During eight turbulent years in the World War I era, policy makers, soldiers, and veterans laid the groundwork for the extension of government sponsored medical care to millions of former service members. In the process, they built a pillar of the American welfare state. Legislation and rehabilitation plans formulated shortly after the U.S. entered the Great War aimed to minimize the government's long-term obligations to veterans, but within less than a decade, those who had served gained conditional access to their own direct assistance agency and a national system of hospitals. This dissertation explains why that drastic transition occurred, and how one group of citizens won the right to obtain publicly funded health services. The story of wartime health policies has a variety of larger implications. It shows how veterans' welfare shifted from centering on pension and domicile care programs rooted in the nineteenth century to the provision of access to direct medical services; how rehabilitation and citizenship rights were conceived of and perceived at the dusk of the Progressive Era; how race, class, and gender shaped the health-related experiences of soldiers, veterans, and caregivers; how shifting ideals about hospitals and medical care influenced policy; and how interest groups capitalized on the tense political and social climate to bring about change. On a general level, an examination of the roots of a nationwide veterans' hospital system demonstrates how privileges were won in the twentieth century United States. It reveals a moment of state expansion, but it also illustrates the wider tendency of the U.S. government to award entitlements selectively. Given those factors, the policies that paved the way for the advent of a veterans' medical system deserve to be considered - alongside later federal assistance programs such as Social Security, Medicare, and Medicaid - as foundational in the development and shape of the American welfare state.

The present study examined the impact of the Verterans Administration disability compensation system on the personality and behavior of psychiatrically disabled veterans who receive compensation payments. Weinstein proposed a "disability process" model in which physical illness or injury was unwittingly utilized as a solution to a network of problems centering on frustrated dependency needs, decreased productivity, and faltering self-esteem. An attempt was made to determine whether Weinstein's model applies to the psychiatric disabilities of veterans. Seventy-one male psychiatric outpatients seen at the Tucson Veterans Administration Medical Center participated in the study. Of this total, 26 had been receiving 100 percent service-connected compensation payments ($809 per month) for at least the past five years (100 percent group), 21 had been receiving between 10 percent and 90 percent payments ($44 to $450 per month) during the same period (10-90 percent group), and 24 had received no Veterans Administration compensation for their psychiatric impairments in the apst five years (UNC group). Personality questionnaires, a self-report demographics questionnaire, and a records search were utilized to compare these three groups. The main hypotheses contended that 10-90 percent group members weould be more self-critical and would view themselves as more psychologically disturbed and externally controlled than members of the other two groups, as they were assumed to be unconsciously fighting to establish the validity and extent of their disabilities. Subjects in the UNC group were hypothesized to be the healthiest psychologically because it was assumed that they had not become enmeshed int he "disability process". On 20 of the 21 subscales meauring some form of psychological distress, no significant differences among groups were uncovered. There were also no differences among groups on the internal-external locus of control dimension. These findings failed to support the hypothesis that the 10-90 percent group would see themselves as most psychologically disturbed and externally controlled. The expectation that 10-90 percent group members would be most self-critical was directly contradicted, as on three of ten subscales subjects in the 10-90 percent group reported significantly more positive self concepts than members of the other two groups. Despite the fact that they were rated for compensation purposes as "totally disabled," 100 percent group members reported no more psychological distress than subjects in the other two groups (with the exception that they reported significantly more hostility than UNC group members). However, both the attainment of inital 100 percent compensation status and of a permanent 100 percent rating led to significant reductions in the number of days 100 percent group members spent in the hospital (when the year after the rating change was compared with the year before). In addition, when they worked, subjects int he 100 percent group were employed in lower status occupations than members of the other two groups. UNC group members were shown to be similar to 100 percent group members on most assessment measures. However, during the past five years UNC group members were hospitalized significantly more times and for significantly more days than subjects in either of the other two groups. A direct discriminant function analysis generated two functions which together correctly classified 74.6 percent of the subjects. An unrotated factor analysis yielded factors descriptive of psychiatrically disabled veterans as a group. An alternative disability process model was proposed that may be more applicable to a psychiatrically impaired population. Also, future research projects were suggested including some possible experimental modifications in the Veterans Administration compensation system that might make it more beneficial to the mental health and self-esteem of psychiatrically impaired veterans, while maintaining cost efficiency.

