Coping as a moderator of disability and psychosocial adaptation among Vietnam theater veterans

Depression, postburn disability & quality of life: The moderating roles of burn specific coping strategies

Depression has been associated with poorer postburn functional outcomes. However, whether or not certain burn specific coping strategies moderate the relationships remains unknown. Burn survivors from 2015 Formosa Fun Coast Water Park explosion were recruited in a 3-year follow-up study. Using Wave 1 data collected 1 year after discharge, we conducted multivariate regression analysis to assess the associations between depression and postburn disability and quality of life. We also performed moderation analysis to determine moderating effects of burn specific coping strategies on the associations. Our results found depression was significantly associated with worsening postburn disability and poorer quality of life. When demographic and burn related variables were accounted for, we found avoidance coping moderated the depression-disability relationship. Depression was significantly and positively correlated with disability at low and medium levels of avoidance but not high. Optimism/problem solving moderated the depression-quality of life relationship. Depression was significantly and negatively correlated with quality of life at low and medium levels of optimism/problem solving but not high. Our study provided evidence supporting early identification and intervention of depression in burn survivors to optimize functional outcomes. Such knowledge may provide insights into potential targets in rehabilitation in depressed burn survivors.

Psychosocial protective factors and suicidal ideation: Results from a national longitudinal study of veterans

BACKGROUND

This study investigates the empirical association between psychosocial protective factors and subsequent suicidal ideation in veterans.

METHODS

We conducted a national longitudinal survey in which participants were randomly drawn from over one million U.S. military service members who served after September 11, 2001. Data were provided by a total of 1090 veterans representative of all 50 states and all military branches in two waves of data collection one year apart (79% retention rate).

RESULTS

In chi-square analyses, psychosocial protective factors at wave 1 (employment, meeting basic needs, self-care, living stability, social support, spirituality, resilience, and self-determination) were significantly related to lower suicidal ideation at wave 2. In multivariable analyses controlling for covariates at wave 1 including suicidal ideation, the total number of protective factors endorsed at wave 1 significantly predicted reduced odds of suicidal ideation at wave 2. In multivariable analysis examining individual risk and protective factors, again controlling for covariates, results showed that money to cover basic needs and higher psychological resilience at wave 1 were associated with significantly lower odds of suicidal ideation at wave 2.

LIMITATIONS

The study measured the link between psychosocial protective factors and suicidal ideation but not suicide attempts, which would be an important next step for this research.

CONCLUSIONS

The results indicate that psychosocial rehabilitation and holistic approaches targeting financial well-being, homelessness, resilience, self-care, social support, spirituality, and work may offer a promising avenue in both veteran and non-veteran populations for treatment safety planning as well as suicide risk management and prevention.

Protective mechanisms and prevention of violence and aggression in veterans

Although a subset of Iraq and Afghanistan Veterans show aggression toward others after they return home from military service, little is known about protective mechanisms that could be bolstered to prevent violence. A national longitudinal survey was conducted between 2009 and 2011 using a random sample of veterans who served in Operation Iraqi Freedom or Operation Enduring Freedom. One thousand and ninety veterans, from 50 states representing all military branches, completed 2 waves of data collection, 1 year apart (retention rate = 79%). The final sample resembled the U.S. military post 9/11 in terms of age, sex, ethnicity, geography, and service branch. Protective mechanisms in socioeconomic (money to cover basic needs, stable employment), psychosocial (resilience, perceiving control over one's life, social support), and physical (healthy sleep, no physical pain) domains were examined. We found these protective mechanisms predicted decreased aggression and violence at follow-up, particularly among higher risk veterans. Multivariable analyses confirmed that protective mechanisms lowered violence through their interaction with risk factors. This study identifies protective mechanisms related to decreased community violence in veterans and indicates that rehabilitation aimed at improving socioeconomic, psychosocial, and physical well-being has potential promise to reduce aggression and violence among veterans after returning home from military service.

