suicidal Behaviors Questionnaire - Revised (SBQ-R). Supporting hypotheses, shame/guilt and PTSD, and PTSD alone, mediated the relation between self-compassion and suicide risk, but shame/guilt alone did not. Our results remained significant when covarying depressive symptoms. Therapeutic interventions such as Mindful Self-Compassion and Compassion-Focused Therapy may increase self-compassion and ameliorate negative cognitive-emotional sequelae, including suicide risk, in veterans.

BACKGROUND: The VA is the nation’s largest hepatitis C virus treatment provider with a large cadre of HCV specialty care providers. Nevertheless, when highly effective, but expensive all-oral interferon-free medications (directly-acting antivirals, DAAs) for HCV were released, the unanticipated high demand created a VA pharmacy funding shortfall. As this shortfall became apparent, the Veterans Choice Program’s “Choice First” (Choice) initiative emerged. Through Choice, veterans could seek HCV care from non-VA community providers in lieu of waiting for VA care, which in turn complicated access and adoption of DAAs. This study examined VA patient and providers’ experience of and reactions to new DAAs and the implementation of Choice for HCV care.

 METHODS: A qualitative study informed by grounded theory methodology was conducted involving semi-structured interviews with 38 veteran patients and 10 of their HCV providers at three VA medical centers in New England. Patient and provider interviews focused on their experiences with the new HCV treatment, and the processes of care in the VA and through Choice.

 RESULTS: Five themes emerged: 1) the VA’s implementation was considerably more reactive than planned, 2) adopting highly effective HCV medication and Choice were both symbiotic and reciprocally confounding, 3) patient demand and provider awareness were attributed to direct-to-consumer-advertising, 4) the VA organizational structure was not perceived as conducive to rapid implementation of highly effective, demanded, yet costly medication, and 5) veterans and providers had similar perceptions of treatment candidacy. 

 CONCLUSIONS: The VA initially achieved a rapid pace of treating veterans with the DAAs, but eventually could not keep up with demand, leading to a largely unsuccessful attempt to refer patients to non-VA care for HCV treatment. The VA acted as a complex adaptive system and responded to implementation difficulties by applying new policies, which were often opaque, disrupted provider heuristics and practices, and impaired patient autonomy. Patients and providers embraced the HCV treatment innovation, but their experiences navigating community HCV care through Choice indicated a number of flaws in the execution of that program. Choice could have been implemented more effectively with proper recognition and measurement of system antecedents. / 2026-10-31T00:00:00Z

This study argues that the American Relief Administration (ARA) operationally and culturally was defined by the character and experiences of First World War American military veterans. The historiography of the American Relief Administration in the last half-century has painted the ARA as a purely civilian organization greatly detached from the military sphere. By examining the military veterans of the ARA scholars can more accurately assess the image of the ARA, including what motivated their personnel and determined their relief mission conduct. Additionally, this study will properly explain how the ARA as an organization mutually benefited and suffered from its connection to the U.S. military throughout its European missions, in particular, the 1921 Russian famine relief expedition.

No description available.

This paper explores how gender and veteran status effects the level of stigmatization around Posttraumatic Stress Disorder (PTSD). Participants were randomly assigned to one of four vignette conditions, which were distinguished by gender and veteran status. Participants were then asked to rate how they perceived the individual depicted in the vignette. The researchers analyzed the results by examining how the participants own report of gender, and masculinity, effected how each of the vignettes were judged. This paper addresses the stigma surrounding mental health in general, and more specifically how that stigma affects individuals suffering from PTSD across multiple domains. For the purposes of this paper, the domains of stigma explored include public stigma, social distancing, self-stigma and gender role conflict. Research indicates that PTSD is detrimental to both males and female veterans and civilians. In general, research suggests that males are more stigmatized than females and less likely to seek treatment (Addis & Mahalik, 2003; Good, et al., 1995). Individuals with a PTSD diagnosis may not seek services due to self-stigma, public-stigma, and social distancing (Corrigan & Watson, 2002; Girma et al., 2013; Gulliver et al., 2010; Link et al., 2002; Vogel et al., 2006; Weiner et al., 1988). Women are also more likely to be diagnosed with PTSD than men, and veterans are more likely to be diagnosed with PTSD than civilians (Breslau, 2001; Kessler et al., 1995; Olff et al., 2002). Although women are diagnosed with PTSD more frequently than men, research indicates that male veterans are the most stigmatized (Daoud, 2009; Mittal et al., 2007).

