Patterns of psychological health problems and family maltreatment among United States Air Force members

Predictors of Crosscutting Patterns of Psychological Health and Family Maltreatment

INTRODUCTION

Psychological problems and family maltreatment are significant public health problems. Although research focuses almost exclusively on either individual psychological problems or family maltreatment, there is substantial co-occurrence of these problems. Similarly, intervention services are often "siloed": individuals with mental health needs are referred for mental health services, individuals with family conflict are referred for family-based treatment, etc. These treatment "silos" may miss the larger picture of the co-occurrence of risk, promotion, and the problems themselves. In a previous paper, we used latent class analysis to identify subgroups of individuals with crosscutting patterns (i.e., classes) of psychological and family maltreatment problems. In this study, we explored the predictors of these latent classes.

MATERIALS AND METHODS

Participants consisted of two large population samples of U.S. Air Force active duty members (ns = 27,895 and 30,841) who were married or cohabiting and had one or more children living in their household. Participants completed an anonymous community assessment survey, which included questionnaire items tapping personal, family, and community problems and well-being. Assessments were conducted in 2008 and 2011. All study procedures were approved by the authors' Institutional Review Board. We used exploratory factor analysis and latent class analysis to (1) identify higher-order factors of risk and promotive variables and (2) examine them as predictors of our previously identified latent classes.

RESULTS

Findings indicated that individuals who reported better physical well-being as well as personal and family coping, relationship satisfaction, and support were more likely to be in the lowest-risk subgroup. Notably, individuals in the subgroup most at risk for serious violence and suicide, evidencing disinhibitory psychopathology, endorsed lower risk and higher promotive factors than those individuals in other high-risk subgroups who fell along the internalizing/externalizing continuum.

CONCLUSIONS

These findings reinforce the need for integrated prevention and treatment of psychological and family maltreatment problems. Not only do these problems often co-occur, but their risk and promotive factors also tend to be intertwined. The unique (i.e., not on the continuum of the other five classes) problem profile of participants evidencing disinhibitory psychopathology is matched by a unique risk/promotive factor profile, and they will thus likely require a unique intervention approach.

Pre- and Perinatal Risk Factors for Child Maltreatment in Military Families Across the First Two Years of Life

Military families are exposed to a unique constellation of risk factors, which may impact maltreatment outcomes. The present study examined prospective relationships between demographic, health, birth-related, and military-specific risk factors identified prior to a child's birth on their risk for maltreatment in the first two years of life. Data from the Millennium Cohort Study, Department of Defense (DoD) operational records and Family Advocacy Program data on met-criteria maltreatment, and Birth and Infant Health Research program data on suspected maltreatment were linked for 9076 service member parents. Discrete time survival analysis showed that preterm birth increased risk of maltreatment while parents' older age, physical health, and service in the Navy or Air Force decreased risk. Building on DoD's New Parent Support Program, findings suggest the need for universal and targeted prevention efforts, beginning during pregnancy, which limit or eliminate risk factors for maltreatment in military families.

Intimate Partner Violence (IPV) in Military and Veteran Populations: A Systematic Review of Population-Based Surveys and Population Screening Studies

Intimate partner violence (IPV) may be a major concern in military and veteran populations, and the aims of this systematic review were to (1) provide best available estimates of overall prevalence based on studies that are most representative of relevant populations, and (2) contextualise these via examination of IPV types, impacts, and context. An electronic search of PsycINFO, CINHAL, PubMed, and the Cochrane Library databases identified studies utilising population-based designs or population screening strategies to estimate prevalence of IPV perpetration or victimisation reported by active duty (AD) military personnel or veterans. Random effects meta-analyses were used for quantitative analyses and were supplemented by narrative syntheses of heterogeneous data. Thirty-one studies involving 172,790 participants were included in meta-analyses. These indicated around 13% of all AD personnel and veterans reported any recent IPV perpetration, and around 21% reported any recent victimisation. There were higher rates of IPV perpetration in studies of veterans and health service settings, but no discernible differences were found according to gender, era of service, or country of origin. Psychological IPV was the most common form identified, while there were few studies of IPV impacts, or coercive and controlling behaviours. The findings demonstrate that IPV perpetration and victimisation occur commonly among AD personnel and veterans and highlight a strong need for responses across military and veteran-specific settings. However, there are gaps in understanding of impacts and context for IPV, including coercive and controlling behaviours, which are priority considerations for future research and policy.

Evaluating the Effectiveness of NORTH STAR: a Community-Based Framework to Reduce Adult Substance Misuse, Intimate Partner Violence, Child Abuse, Suicidality, and Cumulative Risk

We evaluated the effectiveness of NORTH STAR, a community assessment, planning, and action framework to reduce the prevalence of several secretive adult problems (hazardous drinking, controlled prescription drug misuse, suicidality, and clinically significant intimate partner violence and child abuse [both emotional and physical]) as well as cumulative risk. One-third of US Air Force (AF) bases worldwide were randomly assigned to NORTH STAR (n = 12) or an assessment-and-feedback-only condition (n = 12). Two AF-wide, cross-sectional, anonymous, web-based surveys were conducted of randomly selected samples assessing risk/protective factors and outcomes. Process data regarding attitudes, context, and implementation factors were also collected from Community Action Team members. Analyzed at the level of individuals, NORTH STAR significantly reduced intimate partner emotional abuse, child physical abuse, and suicidality, at sites with supportive conditions for community prevention (i.e., moderation effects). Given its relatively low cost, use of empirically supported light-touch interventions, and emphasis on sustainability with existing resources, NORTH STAR may be a useful framework for the prevention of a range of adult behavioral health problems that are difficult to impact.

