The purpose of this document is to explore all Combat Stress research over the past decade, which has as its focal point understanding the needs of the veteran community affected by mental health difficulties. This dissemination of study findings has been broadly categorised into individual but overlapping areas of investigation. One line of research describes the demographic profile, referral patterns and health profile of the veterans treated by Combat Stress. Themes also explore the needs of minority veteran groups and women veterans more closely. Studies investigating the nature of difficulties veterans may face are described, such as PTSD, alcohol misuse, physical health problems, complex PTSD (CPTSD), moral injury and military sexual trauma. Another line of research explores Combat Stress treatment outcomes and the interventions that the department has been involved in developing to treat veterans for these difficulties, such as the Residential Treatment Programme offered by the charity service, the Together Programme (an intervention developed to support military partners), remote access therapy, an anger management programme, and art therapy. Clinical trials investigating novel treatments the department has been involved in developing are also described, including treatments for CPTSD and moral injury.
Abstract: Context: In response to the opioid crisis, federal guidelines were implemented, including the Veterans Health Administration's (VA) Opioid Safety Initiative in 2013. The impact of policies on patients near the end of life is unknown. Objective: Examine temporal trends in opioid prescribing, pain, and opioid overdoses among Veterans near the end of life. Methods: Retrospective, time series analysis of VA decedents between October 2009 and September 2018 whose next-of-kin participated in VA's Bereaved Family Survey (BFS). Using multivariate regression to adjust for sociodemographic and clinical covariates, we examined temporal trends in outpatient opioid prescribing, uncontrolled pain based on BFS report, and opioid overdose-related hospitalizations, in the last month of life, overall and by clinical diagnosis (cancer versus non-cancer). Results: Among 79,409 decedents, mean daily outpatient opioid dose in morphine milligram equivalents in the last month of life decreased from 4.6 mg in 2010 to 2.1 mg in 2018 (adjusted change -0.20 mg/year; P