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Veterans of Culturally Diverse Populations

“From this country’s inception, its armed forces has had to create effective and cohesive fighting units from a fractious and heterogeneous population,” claims A History of the Service of Ethnic Minorities in the U.S. Armed Forces, a publication from the Palm Center for Public Policy. Native Americans, for example, played a valuable role in integrated platoons during both World Wars even as they faced significant discrimination at home. Today many different ethnic and cultural groups serve in the military. According to figures from the 2008 American Community Survey, the U.S. veteran population is comprised of 85 percent White (non-Hispanic), 10.3 percent Black (non-Hispanic), 5.1 percent Hispanic/Latino, 1.3 percent Asian American or Pacific Islander and 0.7 percent American Indian or Alaska Native.

If the U.S. military has often been ahead of the general population in its acceptance of diversity, different cultural groups often have distinct experiences as active service members and when they transition to civilian life. Disparities have been found in health outcomes, attitudes towards the Veterans Administration (VA) health system and even the medications used to treat mental illness. Conditions like Posttraumatic Stress Disorder (PTSD) also seem to affect veterans from different cultural groups at differing rates, though determining the causes behind these statistics can be complex. For instance, Latinos in the military may be at a higher risk for developing PTSD and experience more severe PTSD symptoms, but this may be due a higher exposure to combat experiences, previous exposure to trauma or culturally-specific differences in symptom reporting.

The VA is faced with the same questions as the mental health system at a whole: How to create treatment strategies tailored to the unique needs of each cultural group while reducing differences in incidence and outcome. Learn more about the issues affecting veterans from the cultural groups below.

Rates and Experience of Mental Illness             

Culture or ethnic group affiliation may affect a service member’s likelihood of developing PTSD. African American and Latino individuals may be more likely than whites to develop PTSD.

A 2006 study of Asian American veterans reported “a high incidence of diagnosed schizophrenia and psychosis in the presence of no differences in self-reported psychiatric illness.” The same study stated that “VA clinicians [may be] diagnosing psychosis more readily among Asian Americans than in other racial or ethnic groups.”

There are other diagnostic trends that appear along ethnic lines. A survey of VA data related to veterans with a current diagnosis of bipolar disorder found that African Americans, particularly older veterans, were more likely than other groups to have been diagnosed with schizophrenia in the past.

A study comparing Latino veterans with schizophrenia to a similar group of white non-Latino veterans found that while primary symptoms of schizophrenia were very similar for both groups, Hispanic veterans reported a later age of onset, were more likely to report somatic symptoms and spent less time in the hospital than their white counterparts.

The Matsunaga Vietnam Veterans Project, one of the largest surveys of Native American Vietnam Veterans found that one third of these veterans lived with full or partial PTSD at the time of the study, more than 25 years after the war, a prevalence more than twice as high as that of white or Japanese American Vietnam veterans. The project also documented the social isolation experienced by many Native veterans. Untangling these patterns can be difficult: is the high rate of isolation reported by Native veterans related to culture or the fact that many live in rural areas?

Treatment Issues

Cultural differences in the incidence of mental illness are only part of the story—veterans of different ethnic groups may have distinct treatment experiences. A 2002 national study assessing intensive PTSD treatment programs discovered that African American patients showed greater improvement than white patients on one measure of PTSD symptoms and Latino patients were more satisfied with their treatment than white patients although they showed smaller gains in employment income. By contrast, a 2007 study from the Institute on Urban Health Research found a significant relationship between African American veterans' perceived discrimination from health care providers and their satisfaction with care, as well as between quality of care and physical functioning.

Treatment disparities go beyond patient attitudes. A 2003 article from the American Journal of Psychiatry discovered that atypical antipsychotics, especially clozapine, are less likely to be used in the treatment of schizophrenia among African American and Latino veterans. A 2006 study found that African American veterans were more likely to be prescribed antipsychotics, particularly first-generation antipsychotics, than they were to receive lithium or antidepressants.

Access to culturally competent care may greatly affect minority veterans’ treatment experience. Northern Plains American Indian Veterans expressed a high degree of satisfaction and comfort with a weekly telepsychiatric treatment program designed to meet the needs of rural, isolated Native Americans living with Posttraumatic Stress Disorder. Having a clinician of the same race may affect the length of treatment received by African American veterans—a Seattle group therapy program tailored to the needs of African American veterans has been beneficial for many participants.