Protective factors and risk modification of violence in Iraq and Afghanistan War veterans

OBJECTIVE

After returning home, a subset of Iraq and Afghanistan War veterans report engaging in aggression toward others. This study is the first to identify variables empirically related to decreased risk of community violence among veterans.

METHOD

The authors conducted a national survey from July 2009 to April 2010 in which participants were randomly drawn from over 1 million US military service members who served after September 11, 2001. Data were collected from a total of 1,388 Iraq and Afghanistan War era and theater veterans. The final sample included veterans from all 50 states and all military branches.

RESULTS

One-third of survey respondents self-identified committing an act of aggression toward others during the past year, mostly involving minor aggressive behavior. Younger age, criminal arrest record, combat exposure, probable posttraumatic stress disorder, and alcohol misuse were positively related to violence toward others. Controlling for these covariates, multivariate analyses showed that stable living situation and the perception of having control over one's life were associated with reduced odds of severe violence (R2 = 0.24, χ27 = 145.03, P < .0001). Greater resilience, perceiving positive social support, and having money to cover basic needs were linked to reduced odds of other physical aggression (R2 = 0.20, χ28 = 188.27, P < .0001).

CONCLUSIONS

The study identifies aggression as a problem for a subset of Iraq and Afghanistan War veterans who endorsed few protective factors. Analyses revealed that protective factors added incremental value to statistical modeling of violence, even when controlling for robust risk factors. The data indicate that, in addition to clinical interventions directed at treating mental health and substance abuse problems, psychosocial rehabilitation approaches aimed at improving domains of basic functioning and psychological well-being may also be effective in modifying risk and reducing violence among veterans.

Predictors of coping in a group of Turkish patients with physical disability

AIM AND OBJECTIVE

To describe coping strategies used and determine the influence of demographic/health-related variables and perceived social support to the prediction of coping strategies in patients with physical disabilities.

BACKGROUND

The period of psychosocial adaptation following a physical disability is very stressful. The use of effective coping strategies may be helpful in adapting to disability. However, no information is available about the coping strategies used by Turkish patients with physical disability.

DESIGN

The study was designed as a cross-sectional survey. The data were obtained from 51 patients with physical disability in a rehabilitation centre in Ankara, Turkey between May 2004-September 2005.

METHODS

Data were collected using a questionnaire form, the Multidimensional Scale of Perceived Social Support and the Coping Strategy Indicator. Descriptive statistics, reliability analysis, Mann-Whitney U tests, Kruskal-Wallis test, chi-square test, Pearson's correlation coefficients and stepwise multivariate regression analysis were conducted.

RESULTS

The most frequently used coping strategy was problem-solving, followed by avoidance coping and seeking social support. Significant predictors of overall coping strategies were age, financial status, the caregiver's presence and perceived social support, after controlling for specific variables.

CONCLUSIONS

This study demonstrated that patients who were older and had a caregiver were more likely to use problem-solving strategy. Seeking social support was more common among patients who had a caregiver and those with more perceived support from friends, whereas patients who had financial difficulties used more avoidance coping.

RELEVANCE TO CLINICAL PRACTICE

Better understanding the coping strategies used by individuals with physical disabilities and factors affecting coping is provide interventions that reduce the stress and support their adaptation. Nurses should be aware of the factors that affect to coping strategies used to deal with stress.

The Things They Carry: Combat, Disability and Unemployment among US Men

Sociologists have long recognized that historical events, such as wars, depressions, and natural disasters, can affect the trajectories of people's lives and can reproduce or alter social structure. The following paper examines the effect of a type of event, war, on a facet of people's lives, their ability to work. It uses data from the Panel Study of Income Dynamics to test three accounts regarding how wars affect men's lives. The direct cumulative disadvantage account sees wars as negatively affecting the service-men who see combat regardless of their pre-combat characteristics. The moderated cumulative disadvantage account suggests that combat most negatively affects those who, before they fought, had lower status. The turning point account suggests the reverse: combat most negatively affects those who, before they fought, had greater status. The evidence suggests that, with regard to disability and unemployment, the effects of combat are most consistent with the direct cumulative disadvantage account.