A review of the research literature concerning the role of the social network in health and illness has indicated little attention to studying the social networks of psychiatric patients. Even less attention has been given to the study of veteran psychiatric patients. In an effort to understand more about the supportive or non-supportive aspects of social networks, an exploratory study of 224 male veteran psychiatric patients was conducted in two settings--a general hospital and a large psychiatric hospital. A description of the social networks as perceived by the patients themselves was obtained through semi-structured interviews. Network analysis was used to examine the characteristics of veteran psychiatric patients' personal networks within the social context of needing assistance or support for psychosocial problems. Some aspects of network structure, such as size and availability of family-kin members, were addressed, as well as the nature and quality of network links. Findings indicated that patients had an ample number of family-kin sources to turn to for assistance but chose to turn to only a small number (three or less) of informal sources, including nuclear family, kin, or friends. Formal sources of support were found to play a predominate part in the networks of veteran psychiatric patients. Both the immediate family and institutions were considered to be important sources of help in times of need but a great deal of ambivalence was evident concerning the use of them. A factor analysis of the data identified five social network patterns. Three multiplex patterns emerged in which patients were likely to turn primarily to the nuclear family, to kin, or to significant others for support. Two other patterns were identified--an Anomie Pattern and a Self Versus Institution Pattern--in which neither informal nor formal sources were considered by patients to be sources of support. A stepwise regression was also performed to determine the relationship of selected background variables to choice of support pattern. The variables found to be potentially important predictors of the patterns were marital status, living situation, diagnosis, religious preference, religious practice, age, and history of previous treatment. Conclusions of the study have both clinical and theoretical importance. Findings point to the need for not only reviving or expanding the supportive functions of veteran psychiatric patients' networks, but in some instances the necessity of assisting patients in establishing new personal networks.

Approximately 1.76 million men and women have served in the Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF) military campaigns since October 2001. The transition from living in a war zone to resuming a fulfilling life at home is often difficult for veterans. The purpose of this mixed methods study was to gain understanding of the issues that complicate health for veterans and approaches veterans used to resolve complicating health issues associated with the challenge of coming home from war. Qualitative data collection and analysis was guided by story inquiry method. Quantitative data was collected using the 36-item Short-Form Health Survey, Version 2 (SF-36v2) and analyzed using QualityMetric Health Outcomes[TM] Score Software, Version 4.0. Seven OEF/OIF veterans who had completed at least one tour of duty in Iraq since October 2001 participated in this study. Three themes emerged from the qualitative data that capture the complicating health issues that participants encountered when coming home from war: flipping the switch, figuring out how to belong, and living the stress of a new normal. Two themes emerged from the qualitative data that capture approaches used to resolve complicating health issues associated with returning home from war: connecting with others and choosing a positive attitude. Quantitative data revealed that the majority of participants scored at or above general population norms on three of the subscales that measure physical health, as well as on two of the subscales that measure mental health; however a significant percentage scored below norms on the subscale that measures social functioning (57%) and on the subscale that directly measures mental health (43%). / All three themes describing complicating health issues that emerged during qualitative data analysis resonated with the SF-36v2's measures of mental health, especially social functioning which inquires about experiences with social interactions. Both themes describing movement toward resolving resounded strongly with the SF-36v2's measures of mental health. From this study's findings, changes to policy and practice, education of nurses and post-secondary faculty, and future research have been recommended to continue to assist the war veteran who is coming home. / by LisaMarie Wands. / Thesis (Ph.D.)--Florida Atlantic University, 2011. / Includes bibliography. / Electronic reproduction. Boca Raton, Fla., 2011. Mode of access: World Wide Web.

Disabled veterans with post-traumatic stress disorder (PTSD) exist in a category separate from many civilians and soldiers. Their experiences land them in a category distinctly marked as atypical. The standard protocol to manage this atypical subject position is prescription drugs- a mark of the ill. In a distorted, post-war American society, what happens when veterans with PTSD refuse to be labeled as ‘sick,' ‘different,' or even ‘disabled'? This thesis explores the actions and intricacies of a community of veterans who advocate for medical cannabis to manage associated symptoms of PTSD. This group of veterans campaigns for individuality, both in medical treatment and in personal experience. Collaboratively, their experiential evidence indicates that none can be treated in the same fashion. After a year of participant observation and field work, it becomes apparent that their work both individualizes and unifies the veterans. This thesis details their experiences and the results of their activist campaign to demarcate themselves.

