title: A Bayesian model averaging approach to examining changes in quality of life among returning Iraq and Afghanistan veterans.
abstract: Many Veterans from the conflicts in Iraq and Afghanistan return home with physical and psychological impairments that impact their ability to enjoy normal life activities and diminish their quality of life (QoL). The present research aimed to identify predictors of QoL over an eight-month period using Bayesian model averaging (BMA), which is a statistical technique useful for maximizing power with smaller sample sizes. A sample of 117 Iraq and Afghanistan Veterans receiving care in a southwestern health care system was recruited, and BMA examined the impact of key demographics (e.g., age, gender), diagnoses (e.g., depression), and treatment modalities (e.g., individual therapy, medication) on QoL over time. Multiple imputation based on Gibbs sampling was employed for incomplete data (6.4% missingness). Average follow-up QoL scores were significantly lower than at baseline (73.2 initial versus 69.5 four-month and 68.3 eight-month). Employment was associated with increased QoL during each follow-up, while post-traumatic stress disorder and Black race were inversely related. Additionally, predictive models indicated that depression, income, treatment for a medical condition, and group psychotherapy were strong negative predictors of four-month QoL but not eight-month QoL.
authors.affiliation: Center for Applied Health Research, Central Texas Veterans Health Care System in collaboration with Scott & White Healthcare, Temple, TX, USA; Texas A&M Health Science Center, College of Medicine, Bryan, TX, USA.
authors.forename: Eileen M
authors.initials: EM
authors.lastname: Stock
authors.forename: Nathan A
authors.initials: NA
authors.lastname: Kimbrel
authors.forename: Eric C
authors.initials: EC
authors.lastname: Meyer
authors.forename: Laurel A
authors.initials: LA
authors.lastname: Copeland
authors.forename: Ralph
authors.initials: R
authors.lastname: Monte
authors.forename: John E
authors.initials: JE
authors.lastname: Zeber
authors.forename: Suzy Bird
authors.initials: SB
authors.lastname: Gulliver
authors.forename: Sandra B
authors.initials: SB
authors.lastname: Morissette
mesh_terms: D000328:Adult; D055826:Afghan Campaign 2001-; D001499:Bayes Theorem; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology* / Q000534:rehabilitation; D008875:Middle Aged; D011237:Predictive Value of Tests; D011613:Psychotherapy; D011788:Quality of Life / Q000523:psychology*; D014728:Veterans / Q000523:psychology*; D055815:Young Adult
keywords: Bayesian analysis; Veterans; mental health; quality of life