Among military veterans, loneliness is common and associated with poorer mental and physical health and functioning. Epidemiological studies have revealed bidirectional, longitudinal associations between loneliness and posttraumatic stress disorder (PTSD). Little is known about loneliness among treatment-seeking veterans, how loneliness impacts PTSD symptom change during treatment, and whether loneliness has differential associations with specific PTSD symptom clusters.

Data were derived from the Veterans Outcome Assessment, an annual, repeated-measures (baseline and 3-month follow-up) telephone survey of patients beginning new episodes of mental health care in the Department of Veterans Affairs. Participants were 1,155 veterans (23% women) entering PTSD specialty care. We tested whether baseline loneliness predicted change in total PTSD symptom severity and according to the five-factor Dysphoric Arousal model of PTSD using hierarchical regressions in which we statistically adjusted for demographics and mental health encounters.

Loneliness decreased between baseline and 3-month follow-up (d = 0.39). Baseline loneliness predicted change in PTSD for the dysphoric arousal and negative alterations in cognitions and mood symptom clusters, with lonelier veterans demonstrating more PTSD change between baseline and follow-up. However, lonelier veterans also had more severe PTSD symptoms at both timepoints. This pattern of results held even after accounting for different types of treatment encounters between timepoints.

While lonelier veterans have more severe PTSD symptoms, they also make greater improvements in symptoms salient to interpersonal functioning over time. Assessment of loneliness should be incorporated into PTSD treatment planning and considered as a treatment target that could be addressed to promote recovery.

Few studies have examined how differing diagnostic criteria for mild cognitive impairment (MCI) relate to neuroimaging markers of cerebrovascular disease and neurodegeneration in Veterans. We compared three MCI diagnostic schemes on their associations with white matter hyperintensity (WMH) burden, hippocampal volume, and cortical thickness in nondemented Vietnam-era Veterans.

228 Veterans (mean age = 69.65) were classified using: (1) Alzheimer’s Disease Neuroimaging Initiative (ADNI) criteria (subjective memory concerns, impaired Logical Memory, global Clinical Dementia Rating = 0.5); (2) neuropsychological criteria (>1 standard deviation [SD] below norms on two tests within a domain or one test across three domains); and (3) typical criteria (subjective memory concerns and >1.5 SD below norms on one test). Regression models predicting WMH burden adjusted for age and intracranial volume and included MCI status and hippocampal volume; ADNI-based models also included posttraumatic stress disorder symptom severity.

Neuropsychological criteria were associated with greater WMH burden (β = 0.45, p = .024), whereas typical and ADNI criteria were not. Sensitivity analyses found that meeting neuropsychological criteria for amnestic MCI interacted with lower hippocampal volume to predict greater WMH burden (β = −0.001, p = .028). No criteria were associated with cortical thickness.

Neuropsychological criteria more sensitively identified Veterans with greater WMH burden and demonstrated a small, hippocampal volume-dependent effect in amnestic MCI. These findings support the clinical utility of multi-test neuropsychological approaches for detecting complex brain changes in high-comorbidity populations, with implications for risk stratification and targeted intervention in aging Veterans.

To evaluate the feasibility and preliminary efficacy of a clinical program designed to teach informal caregivers of older Veterans with pain and mild-to-moderate dementia or mild cognitive impairment (MCI), pain management, pain coping and pain communication skills.

Twenty caregivers of older Veterans with pain and dementia or MCI and the Veterans themselves participated in a 5-session program taught by trained Veterans Affairs (VA) clinicians. All sessions were conducted remotely using video-technology, with caregivers and Veterans. Two sessions were conducted with individual Veteran-caregiver dyads, and three sessions were conducted with caregiver groups. Caregivers and Veterans completed baseline and post-intervention measures. Qualitative interviews of 10 caregivers who completed the program were also conducted and focused on identifying themes related to caregiving for their loved ones with pain and dementia and related to participating in the program.

The program was well received and almost all caregivers identified videoconferencing as the preferred venue for participating in such a program. They most valued learning about dementia and participating with other caregivers. Pre-post analyses revealed significant improvements in perceived caregiving competence and self-efficacy for managing pain. Challenges encountered included scheduling related to caregivers’ multiple competing responsibilities and lack of familiarity with tele-conferencing technology.

Patients with pain and mild to moderate dementia or MCI have been relatively ignored in current literature. Our preliminary findings suggest that a program delivered by trained healthcare professionals to caregivers and Veterans using tele-conferencing could benefit caregivers.

