Associations between probable eating disorders and healthcare use among post-9/11 veteran men and women

Mitchell, Karen S.; Sienkiewicz, Megan; Smith, Brian N.; Vogt, Dawne; Kehle‐Forbes, Shannon M.; Cooper, Zafra

doi:10.1016/j.jpsychores.2022.110811

Cited by 14 publications

(19 citation statements)

References 45 publications

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“…Notably, our probable diagnoses were limited by use of a self‐report measure, which may somewhat over‐estimate the prevalence of EDs (Berg et al, 2011). Our findings are consistent with other studies reporting high levels of ED psychopathology among male and female veterans, however (Huston et al, 2019; Masheb et al, 2021; Mitchell et al, 2022; Mitchell & Wolf, 2016). Further, although our sample was drawn from a national sample of veterans, the number of respondents at T2 was relatively small.…”

Section: Discussionsupporting

confidence: 93%

“…However, EDs are frequently under‐diagnosed in healthcare settings, and the majority of people with EDs do not receive treatment for them. A recent study found that only 4.5% of veteran women and 3.2% of veteran men with probable EDs had received treatment for ED since separating from service within the previous 18 months (Mitchell et al, 2022). Similarly, in the current sample, only 3.1% had received any ED treatment prior to the pandemic, and 2.4% had received any ED treatment since March 2020.…”

Section: Discussionmentioning

confidence: 99%

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The impact of the COVID‐19 pandemic on eating disorders in U.S. military veterans

Mitchell

Smith

Masheb

et al. 2022

Intl J Eating Disorders

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Purpose The COVID‐19 pandemic has had a profound impact on mental health around the world. Although there have been reports that the incidence of eating disorders (EDs) has increased during the pandemic, few longitudinal studies have examined recent changes in EDs. Men and women with military histories may be particularly vulnerable to EDs, underscoring the importance of investigating the impact of the COVID‐19 pandemic on EDs in this population. Method We examined whether early‐pandemic (Time 1; T1) posttraumatic stress disorder, depression, anxiety, and stress symptoms were associated with change in probable ED diagnostic status 1 year later (T2). We also investigated relationships from early pandemic mental health symptoms to change in ED diagnostic status from T1 to T2 via pandemic‐related life circumstance pathways (health, financial, social, etc.). Participants included a population‐based sample of 372 U.S. veterans who completed the T1 and T2 surveys. Results Early pandemic mental health was significantly and positively associated with probable ED diagnostic status. Social and health satisfaction as well as physical health pandemic impacts mediated the associations between mental health symptoms and ED diagnostic status. Discussion Findings highlight the importance of bolstering social connection, health‐promoting behaviors, and access to ED treatment among veteran men and women impacted by the COVID‐19 pandemic. Public Significance The COVID‐19 pandemic has had a profound impact on mental health, including eating disorders (EDs). We found that early pandemic mental health symptoms were significantly associated with changes in U.S. veterans' ED diagnostic status 1 year later. Mental health symptoms increased ED diagnoses via their impact on social and health satisfaction, as well as physical health impacts of the pandemic. Findings highlight the importance of increasing social connection, health‐promoting behaviors, and ED treatment access among veteran men and women, who may be particularly vulnerable to EDs, during the COVID pandemic.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionmentioning

confidence: 99%

The impact of the COVID‐19 pandemic on eating disorders in U.S. military veterans

Mitchell

Smith

Masheb

et al. 2022

Intl J Eating Disorders

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“…Not only was health service utilization in these areas greater among women with higher eating disorder symptoms, but even moderately elevated eating disorder symptom scores (i.e., +1 standard deviation above the sample mean on the EDE-Q) showed increases of 17%-58% in the number of overall primary care, mental health, and telephone visits. These findings on objective health service utilization are consistent with prior work which has shown higher self-reported health service utilization among veterans with eating disorder symptoms (Huston et al, 2018;Mitchell et al, 2022).…”

