From Homelessness to Employment: Perceptions of OEF and OIF Veterans With Posttraumatic Stress Disorder
Abstract: The purpose of this study was to document the first-person perspectives of 10 Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF) veterans with posttraumatic stress disorder (PTSD) regarding their efforts to move from homelessness to employment. A qualitative, phenomenological study design was employed through the use of in-depth interviews. Five themes emerged, labeled as (a) fallout from PTSD, (b) motivation to change, (c) family support, (d) rehabilitation counseling, and (e) developing a new work identity. Findings suggest that veterans of this era with PTSD express the values and attitudes needed for work adjustment and successful reintegration into the workforce. It is anticipated that the results of this study will stimulate the rehabilitation counseling profession to continue advancements in training, research, and service provision to better meet the vocational rehabilitation needs of veterans with PTSD.
Abstract: Novel and automated means of opioid use and relapse risk detection are needed. Unstructured electronic medical record data, including written progress notes, can be mined for clinically relevant information, including the presence of substance use and relapse-critical markers of risk and recovery from opioid use disorder (OUD). In this study, we used natural language processing (NLP) to automate the extraction of opioid relapses, and the timing of these occurrences, from veteran patients' electronic medical record. We then demonstrated the utility of our NLP tool via analysis of pre-/post-COVID-19 opioid relapse trends among veterans with OUD. For this demonstration, we analyzed data from 107,606 veterans OUD enrolled in Veterans Health Administration, comparing a pandemic-exposed cohort (n = 53,803; January 2019-March 2021) to a matched prepandemic cohort (n = 53,803; October 2017-December 2019). The recall of our NLP tool was 75% and our precision was 94%, demonstrating moderate sensitivity and excellent specificity. Using the NLP tool, we found that the odds of opioid relapse postpandemic onset were proportionally higher compared to prepandemic trends, despite patients having fewer mental health encounters from which to derive instances of relapse postpandemic onset. In this research application of the tool, and as hypothesized, we found that opioid relapse risk was elevated postpandemic. The application of NLP Methods: to identify and monitor relapse risk holds promise for future surveillance, risk prevention, and clinical outcome research.