No description available.

No description available.

OBJECTIVES: Veterans of the armed forces, like most population groups, have a high prevalence of vitamin D deficiency, which may be associated with adverse outcomes in several types of cancer. Ultraviolet irradiation is inversely linked with the risk of bladder cancer, presumably through enhanced vitamin D synthesis. We hypothesized that variations in vitamin D status and monitoring predict adverse outcomes in bladder cancer among veterans. METHODS: A retrospective analysis of data in the Veterans Integrated Service Network-9 (southeastern United States) was performed for patients diagnosed between October 1, 1999 and February 29, 2008. Age, tobacco exposure, body mass index, and latitude and seasonality of sampling were included as variables in addition to serum vitamin 25(OH)D levels. RESULTS: Monitoring of vitamin D and vitamin D levels and status were closely linked to survival in bladder cancer. Both the chances of survival and longevity improved with enhanced vitamin D status and monitoring. Veterans with bladder cancer had better outcomes if the initial vitamin D level was higher and had more monitoring of the vitamin. Initial vitamin D levels were more strongly related to outcomes than follow-up levels. The link between vitamin D and outcomes remained after adjusting for background variables such as age, body mass index, latitude, seasonality, and tobacco exposure. CONCLUSIONS: Findings suggest that adequate vitamin D levels early in the course of the disease provide the best opportunity to improve outcomes. Ensuring that veterans with bladder cancer have adequate vitamin D reserves with appropriate monitoring may play a role in improving outcomes in bladder cancer.

OBJECTIVES: Veterans of the armed forces, like most population groups, have a high prevalence of vitamin D deficiency, which may be associated with adverse outcomes in several types of cancer. Ultraviolet irradiation is inversely linked with the risk of bladder cancer, presumably through enhanced vitamin D synthesis. We hypothesized that variations in vitamin D status and monitoring predict adverse outcomes in bladder cancer among veterans. METHODS: A retrospective analysis of data in the Veterans Integrated Service Network-9 (southeastern United States) was performed for patients diagnosed between October 1, 1999 and February 29, 2008. Age, tobacco exposure, body mass index, and latitude and seasonality of sampling were included as variables in addition to serum vitamin 25(OH)D levels. RESULTS: Monitoring of vitamin D and vitamin D levels and status were closely linked to survival in bladder cancer. Both the chances of survival and longevity improved with enhanced vitamin D status and monitoring. Veterans with bladder cancer had better outcomes if the initial vitamin D level was higher and had more monitoring of the vitamin. Initial vitamin D levels were more strongly related to outcomes than follow-up levels. The link between vitamin D and outcomes remained after adjusting for background variables such as age, body mass index, latitude, seasonality, and tobacco exposure. CONCLUSIONS: Findings suggest that adequate vitamin D levels early in the course of the disease provide the best opportunity to improve outcomes. Ensuring that veterans with bladder cancer have adequate vitamin D reserves with appropriate monitoring may play a role in improving outcomes in bladder cancer.

All known cases of breast cancer in patients with a diagnosis consistent with transgender identification were identified in the Veterans Health Administration (1996-2013). Ten cases were confirmed: seven birth sex females and three birth sex males. Of the three birth sex males, two identified as gender dysphoric male-to-female and one identified as transgender with transvestic fetishism. The birth sex males all presented with late-stage disease that proved fatal, whereas most of the birth sex female transgender veterans presented with earlier stage disease that could be treated. These cases support the importance of screening for breast cancer using standard guidelines in birth sex males and females. Family history of breast cancer should be obtained from transgender people as part of routine care. This report expands the known cases of breast cancer in transgender persons from 5 to 12 (female-to-male) and from 10 to 13 (male-to-female).