Veterans’ ethnicity may affect the chances of their PTSD-related claim being approved by the Veterans Administration—African Americans are less likely to have claims files for PTSD approved.

Homelessness and Substance Abuse

One of the clearest discrepancies among veterans is their likelihood in becoming homeless. Approximately 56 percent of all homeless veterans are African American or Hispanic and 40 percent of these homeless veterans live with some form of mental illness. Native Americans are also overrepresented in the homeless veteran population and tend to display higher rates of alcohol abuse. Asian Americans are about one-fourth as likely as other veterans to become homeless and are also less likely to abuse alcohol.

See the culture-specific resources below.

American Indian and Alaska Native

Learn more about the history of Native Americans’ service in the U.S. military, including the Navajo Code Talkers who played a significant role in World War II.

Watch the video from the VA: Wounded Spirits, Ailing Hearts: PTSD in Native American War Veterans.

Psychological Trauma for American Indians Who Served in Vietnam: The Matsunaga Vietnam Veterans Project contains some interesting first-person information about Native American veterans.

Information for American Indian and Alaska Native individuals is available in NAMI's Multicultural Action Center.

African Americans

Another site, History of Black Military Service, looks at the history of African American military service, from the Colonial Era through World War II.

War on Many Fronts: African American Veterans with PTSD is a video from the National Center for PTSD about veterans from the African American community.

The African American Post Traumatic Stress Disorder Association has resources for African Americans living with PTSD and their families.

National Association of Black Veterans is an advocacy organization that promotes the collective cause of African American veterans by advocating on behalf of veterans and their families.

Information for African Americans can be found in NAMI's Multicultural Action Center.

Combat on Many Fronts: Latino Veterans and Family is a video produced by the National Center for PTSD to increase awareness of the cultural aspects of PTSD care for Latino American Veterans. It is available in English and Spanish.

The Society of Hispanic Veterans is dedicated to supporting Latino veterans. There are also numerous other organizations focused on a particular state or country of origin.

Find information for Latino individuals from NAMI's Multicultural Action Center.

NAMI’s Connection Support Group is available in Spanish.

Asian American and Pacific Islander

Asian Americans in the U.S. Military, a website created by the Asian American Studies Program at the University of Maryland, provides links on the contributions and experiences of Asian Americans in the U.S. military.

There are a number of organizations and websites dedicated to veterans with a specific country of origin, Japanese American Veteran Association, Filipino American Veterans Society and the Chinese American Veterans History project.

Information for Asian American and Pacific Islander people can be found in NAMI's Multicultural Action Center.

Ethnic Minorities and PTSD

The National Center for PTSD developed a fact sheet on PTSD among ethnic minority veterans. The fact sheet includes results from studies on ethnic minorities living with PTSD. There is also advice for mental health professionals treating minorities living with PTSD as well as minorities seeking treatment. 

Gay/Lesbian/Bisexual/Transgender (GLBT) Populations

Servicmembers United is a nonpartisan organization of gay and lesbian troops and veterans, their allies and their supporters. Their programs include MilitaryPartners.org, a campaign to reach out to the civilian partners of gay and lesbian service members.

American Veterans for Equal Rights (AVER) is a nonprofit organization dedicated to equal rights and treatment for all members of the U.S. military, past and present.

Find information for GLBT individuals in NAMI's Multicultural Action Center.

NAMI Resources

NAMI's Multicultural Action Center  provides information and resources on mental health care for culturally diverse and underserved populations.

NAMI’s brochure on PTSD, Understanding Posttraumatic Stress Disorder and Recovery, is available in the NAMI store. You can also download the PDF for free.

A booklet for the African American community about mental illness, A Family Guide to Mental Health: What you Need to Know, is available in the NAMI store.

Sharing Hope is a faith-based outreach program for African American individuals and families affected by mental illness. You can download the brochure online for free.

NAMI’s publication, A Mental Health Recovery and Community Integration Guide for GLBTQI Individuals: What You Need to Know, is available in the NAMI store.

NAMI’s publication, A Mental Health Recovery and Community Integration Guide for GLBTQI Individuals: What You Need to Know, is available in the NAMI store.

Other Resources

The U.S.Department of Veterans Affairs Center for Minority Veterans assists eligible veterans in their efforts to receive benefits and services from the VA.

The U.S.Department of Veterans Affairs Mental Health website has resources for veterans from all backgrounds.

SAMHSA Veteran Resources include information on substance abuse, PTSD, depression and many other issues affecting veterans

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