Negative metacognitive bias, underestimating one’s abilities, is consistently linked to psychopathology, yet prior work has often collapsed anxiety/stress and depression or examined depression alone. We tested the unique associations of depression, anxiety/stress, and posttraumatic stress disorder (PTSD) with metacognitive bias in post-9/11 veterans.

Veterans from the Translational Research Center for TBI and Stress Disorders (TRACTS, N = 601; 90% male; M age = 34.31) completed 21-item Depression, Anxiety, and Stress Scale (depression, anxiety/stress), CAPS-IV (PTSD), WHODAS-II Understanding/Communicating (self-reported cognition), and an objective cognition composite (assessment of executive function, memory, and attention). Bias was computed as self-report minus objective cognition. A subsample (n = 239) repeated testing ∼2 years later.

At time 1, more negative metacognitive bias was associated with greater anxiety/stress (r = −.41), depressive (r = −.37), and PTSD symptoms (r = −.31) (all ps < .001). In a simultaneous model, anxiety/stress (β = −.29 p < .001) and depressive symptoms (β = −.12, p = .045) explained unique variance though PTSD symptoms did not (β = −.03, p = .524). Longitudinally, changes in bias were uniquely predicted by symptom changes in anxiety/stress (β = −.33, p < .001) and PTSD (β = −.16, p = .001), but not depression (β = −.10, p = .137).

Across cross-sectional and longitudinal models, anxiety/stress emerged as the most consistent correlate of metacognitive bias, with weaker contributions from depression and PTSD. These findings highlight the importance of assessing the self-report versus objective cognition gap and the need to further understand the temporal relationship between anxiety/stress and metacognitive bias.

This study evaluated the impact of a novel social prescribing service designed specifically for the Armed Forces Community (AFC) and its influence on service users’ wellbeing.

Social prescribing connects individuals with non-clinical, community-based support to address loneliness, long-term conditions, and mental health. Despite advances in social prescriber training, a gap remains in resources for working with the AFC, who present distinct wellbeing needs. A two-year project, funded by the NHS Armed Forces Health and the Armed Forces Covenant Fund Trust, sought to enhance provision by equipping Social Prescriber Link Workers with specialist skills.

A sequential mixed-method design was adopted. Quantitatively, changes in wellbeing for 259 AFC service users were measured using the Short Warwick and Edinburgh Wellbeing Scale before and after consultations with Armed Forces Social Prescriber Link Workers (AFCSPLWs). Qualitatively, semi-structured interviews were undertaken with AFCSPLWs, general social prescribers, General Practitioners, and AFCSPLW line managers to explore experiences of service delivery.

Wellbeing scores significantly increased from initial (mean = 15.3) to final consultations (mean = 18.79), indicating positive effects; however, scores remained lower than national averages, reflecting the complex needs within the AFC population. Thematic analysis identified four themes: Armed Forces Experience and Perspective, Challenges and Barriers, Service Delivery and Effectiveness, and Skill Development and Attributes. Subthemes highlighted AFC-specific challenges, the practical complexity of the AFCSPLW role, and the importance of cultural competence. Advocacy, navigation, and relationship-building emerged as central mechanisms, with AFCSPLWs acting as vital connectors across primary care, third-sector services, and professional networks.

Veterans Affairs Medical Centers offer multiple weight-loss treatments, including a comprehensive lifestyle intervention program (i.e., MOVE!), anti-obesity medications (AOMs) and bariatric surgery. Yet, most eligible veterans do not receive these treatments.

To describe the design, rationale, and planned evaluation of a comprehensive Weight Management and Metabolic Health program (WMMHP), consisting of (1) weight-focused visits with physicians or pharmacists trained in obesity medicine; (2) patient-centered use of available weight-loss treatments; and (3) coordinated, team-based care.

This is a quality improvement program implemented within the VA Ann Arbor Healthcare System. WMMHP eligibility criteria include body mass index (BMI) ≥ 30 kg/m2 or BMI ≥ 27 kg/m2 and ≥ 1 weight-related condition and participation in the MOVE! program. We plan to conduct an 18-month retrospective program evaluation using a propensity-matched cohort analysis to estimate the added benefit of WMMHP vs. MOVE! alone. The primary outcome will be mean change in weight at 18 months after baseline. Secondary outcomes will include mean weight loss at 6, 12, and 24 months, percentage of patients achieving thresholds of ≥ 5%, ≥ 10%, and ≥ 15% weight loss, initial prescriptions for and refilled prescriptions as a measure of adherence to AOMs, and referrals to, engagement with, and completion of bariatric surgery. We will also examine between-group differences in health system resource utilization.

The WMMHP is an innovative approach to improving treatment and outcomes for veterans with overweight and obesity. If effective, its components may inform obesity care delivery in VA and non-VA settings.