Insomnia and Insomnia-Related Care in the Department of Veterans Affairs: An Electronic Health Record Analysis

The objective was to examine insomnia and insomnia-related care within a regional network of Department of Veterans Affairs (VA) facilities since the VA roll-out of cognitive behavioral therapy for insomnia (CBT-I) in 2011. A retrospective analysis of VA electronic health records (EHR) data from 2011 to 2019 was conducted. The annual and overall prevalence of four insomnia indicators was measured: diagnoses, medications, consultations for assessment/treatment, and participation in CBT-I. Also examined were sociodemographic and clinical differences among veterans with and without an insomnia indicator, as well as differences among the four individual insomnia indicators. The sample included 439,887 veterans, with 17% identified by one of the four indicators; medications was most common (15%), followed by diagnoses (6%), consults (1.5%), and CBT-I (0.6%). Trends over time included increasing yearly rates for diagnoses, consults, and CBT-I, and decreasing rates for medications. Significant differences were identified between the sociodemographic and clinical variables across indicators. An evaluation of a large sample of veterans identified that prescription sleep medications remain the best way to identify veterans with insomnia. Furthermore, insomnia continues to be under-diagnosed, per VA EHR data, which may have implications for treatment consistent with clinical practice guidelines and may negatively impact veteran health.

Equity in military and Veteran research: Why it is essential to integrate an intersectional sex and gender lens

Lay Summary For a long time, it has been assumed that to study military members and Veterans means to study men. Further com-pounding the problem, military and Veteran health research has historically neglected sex and gender issues. This has resulted in systemic biases and gaps in military and Veteran health research that perpetuate existing inequities. How-ever, as this Perspectives piece argues, equity should be a key objective of military and Veteran research. Equity means that the diverse needs of all in the military and Veteran population are considered and addressed. Equity helps ensure fairness and justice in the military and Veteran sector. One of the best ways to advance the goal of equity in research and beyond is to apply an intersectional sex and gender lens. This means, for example, to make visible women’s specific experiences and health outcomes, as well as those of sub-groups of women, men, or gender-diverse military members and Veterans. The author provides tools and considerations for the application of an intersectional sex and gender lens in military, Veteran, and family health research.

Development of a Multi-Study Repository to Support Research on Veteran Health: The VA Cooperative Studies Program Epidemiology Center-Durham (CSPEC-Durham) Data and Specimen Repository

Federal agencies, including the Department of Veterans Affairs (VA), have prioritized improved access to scientific data and results collected through federally funded research. Our VA Cooperative Studies Program Epidemiology Center in Durham, North Carolina (CSPEC-Durham) assembled a repository of data and specimens collected through multiple studies on Veteran health issues to facilitate future research in these areas. We developed a single protocol, request process that includes scientific and ethical review of all applications, and a database architecture using metadata (common variable descriptors) to securely store and share data across diverse studies. In addition, we created a mechanism to allow data and specimens collected through older studies in which re-use was not addressed in the study protocol or consent forms to be shared if the future research is within the scope of the original consent. Our CSPEC-Durham Data and Specimen Repository currently includes research data, genomic data, and study specimens (e.g., DNA, blood) for three content areas: colorectal cancer, amyotrophic lateral sclerosis, and Gulf War research. The linking of the study specimens and research data can support additional genetic analyses and related research to improve Veterans' health.