Health-related quality of life among veterans in addictions treatment: identifying behavioral targets for future intervention
US veterans report lower health-related quality of life (HRQoL) relative to the general population. Identifying behavioral factors related to HRQoL that are malleable to change may inform interventions to improve well-being in this vulnerable group.
The current study sought to characterize HRQoL in a largely male sample of veterans in addictions treatment, both in relation to US norms and in association with five recommended health behavior practices: regularly exercising, managing stress, having good sleep hygiene, consuming fruits and vegetables, and being tobacco free.
We assessed HRQoL with 250 veterans in addictions treatment (96 % male, mean age 53, range 24–77) using scales from four validated measures. Data reduction methods identified two principal components reflecting physical and mental HRQoL. Model testing of HRQoL associations with health behaviors adjusted for relevant demographic and treatment-related covariates.
Compared to US norms, the sample had lower HRQoL scores. Better psychological HRQoL was associated with higher subjective social standing, absence of pain or trauma, lower alcohol severity, and monotonically with the sum of health behaviors (all p < 0.05). Specifically, psychological HRQoL was associated with regular exercise, stress management, and sleep hygiene. Regular exercise also related to better physical HRQoL. The models explained >40 % of the variance in HRQoL.
Exercise, sleep hygiene, and stress management are strongly associated with HRQoL among veterans in addictions treatment. Future research is needed to test the effect of interventions for improving well-being in this high-risk group.
KeywordsHealth behaviors Health-related quality of life Veterans Substance abuse
We acknowledge Kevin Ahern for his assistance with data analysis and variable computation; David Feeny for his help with HUI3 interpretations and score conversions; Daniel Schwartz for his generous time and help with data analysis; Carson Benowitz-Fredericks for his assistance with recruitment and data collection; and the clinical team that provided valuable treatment referrals and support throughout the duration of the trial, including Peter Banys, MD, David Kan, MD, Steven Batki, MD, Ricky Chen RN, William Clift, AT, Ellen Herbst, MD, Patricia Lane RN, and Rebecca Young, RN. Study was supported by the National Institutes of Health Grant #P50DA09253.
Compliance with ethical standards
Conflict of interest
None of the authors have conflicts of interest.
Ethical responsibilities of the authors
All authors provided consent to submit this paper, and the authors whose names appear on the submission have significantly contributed to the scientific work and therefore share collective responsibility and accountability for the results. This manuscript has not been submitted to any other journal and has not been partly or fully published previously, and no data were fabricated. If requested to share relevant documentation of the IRB or raw data to verify the validity of the results, we will send it.
Ethical approval/informed consent
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. Ethics review boards for UCSF, SF VAMC, and Stanford approved the study procedures, and all participants provided informed consent.
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