Multimorbidity: Perspectives from the DoD and VA

Julie C. Gass, MA, PhD; Ryan J. Kalpinski, PhD; Justin M. Kimber, MA; and Katherine Hall, PhD; Military and Veterans' Health SIG

Members of the Society of Behavioral Medicine are not strangers to the prevalence and costs associated with multimorbidity (i.e., co-occurrence of two or more disorders). The Military and Veteran’s Health SIG of SBM has members who are acutely aware of the uniquely high costs that multimorbidity  has on active duty military and US Veterans. In this article, we review some of the basic research on multimorbidity and its impact in these populations, and finish with a call to service for all researchers who may have opportunities to work with Department of Defense (DoD) and Veterans Administration (VA) to improve the lives of our Servicewomen/Servicemen and Veterans who live with multimorbidity.

Those who Serve. In 2018, DoD Secretary Jim Mattis and Under Secretary Robert Wilkie released “Deploy or get out,” which outlines the importance of health and physical fitness as paramount to military readiness.¹ This standard aims to reinvigorate the DoD’s focus on achieving optimal numbers of ‘deployable’ members, especially during times of active conflict. When military members are injured or ill, their ability to deploy and continue serving in the military is limited. Whether military members sustain injuries or become ill following deployment activities or other natural changes in their health, their active duty career depends on the speed with which they return to health. Multimorbidity among active duty members most often results in early medical retirement or administrative separation and premature transition to the VA system where most of the research has historically been implemented. Multimorbidity not only affects careers, it impairs our Nation’s ability to defend against foreign and domestic enemies.

Those who Have Served. In part directly due to their service, Veterans are at higher risk than civilians for many of the common diagnoses associated with multimorbidity (cardiovascular diseases, diabetes, cancer, mental health conditions).^1-2 Though some of the contributing factors to Veteran’s multimorbidity are non-modifiable (e.g., past exposure to chemicals, military injuries, experiencing trauma), many aspects of Veteran’s multimorbidity are partially attributable to health-risk behaviors, such as smoking, excessive alcohol use, and overweight/obesity, in addition to mental health concerns such as depression. Furthermore, post-deployment reintegration problems predict later development of mental and physical problems,³ and Veterans who have seen combat are at the highest risk of conditions associated with multimorbidity.⁴ There is evidence that military- and Veteran issues (e.g., moral injury, military sexual trauma) specifically increase risk of modifiable diseases.^5-7 Therefore, we surmise that Veterans have complex and unique needs that we cannot ignore – from reintegration to moral injury to military sexual trauma, Veteran-specific issues deserve a seat at the table when discussing behavioral interventions to reduce multimorbidity.

What are we Doing About it and What Else can we Do? Many SBM members currently work within DoD/VA settings, and we were very excited to see many presentations, symposia, plenary sessions and posters at the March Annual Meeting that focused on strategies to improve Servicemembers/Veteran’s health. Increased research and strategic planning is key – behavioral health researchers are excellently poised to improve the health of Servicemembers and Veterans. Members of SBM can contribute by (a) collaborating across systems and with DoD/VA researchers, (b) recruiting Veterans (and if possible, military members) into your research samples to improve representation, and (c) creating innovative technologies and practice to treat multimorbidity. Together, we at SBM can say “Thank You for your Service” by conducting research to improve the health and well-being of all those who have served.

 

References

1. Department of Defense. (2018, July 30). Retention Determinations for Non-Deployable Service Members (DoD Instruction 1332.45). Washington, DC. Retrieved from https://www.esd.whs.mil/Portals/54/Documents/DD/issuances/dodi/133245p.pdf?ver=2018-08-01-080044-667
2. Hoerster, K. D., Lehavot, K., Simpson, T., McFall, M., Reiber, G., & Nelson, K. M. (2012). Health and health behavior differences: US Military, veteran, and civilian men. American journal of preventive medicine, 43(5), 483-489.
3. Lehavot, K., Hoerster, K. D., Nelson, K. M., Jakupcak, M., & Simpson, T. L. (2012). Health indicators for military, veteran, and civilian women. American journal of preventive medicine, 42(5), 473-480.
4. McAndrew, L. M., D’Andrea, E., Lu, S. E., Abbi, B., Yan, G. W., Engel, C., & Quigley, K. S. (2013). What pre-deployment and early post-deployment factors predict health function after combat deployment?: a prospective longitudinal study of Operation Enduring Freedom (OEF)/Operation Iraqi Freedom (OIF) soldiers. Health and quality of life outcomes, 11(1), 73.
5. Thomas, M. M., Harpaz-Rotem, I., Tsai, J., Southwick, S. M., & Pietrzak, R. H. (2017). Mental and Physical Health Conditions in US Combat Veterans: Results From the National Health and Resilience in Veterans Study. The primary care companion for CNS disorders, 19(3).
6. Jacob, L., Haro, J. M., & Koyanagi, A. (2018). Post-traumatic stress symptoms are associated with physical multimorbidity: Findings from the Adult Psychiatric Morbidity Survey 2007. Journal of affective disorders, 232, 385-392.
7. Washington, D. L., Davis, T. D., Der-Martirosian, C., & Yano, E. M. (2013). PTSD risk and mental health care engagement in a multi-war era community sample of women veterans. Journal of general internal medicine, 28(7), 894-900.
8. Westphal, R. J., & Convoy, S. P. (2015). Military culture implications for mental health and nursing care. OJIN: The Online Journal of Issues in Nursing, 20(1), 47-54.