American Indian Vietnam Veterans Project (AIVVP)
NIMH, NCAIANMHR Center Grant and the Veterans Administration
DATES OF FUNDING:
1991 - 1997
Spero Manson, Ph.D.; Jan Beals, Ph.D.
CENTER STAFF INVOLVED:
Janette Beals, Ph.D.; Theresa O'Nell, Ph.D.; llena Norton, M.D.; Joan Piasecki, Ph.D.; Monica Jones, MS; Ellen Keane, MSPH; Catherine Dempsey, MPH; Sonia Bauduy MSW.
SPECIFIC AIMS/RESEARCH GOALS:
The AIVVP had 6 specific aims:
- to develop a registry of American Indian populations of Vietnam theater veterans in two geographic locations: Northern Plains and Southwest Indian Reservations;
- to determine rates of post-traumatic stress and related disorders among samples of Vietnam theater veterans from these two groups (Northern Plains and Southwest);
- to conduct a culturally sensitive epidemiological study designed to parallel the National Vietnam veterans Readjustment Study conducted by the Research Triangle Institute (RTI), North Carolina for the Veterans Administration;
- to determine tribal variations in the definitions and clinical parameters (onset, manifestation, course ) of PTSD and related disorders among the samples to be studied;
- to identify and understand respondent health belief and treatment preferences regarding PTSD and related disorders;
- to document respondent perceptions of their experiences regarding their contacts with Veterans Administration clinical service
- to determine clinical and psychosocial outcomes among respondents who have received VA care and respondents who have not received VA care;
- to determine respondent knowledge, attitudes, and practices regarding the Veterans Administration clinical services;
- to determine caregiver knowledge, attitudes, and practices toward American Indian Vietnam theater veterans with PTSD within selected geographic areas.
Congress mandated that the National Vietnam Veterans Readjustment Study (NVVRS) be replicated among American Indian, Alaska Native, Native Hawaiian, and Japanese American Vietnam veterans, ethnic minority groups that were underrepresented in the NVVRS. The AIVVP was part of a large multi-site study conducted to fulfill this mandate. The AIVVP was comprised of four phases. The 1st phase entailed an item-by-item review of the NVVRS instrumentation, employing focus groups of Vietnam veterans, their family members, service providers and elders, to identify ways of improving comprehension. The 2nd stage involved the development of a sound, ecologically relevant sampling frame. Eligible participants have been restricted to Vietnam veterans of the 2 tribes who are enrolled members and currently live on or near the reservation. Approximately 300 veterans from each community are randomly selected from each community for an interview. The 3rd stage was a lay-administered interview. The 4th stage was the clinical reinterview of all participants deemed probable cases of PTSD based on the Mississippi-PTSD (M-PTSD) scores reported in the prior phase and a small control group screening below that threshold. Trained clinicians conducted the follow-up Structured Clinical Interviews for Diagnosis (SCID).
The NCAIANMHR completed AIVVP data collection in April, 1995. The funding for the American Indian and Native Hawaiian portion of this project was provided by the Veterans Administration (VA). The NCAIANMHR has also received funding from the VA to conduct a comparative analysis of PTSD rates across ethnic groups (American Indian, Black, Hispanic, White, Japanese American, and Native Hawaiian).
All participants were Vietnam Theater veterans who served on active duty in the U.S. Armed forces between August 5, 1964 and May 7, 1975, stationed in Vietnam, Laos, or Cambodia. Female veterans were excluded because of the low frequency of these veterans. The total sample size on the Northern Plains reservation is 348 veterans. Completed lay-interviews were collected on 305 veterans. The total sample size for the Southwest reservation was 3588. A total of 316 lay-interviews were completed on the Southwest reservation.
The AIVVP measures were designed to maintain comparability to the NVVRS The lay interview covers childhood, family and marital history, parenting, education, occupation, military service, physical health status, post-service experiences (M-PTSD), self-perceptions, attitudes and nonspecific distress, stressful and traumatic events, social support, health services utilization, experience in Vietnam, and psychiatric status (CIDI). The scales were categorized according to pre-military, military, and post-military risk factors. Pre-military factors covered included, marital history and adjustment, parenting history and adjustment, educational history, occupational history, childhood and family history. Military factors were addressed in the following scales: M-PTSD scale and traumatic life events index, warzone stress exposure scales, ethnic identity and warrior identity scales, physical health status and the Composite International Diagnostic Interview, University of Michigan version (UM-CIDI). Finally, post-military factors were assessed with the postmilitary social support scale, readjustment problem inventory and reaction upon return scale, services utilization questionnaire, and the Structured Clinical Interview for Diagnosis (SCID).
Beals, J., Holmes, T., Ashcraft, M., Fairbank, J., Friedman, M., Jones, M., Schlenger, W., Shore, J., & Manson, S. M. (2002). The prevalence of post-traumatic stress disorder among Vietnam veterans: Disparities and context. Journal of Traumatic Stress, 15(2), 89-97.
Beals, J., Novins, D., Holmes, T., Jones, M., Shore, J., & Manson, S. (2002). Comorbidity between alcohol abuse/dependence and psychiatric disorders: Prevalence, treatment implications, and new directions for research among American Indian populations. In P. Main, S. Heurtin-Roberts, S. E. Martin, & J. Howard (Eds.), Alcohol use among American Indians and Alaska Natives: Multiple perspectives on a complex problem (pp. 371-410). Bethesda, MD: U.S. Dept. of Health and Human Services.
Gurley, D., Novins, D. K., Jones, M. C., Beals, J., Shore, J. H & Manson, S. M. (2001). Comparative use of biomedical services and traditional healing options by American Indian veterans. Psychiatric Services, 52(1), 68-74.
Manson, S.M. (1994). Culture and depression: Discovering variations in the experience of illness. In W.J. Lonner & R.S. Malpass (Ed.), Psychology and culture (pp. 285-290). Needham, MA: Allyn and Bacon.
Manson, S. M. (1996). Cross-cultural and multi-ethnic assessment of trauma. In J. P. Wilson & T. M. Keane (Eds.), Assessing psychological trauma and PTSD: A handbook for practitioners (pp. 239-266). New York, NY: Guilford Press.
Manson, S. M. (1996). The wounded spirit: A cultural formulation of Post-traumatic Stress Disorder. Culture, Medicine and Psychiatry, 20(4), 489-498.
Manson, S. M. (1997). Ethnographic methods, cultural context, and mental illness: Bridging different ways of knowing and experience. Ethos, 25(2), 249-258.
Manson, S.M., Beals, J., O'Nell, T. & Dauphinais, P. (1996). Wounded spirits, ailing hearts: The nature and extent of PTSD among American Indians. In A. Marsella & M. Friedman (Ed.) Ethnocultural aspects of post-traumatic stress and related disorders. Washington, D.C.: American Psychiatric Association Press.
National Center for PTSD and National Center for American Indian and Alaska Native Mental Health Research. (1997). Matsunaga Minority Vietnam Veterans Project: Final Report