Momentary Assessment of PTSD Symptoms & Sexual Risk Behavior in Male OEF/OIF/OND Veterans

Post-traumatic stress disorder (PTSD) in Veterans is associated with increased sexual risk behaviors, but the nature of this association is not well understood. Typical PTSD measurement deriving a summary estimate of symptom severity over a period of time precludes inferences about symptom variability, and whether momentary changes in symptom severity predict risk behavior.

We assessed the feasibility of measuring daily PTSD symptoms, substance use, and high-risk sexual behavior in Veterans using ecological momentary assessment (EMA). Feasibility indicators were survey completion, PTSD symptom variability, and variability in rates of substance use and sexual risk behavior. Nine male Veterans completed web-based questionnaires by cell phone three times per day for 28 days.

Median within-day survey completion rates maintained near 90%, and PTSD symptoms showed high within-person variability, ranging up to 59 points on the 80-point scale. Six Veterans reported alcohol or substance use, and substance users reported use of more than one drug. Eight Veterans reported 1 to 28 high-risk sexual events. Heightened PTSD-related negative affect and externalizing behaviors preceded high-risk sexual events. Greater PTSD symptom instability was associated with having multiple sexual partners in the 28-day period.

These results are preliminary, given this small sample size, and multiple comparisons, and should be verified with larger Veteran samples.

Results support the feasibility and utility of using of EMA to better understand the relationship between PTSD symptoms and sexual risk behavior in Veterans. Specific antecedent-risk behavior patterns provide promise for focused clinical interventions

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By:  Black AC1, Cooney NL2, Justice AC3, Fiellin LE4, Pietrzak RH5, Lazar CM6, Rosen MI7.

• 1Yale School of Medicine, New Haven, CT 06519, USA; VA Connecticut Healthcare System, West Haven, CT 06516, USA. Electronic address: anne.black@yale.edu.
• 2Yale School of Medicine, New Haven, CT 06519, USA; VA Connecticut Healthcare System, West Haven, CT 06516, USA. Electronic address: ned.cooney@va.gov.
• 3Yale School of Medicine, New Haven, CT 06519, USA; Yale School of Public Health, New Haven, CT 06519, USA; VA Connecticut Healthcare System, West Haven, CT 06516, USA. Electronic address: amy.justice2@va.gov.
• 4Yale School of Medicine, New Haven, CT 06519, USA. Electronic address: lynn.fiellin@yale.edu.
• 5Yale School of Medicine, New Haven, CT 06519, USA; VA Connecticut Healthcare System, West Haven, CT 06516, USA; U.S. Department of Veterans Affairs National Center for PTSD, USA. Electronic address: robert.pietrzak@yale.edu.
• 6Yale School of Medicine, New Haven, CT 06519, USA; VA Connecticut Healthcare System, West Haven, CT 06516, USA. Electronic address: christina.lazar@yale.edu.
• 7Yale School of Medicine, New Haven, CT 06519, USA; VA Connecticut Healthcare System, West Haven, CT 06516, USA. Electronic address: marc.rosen@yale.edu. 

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STI Diagnosis and HIV Testing among OEF/OIF/OND Veterans

Patients with sexually transmitted infection (STI) diagnosis should be tested for human immunodeficiency virus (HIV), regardless of previous HIV test results.

Estimate HIV testing rates among recent service Veterans with an STI diagnosis and variation in testing rates by patient characteristics.

The sample comprised 243,843 Veterans who initiated Veterans Health Administration (VHA) services within 1 year after military separation. Participants were followed for 2 years to determine STI diagnoses and HIV testing rates. We used relative risks regression to examine variation in testing rates.

We used VHA administrative data to identify STI diagnoses and HIV testing and results.

Veterans with an STI diagnosis (n = 1815) had higher HIV testing rates than those without (34.9% vs. 7.3%), but were not more likely to have a positive test result (1.1% vs. 1.4%). Among Veterans with an STI diagnosis, testing increased from 25% to 45% over the observation period; older age was associated with a lower rate of testing, whereas race and ethnicity, multiple deployments, posttraumatic stress disorder, and substance abuse disorders were associated with a higher rate.

Since VHA implemented routine HIV testing, overall rates of testing have increased. However, among Veterans at significant risk for HIV because of an STI diagnosis, only 45% had an HIV test in the most recent year of observation. Other patient characteristics such as alcohol and drug abuse were associated with being tested for HIV. Providers should be reminded that an STI is a sufficient reason to test for HIV.

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By: Goulet JL1, Martinello RA, Bathulapalli H, Higgins D, Driscoll MA, Brandt CA, Womack JA.

• 1*VA Connecticut Healthcare System †Department of Psychiatry, Yale School of Medicine, New Haven, CT ‡Office of Public Health, Department of Veterans Affairs, Washington, DC Departments of §Internal Medicine and Pediatrics, Emergency Medicine, Yale School of Medicine, Yale School of Nursing, New Haven, CT. 

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