Additionally, there are demographic differences between the groups, with Vietnam era veterans being more likely to have been married, less likely to be female, less likely to be working, and more likely to have a history of incarceration (Fontana & Rosenheck, 2008 Maclean & Elder, 2007). They are also more likely to apply for social security disability than Gulf War Veterans (Muller, Early, & Ronca, 2014).
Vietnam veterans report experiencing social rejection and feelings of betrayal lasting for over 30 years following their service (Desai, Pavlo, Harpaz-Rotem, & Rosenheck, 2016). They tend to not only seek treatment at different rates and in different ways (Boyd, Juanamarga, & Hashemi, 2015 Rosenheck & Fontana, 2008 Quatana et al., 2014), but also present with distinct sets of medical and diagnostic concerns stemming from actual or perceived wartime conditions (e.g., varying rates of exposure to blast concussive force, Gulf War Syndrome, and Agent Orange Exposure Haley, Kurt, & Hom, 1997 Stellman & Stellman, 2018 Wells et al., 2011). These groups report a variety of substantially different wartime, homecoming, and medical experiences. Moreover, research frequently examines differences between service eras (e.g., Mclaughlin, Nielsen, & Waller, 2008 Teigen, 2006 Wilmoth, London, & Parker, 2010) or provides information on service era as a critical sample descriptive characteristic (e.g., Bellet, McDevitt-Murphy, Thomas, & Luciano, 2018 Ingram, Tarescavage, Ben-Porath, & Oehlert, 2019a, b Mozley, Willer, Weathers, Beckham, & Feldman, 2005).Ĭurrently, the two largest groups of veterans receiving treatment within the VA healthcare system are those who served during the Vietnam era (roughly 1961–1975) and the Gulf War (1990 until present Department of Veteran Affairs, 2018). Bumper stickers, descriptive apparel, self-affirming statements (e.g., “I am a Vietnam Vet”), and other expressive methods are often used to express the time and deployment locations occurring within their service record. For instance, compensation for injuries are categorized by periods of eligible service (Department of Veteran Affairs, 2018). The era during which a veteran served in the military, and the associated country or region in which they were deployed, is a common descriptive characteristic for contextualizing an individual’s military service history. Efforts to evaluate and understand veteran experience, and subsequently presentation of healthcare concerns, require consideration of an array of distinct service experiences (Armistead-Jehle, Soble, Cooper, & Belanger, 2017 Coll & Weiss, 2016). Veterans frequently view their military identity as distinct from their civilian self, and reintegration into society requires an adjustment and consolidation of these two identities (Orazem et al., 2017). Thus, provision of services within the VA medical system that is sensitive to both medical and psychological concerns is vital to meeting the healthcare needs of veterans. Psychologists play an increasingly important role in the VA as there is an ongoing effort to implement integrated mental health interventions (Zeiss & Karlin, 2008). Indeed, of the 4.5 million veterans screened in primary care settings, approximately a quarter, or 1.15 million, were diagnosed with at least one of five common mental health concerns (depression, posttraumatic stress disorder, substance use disorder, anxiety, and serious mental illness Trivedi et al., 2015). Moreover, mental health problems frequently exist in addition to the physical health concerns veterans experience (Selim et al., 2004).
Accordingly, those who are service connected frequently receive compensation for multiple conditions, including both physical and mental health diagnoses (Veterans Benefit Administration, 2017) and a variety of services options exist within the Veteran Affairs (VA) system to address veteran healthcare concerns (e.g., routine and emergency medical care, home-based primary care, domiciliary support, community living centers, and behavioral health). There are approximately 18.5 million veterans presently in the United States and about 21% have mental or physical health conditions resulting from, or exasperated by, their military service (United States Census Bureau, 2017).
The Veteran Health Administration (VHA) provides medical and psychological care for a large portion of the country’s veterans.