Indiana University-Purdue University Indianapolis (IUPUI) / Traumatic brain injury (TBI) has emerged as a major cause of morbidity among U.S. soldiers who have served in Iraq and Afghanistan. Even mild TBI (mTBI) can result in cognitive impairments that can impact how veterans experience such things as physical symptoms, emotions and behaviors, instrumental activities of daily living, interpersonal interactions, and community reintegration. The purpose of this study was to develop a comprehensive self-management intervention for veterans with mTBI to facilitate their community reintegration upon returning from deployment to combat zones. This study was conducted in two Phases. Phase I entailed collecting qualitative data regarding needs, concerns, strategies used, and advice given by eight veterans with mTBI, guided by a conceptual model derived from Ferrans’ and colleagues’ health-related quality of life model and the TBI literature. Six key categories and predominant themes emerged providing further support for the model (cognitive impairments, physical symptoms, emotions and behaviors, instrumental activities of daily living, interpersonal interactions, and community reintegration). Guided by the conceptual model, a mTBI Veteran Needs and Concerns Checklist and 14 algorithms making up the VETeranS Compensate, Adapt, REintegrate (VETSCARE) intervention were developed. Phase II entailed obtaining review of the mTBI Veteran Needs and Concerns Checklist and the 14 VETSCARE algorithms from six TBI experts. On a scale of 1 to 5, with 5 being strongly agree, expert ratings provided moderate evidence of content validity for the checklist (3.33), and for the 14 algorithms (problem relevance 3.92, accuracy 3.73, feasibility 3.80, acceptability 3.84). The average overall expert rating for the VETSCARE intervention was 3.82. The checklist and the 14 algorithms are being revised based on specific comments provided by the experts. Once revised, the mTBI Veteran Needs and Concerns Checklist and the VETSCARE intervention will be tested for feasibility in a future pilot study with veterans with mTBI who have recently returned from combat zones in Iraq and Afghanistan.

Indiana University-Purdue University Indianapolis (IUPUI) / Symptoms of post-traumatic stress disorder (PTSD) are a common comorbidity in veterans seeking treatment of chronic musculoskeletal pain (CMP). However, little is known regarding the mutual influence of PTSD and CMP in this population. Using cross-sectional and longitudinal data from a randomized clinical trial evaluating a stepped care intervention for CMP in Iraq/Afghanistan veterans (ESCAPE), this dissertation examined the relationships between PTSD and CMP along with other factors including depression, anxiety, catastrophizing and health-related quality of life. The Classification and Regression Tree (CART) analysis was conducted to identify key factors associated with baseline PTSD besides CMP severity. A series of statistical analyses including logistical regression analysis, mixed model repeated measure analysis, confirmatory factor analysis and cross-lagged panel analysis via structural equation modeling were conducted to test five competing models of PTSD symptom clusters, and to examine the mutual influences of PTSD symptom clusters and CMP outcomes. Results showed baseline pain intensity and pain disability predicted PTSD at 9 months. And baseline PTSD predicted improvement of pain disability at 9 months. Moreover, direct relationships were found between PTSD and the disability component of CMP, and indirect relationships were found between PTSD, CMP and CMP components (intensity and disability) mediated by depression, anxiety and pain catastrophizing. Finally, the coexistence of PTSD and more severe pain was associated with worse SF-36 Physical Component Summary (PCS) and Mental Component Summary (MCS) scores. Together these findings provided empirical support for the mutual maintenance theory.

Indiana University-Purdue University Indianapolis (IUPUI) / This study investigates differences between Veterans and non-Veterans with severe mental illness (SMI) regarding perceptions of their illness, themselves, and treatment. I compare patient interviews (using the Indiana Psychiatric Illness Interview, IPII) of Veterans (N=20) and non-Veterans (N=26). Modified grounded theory and qualitative coding software Atlas-TI were used to develop codebooks for each group, and these were compared for differences. I examined differences in both code frequency and meaning. Statistically, more Veterans were male, employed, married, had higher income, and had higher education. Statistical differences in code frequency included: more Veterans discussing boredom, regret/guilt/loss, and wanting to be “normal.” More non-Veterans had codes of pessimism and religion/spirituality, wanting a different future, bringing up mental health, family, future: no change, life goals, and relapse. Key differences in narrative themes included: (1) Veterans’ “military mindset”/discussion of anger as part of mental illness, (2) non-Veterans’ focus on mental-illness, (3) differing attitudes regarding stigma, (4) active versus passive attitudes toward treatment, and (5) degree of optimism regarding the future. Differences are described and then potential relationships and interactions are proposed. Veterans appear to have several protective factors (i.e., finances, employment, marriage). Additionally, Veterans’ military-mindset seems to encourage greater stigma-resistance, and thereby also facilitate Veterans being more active and optimistic toward treatment and recovery. By contrast, non-Veteran focus on mental illness may be related to increased self-stigma, passive and pessimistic attitudes. I propose that Veteran identity can serve as an additional protective factor against stigma, pessimism, and passivity. Veteran-identity may also be a useful framework clinically, to help promote active approaches to treatment (e.g., “fighting symptoms”). Further, Veterans emphasized issues relating to anger as important and part of their mental health. It may be that Veterans are more comfortable discussing mental health in the language of “anger,” given stigma. Finally, findings suggest that helping individuals in both groups engage in meaningful, non-mental illness-related life activities may help shape self-perception, and thereby responses to stigma, attitudes toward treatment, and hope for the future.