Systematic Review of the Military Career Impact of Mental Health Evaluation and Treatment

INTRODUCTION

Military leaders are concerned that active duty members' fear of career impact deters mental health (MH) treatment-seeking. To coalesce research on the actual and perceived consequences of MH treatment on service members' careers, this systematic review of literature on the U.S. Military since 2000 has been investigating the following three research questions: (1) is the manner in which U.S. active duty military members seek MH treatment associated with career-affecting recommendations from providers? (2) Does MH treatment-seeking in U.S. active duty military members impact military careers, compared with not seeking treatment? (3) Do U.S. active duty military members perceive that seeking MH treatment is associated with negative career impacts?

MATERIALS AND METHODS

A search of academic databases for keywords "military 'career impact' 'mental health'" resulted in 653 studies, and an additional 51 additional studies were identified through other sources; 61 full-text articles were assessed for eligibility. A supplemental search in Medline, PsycInfo, and Google Scholar replacing "career impact" with "stigma" was also conducted; 54 articles (comprising 61 studies) met the inclusion criteria.

RESULTS

As stipulated by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, studies were summarized on the population studied (U.S. Military Service[s]), sample used, intervention type, comparison group employed, outcome variables, and findings. Self-referred, compared with command-directed, service members appear to be less likely to face career-affecting provider recommendations in non-deployed and deployed settings although the data for the latter are not consistent. Of the two studies that tested if MH treatment actually negatively impacts military careers, results showed that those who sought treatment were more likely to be discharged although the casual nature of this relationship cannot be inferred from their design. Last, over one-third of all non-deployed service members, and over half of those who screened positive for psychiatric problems, believe that seeking MH treatments will harm their careers.

CONCLUSIONS

Despite considerable efforts to destigmatize MH treatment-seeking, a substantial proportion of service members believe that seeking help will negatively impact their careers. On one hand, these perceptions are somewhat backed by reality, as seeking MH treatment is associated with a higher likelihood of being involuntarily discharged. On the other hand, correlational designs cannot establish causality. Variables that increase both treatment-seeking and discharge could include (1) adverse childhood experiences; (2) elevated psychological problems (including both [a] the often-screened depression, anxiety, and posttraumatic stress problems and [b] problems that can interfere with military service: personality disorders, psychotic disorders, and bipolar disorder, among others); (3) a history of aggressive or behavioral problems; and (4) alcohol use and abuse. In addition, most referrals are self-directed and do not result in any career-affecting provider recommendations. In conclusion, the essential question of this research area-"Does seeking MH treatment, compared with not seeking treatment, cause career harm?"-has not been addressed scientifically. At a minimum, longitudinal studies before treatment initiation are required, with multiple data collection waves comprising symptom measurement, treatment, and other services obtained, and a content-valid measure of career impact.

The Impact of NORTH STAR on Suicidality, Substance Problems, Intimate Partner Violence, and Child Abuse

INTRODUCTION

We evaluated the effectiveness of New Orientation for Reducing Threats to Health from Secretive-problems That Affect Readiness (NORTH STAR), a community assessment, planning, and action framework to reduce the prevalence of suicidality, substance problems, intimate partner violence, and child abuse.

MATERIALS AND METHODS

One-third of U.S. Air Force bases worldwide were randomly assigned to NORTH STAR (n = 12) or an assessment-and-feedback-only condition (n = 12). Two Air Force-wide, cross-sectional, anonymous, web-based surveys were conducted of randomly selected samples assessing risk/protective factors and outcomes. This study was reviewed and approved by the institutional review board at the investigators' university and by the institutional review board at Fort Detrick.

RESULTS

NORTH STAR, relative to control, bases experienced a 33% absolute risk reduction in hazardous drinking rates and cumulative risk, although, given the small number of bases, these effects were not statistically significant.

CONCLUSIONS

Given its relatively low cost, use of empirically supported light-touch interventions, and emphasis on sustainability with existing resources, NORTH STAR may be a useful system for prevention of a range of adult behavioral health problems that are difficult to impact.

The prevalence of intimate partner violence among couples signing up for universally offered parent preparation

BACKGROUND

Intimate partner violence (IPV) during pregnancy can have serious health consequences for mothers and the unborn child. Nevertheless, IPV is seldom addressed in the context of parent preparation.

AIM

This study aimed to map the prevalence, direction, and severity of IPV in a sample of expectant couples signing up for universally-offered parent preparation.

METHOD

A total of 1726 Danish couples expecting their first child provided data on physical and psychological IPV by completing the Family Maltreatment measure during the second trimester of pregnancy.

RESULTS

In 18.5% of the couples, at least one partner reported psychological or physical IPV acts during the past year. In more than 8% of couples, one or both partners reported acts and impacts above the ICD-11 threshold for clinically-significant IPV (CS-IPV) during the past year (3.6% physical CS-IPV, 5.3% psychological CS-IPV, and 0.8% both physical and psychological CS-IPV). Among couples with physical IPV below the clinical threshold, pregnant-woman-to-partner (50%) and bidirectional (38.2%) IPV were more common than partner-to-pregnant-woman IPV (11.8%). Among couples with physical CS-IPV, pregnant-woman-to-partner (36.1%), partner-to-pregnant-women (29.1%) and bidirectional (34.4%) forms were equally common. Among couples with psychological IPV, pregnant-woman-to-partner (54.9%) and partner-to-pregnant-woman (39.6%) IPV were more common than bidirectional IPV (5.5%).

DISCUSSION

The prevalence of violence was markedly higher in this study compared with previous reports from the Nordic region and highlights a previous oversight of a substantial and clinically significant level of pregnant-woman-to-partner IPV-as well as the reverse. Data from this study call for IPV to be addressed in universally offered parent preparation programs.