Section: Discussionsupporting

confidence: 90%

Health service utilization among women veterans who report eating disorder symptoms

Krupp,

King,

Wade

et al. 2023

Intl J Eating Disorders

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ObjectiveDescribe health service utilization in women veterans with eating disorder symptoms and characterize the nature of mental health services received.MethodWomen veterans (N = 191) in a northeastern Veterans Health Administration region completed the Eating Disorders Examination Questionnaire. Health service utilization was then observed for 5 years across multiple domains (i.e., mental health, primary care, telephone consultations, emergency services); negative binomial or zero‐inflated negative binomial regression models (mental health) estimated the relative impact of reported eating disorder symptoms on health service utilization.ResultsAfter adjusting for the effects of age and body mass index, higher eating disorder symptoms were associated with higher primary care, mental health services, and telephone consultations. Eating disorder diagnoses were infrequent across the sample.DiscussionWomen veterans with higher self‐reported eating disorder symptoms evidence higher health service utilization across common healthcare domains. Encounter data suggest that eating disorder symptoms are rarely identified or clinically addressed by providers. Existing mental health visits may represent an opportunity for selective screening for eating disorder symptoms, particularly among women who evidence known risk factors.Public SignificanceThis study reveals that women veterans with higher levels of eating disorder symptoms (e.g., dietary restriction, poor body image) use more primary care, mental health, and telephone consultations than others, but may not receive services that target disordered eating. Opportunities may exist to better identify eating disorder symptoms in the context of existing mental health visits, or potentially to combine treatment for eating disorder symptoms into their mental health care.

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“…Studies with nonveteran samples suggest women are more likely to seek DES treatment in primary vs. specialty care settings (Mond et al, 2007). Though recent work with veterans (Mitchell et al, 2022) suggests uncertainty of where to seek DES care, Breland et al (2016) reported on women veterans' treatment preferences, highlighting an openness to interdisciplinary care and desire for flexible, skills-focused, group interventions. Within the Veterans Health Administration (VHA), integrated primary care (IPC) embeds MH providers in interdisciplinary care teams (Kearney et al, 2014).…”

Section: Public Significance Statementmentioning

confidence: 99%

Qualitative exploration of factors influencing women veterans’ disordered eating symptoms and treatment preferences in VHA primary care.

King¹,

Buchholz²,

Tauriello³

et al. 2023

Families, Systems, & Health

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Introduction: Disordered eating symptoms (DES) are common among women veterans. While integrated primary care (IPC) may be an important venue to treat DES, little is known on patients' treatment preferences. The purpose of this study was to gather patient feedback on factors that may influence women veterans' DES and preferences for IPC services. Method: We conducted semistructured interviews with purposefully sampled women who reported DES using the Eating Disorder Examination Questionnaire (EDE-Q). Twelve veterans (M age = 54.0, SD = 8.38 years, 83.3% Caucasian, M EDE-Q Total = 3.87, SD = .77) enrolled in Veterans Health Administration primary care participated. Interviews gathered opinions on weight, appearance, and eating behaviors; experiences and preferences in addressing DES; and opinions on ways to improve their health care experience.Responses were analyzed via a directed content analysis that utilized a priori codes pertaining to health care utilization and compensatory health beliefs. Results: Results revealed longstanding DES of various types, including those consistent with restriction, binge eating, and bulimia. However, past experiences with symptom management primarily involved self-management vs. clinical management. Participants also endorsed multiple perceived treatment facilitators and barriers. Among facilitators were strong provider relationships, patient-centered communications, personalized goal setting, and

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Associations between probable eating disorders and healthcare use among post-9/11 veteran men and women

Cited by 14 publications

References 45 publications

The impact of the COVID‐19 pandemic on eating disorders in U.S. military veterans

The impact of the COVID‐19 pandemic on eating disorders in U.S. military veterans

Health service utilization among women veterans who report eating disorder symptoms

Qualitative exploration of factors influencing women veterans’ disordered eating symptoms and treatment preferences in VHA primary care.

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