Eighteen women who served in Operation Iraqi Freedom/Operation Enduring Freedom (OIF/OEF) sought mental health services at a Veterans' Affairs (VA) medical center. Ten of the 18 women (56%) reported military sexual trauma (MST) while serving in OIF/OEF. All 10 with MST reported sexual harassment, 6 of the 10 (33% of the sample) reported unwanted physical advances, and 3 (17%) reported completed assault or rape. Fifteen women also completed a questionnaire about their experiences and the Iraq Readjustment Inventory (IRI) developed for this study. High reliability and high correlations with clinician ratings make the IRI a promising measure for future research. A comparison between those with and without MST revealed that those with MST had higher clinician ratings and IRI scores, suggesting greater difficulty with readjustment. And, while MST was significantly correlated with clinician ratings and readjustment scores, the variables "being injured" and "witnessing others injured or killed" were not. These preliminary data suggest that MST OIF/OEF women seeking mental health services is a critical factor for predicting symptoms and difficulty with readjustment to civilian life.

ObjectiveThis study was designed to evaluate the determinants of patient and physician global assessments (PtGA and MDGA, respectively) of disease activity, their discordance and change over 2 years in Hispanics with rheumatoid arthritis (RA). We further examined the impact of discordance and its persistence on health-related quality of life (HRQOL) and work productivity on final visit.MethodsWe studied 536 Hispanics with established RA from a single centre. PtGA and MDGA were measured annually on 10 cm visual analogue scales and discordance was defined as absolute difference between them ≥3 cm. Associations between predictors and outcomes of interest were evaluated using multivariable regression and analysis of covariance for cross-sectional and longitudinal data, respectively.ResultsIndependent predictors of baseline PtGA were pain, fatigue, depression, general health perceptions and tender joint count. MDGA was predicted by swollen joint count, tender joint count, erythrocyte sedimentation rate, fatigue and depression. Both PtGA and MDGA improved over time (all p<0.001). Discordance was observed in 43% at baseline, with fair stability over 2 years. Higher (worse) patient ratings were most prevalent; their presence at any time and increasing persistence predicted lower physical and mental HRQOL, decreased work productivity and more activity impairment at 2-year follow-up (all p<0.001).ConclusionsDeterminants of PtGA, MDGA and changes over 2 years were disparate in Hispanics with RA yielding significant discordance. Higher patient ratings at any time contributed to worse HRQOL, work productivity and activity impairment on final visit.

Reduced psychosocial reserve capacity in individuals leads to vulnerabilities that may ultimately result in greater disease burden and psychological distress. Low self-esteem, optimism, coping and social support were associated with depression and low self-esteem was associated with anxiety for both groups. Despite the Filipino cohort's lower reserve capacity and SES, Filipino patients exhibited less depression than their SoCal counterparts, suggesting that other factors may protect them from experiencing depression.

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Results suggest that disease activity, depression, and pain are modifiable parameters with consistent, significant, independent, and additive contributions to HAQ DI changes across the disease trajectory in vulnerable Hispanic patients with RA. Their improvement over time, collectively or in isolation, may yield clinically measurable improvements in functional disability and reaffirms these parameters as actionable items in a patient-centered treat-to-target approach.