Intimate relationships among returning soldiers: the mediating and moderating roles of negative emotionality, PTSD symptoms, and alcohol problems

Psychological Predictors of Recidivism for Intimate Partner Violence Perpetrators: A Systematic Scoping Review

Theoretical accounts of recidivistic intimate partner violence (IPV) continue to differ considerably in relation to the relative weight given to psychological risk factors. A systematic overview of studies that have established psychological predictors of reoffending is currently lacking. This study aimed to identify and provide an overview of studies examining various psychological factors associated with IPV perpetration patterns. A systematic search of research conducted from 1945 to 2024 was carried out on PsycINFO, PubMed, and PILOTS. The inclusion criteria were that studies must not use self-reported reoffending data only, must use a criminal justice sample, must be longitudinal, participants must be over 17 years of age, and that studies must be published in the English language and peer reviewed. A total of 25 longitudinal studies examining individual psychological factors, proposed as potential predictors of IPV reoffending, were eligible. The identified factors were grouped into five categories: personality, anger and hostility, beliefs, attitudes and motivation, neurocognitive deficits and trauma (i.e., family of origin abuse/post-traumatic stress disorder). The current systematic scoping review found that the most-researched psychological predictor of IPV recidivism was personality. While studies vary in relation to the personality traits or disorders that contribute most to the likelihood of reoffending, in general, personality assessment appears to be a promising tool in predicting reoffending. Anger, childhood maltreatment, post-traumatic stress disorder (PTSD), implicit attitudes, and neurocognitive deficits were also identified as predictors of IPV recidivism. Methodological issues were found to be present across studies.

A systematic review and meta-analysis of individual and couple therapies for posttraumatic stress disorder: Clinical and intimate relationship outcomes

The association between symptoms of posttraumatic stress disorder (PTSD) in adults and difficulties in intimate relationships is well documented. Growing literature suggests that interpersonally-oriented therapies, such as couple and family interventions, may lead to improvements in both PTSD symptoms and intimate relationship functioning. However, it is unknown how individual PTSD treatments compare to couple/family interventions in relational outcomes. The present study was a systematic review and meta-analysis of individual and couple/family treatments to examine changes in PTSD symptoms and intimate relationship functioning. Twelve couple treatment studies with 13 unique samples and 7 individual treatment studies with 9 unique samples met inclusion criteria. No family-based treatments were identified. Meta-analytic findings indicated moderate to large reductions in PTSD symptoms for both couple and individual studies. Small but significant improvements in intimate relationship functioning across individual and couple studies were observed. Moderation analysis suggested that across both individual and couple treatment formats, trauma-focused treatments had larger effects on PTSD symptoms. Trauma-focused treatments had larger effects on intimate relationship functioning for individual studies. Military status did not moderate outcomes. This study supports the utility of both individual and couple treatment formats for treating PTSD and provides preliminary support for these modalities for also enhancing intimate relationship functioning.

Advancing Research on Mechanisms of Resilience (ARMOR) Longitudinal Cohort Study of New Military Recruits: Results from a Feasibility Pilot Study

Psychological resilience as a longitudinal process is highly relevant for understanding the functioning outcomes of military populations. Here, we review the extant literature on resilience among military service members, focusing on National Guard Soldiers. Our specific project (Advancing Research on Mechanisms of Resilience, "ARMOR") aims to develop a comprehensive model of resilience using a multilevel perspective. We report results from our prospective pilot study (n = 103) conducted in preparation for our large-scale longitudinal cohort study of Basic Combat Training (BCT) and its impact on military recruits' wellbeing. Results support feasibility of the larger study, evidence for a new measure of BCT stressor exposure, and demonstrate preliminary associations with BCT-related stressors and longitudinal changes in adaptive functioning. Future directions for our larger study will utilize data from survey responses, structured clinical interviews, neurobehavioral tasks, and neurobiological measures (functional and structural MRI and electroencephalography [EEG]) to examine individual differences in self-regulation as a predictor of resilience-related processes. ARMOR is well positioned to elucidate mechanisms that could be targeted for promoting wellbeing, preventing psychopathology, and facilitating long-term recovery.

Social Support and Relationship Satisfaction as Moderators of the Stress-Mood-Alcohol Link Association in US Navy Members

The present study examined associations between stress and problematic alcohol use among US Navy members anticipating deployment, whether depressive symptoms mediated the stress-alcohol link, and whether social support and relationship satisfaction moderated associations between stress, depressive symptoms, and problematic alcohol use. Participants were 108 US Navy members assigned to an Arleigh Burke-class destroyer anticipating an 8-month deployment after Operational Enduring Freedom/Operation Iraqi Freedom. Stress was indirectly related to problematic alcohol use such that higher levels of stress were associated with higher levels of depressive symptoms, which were further associated with higher levels of alcohol use. The indirect effect of stress to problematic alcohol use via depressive symptoms was tested at different levels of social support and relationship satisfaction. At higher levels of social support and relationship satisfaction, the association between stress and problematic alcohol use via depressive symptoms decreased. Results help identify targets for alcohol prevention efforts among current military members.

PTSD, alcohol dependence, and conduct problems: Distinct pathways via lability and disinhibition

This study tested the role of affect lability and disinhibition in mediating associations between PTSD symptoms and two forms of alcohol-related problems, dependence syndrome symptoms (e.g., impaired control over consumption) and conduct problems (e.g., assault, risk behaviors). Genotype at the serotonin transporter linked polymorphic region (5-HTTLPR) was hypothesized to moderate associations between traumatic stress and PTSD symptoms. In addition, the study tested whether childhood traumatic stress moderated associations between combat trauma and PTSD symptoms. Participants were 270 OIF/OEF/OND veterans. The hypothesized model was largely supported. Participants with the low expression alleles of 5-HTTLPR (S or L_G) exhibited stronger associations between childhood (but not combat) traumatic stress and PTSD symptoms. Affect lability mediated the associations between PTSD symptoms and alcohol dependence symptoms. Behavioral disinhibition mediated associations between PTSD symptoms and conduct related problems. Conditional indirect effects indicated stronger associations between childhood traumatic stress and lability, behavioral disinhibition, alcohol consumption, AUD symptoms, and associated conduct problems via PTSD symptoms among those with the low expression 5-HTTLPR alleles. However, interactions between combat trauma and either childhood trauma or genotype were not significant. The results support the hypothesis that affect lability and behavioral disinhibition are potential intermediate traits with distinct associations with AUD and associated externalizing problems.

Weathering the storm? The impact of trauma on romantic relationships

The current paper reviews the recent literature examining the impact of trauma on romantic relationships. We introduce the Dyadic Responses to Trauma (DRT) Model as a framework for organizing existing research and guiding future research. A traumatic event affects romantic relationships for the better or for the worse depending on the diverse trauma-related experiences people can have, influencing the way partners interact with each other and ultimately the quality of the relationship. In addition, recent research demonstrates how romantic partners can demonstrate resiliency in spite of a negative trauma experience depending on how they interpret and cope with the experience individually and as a couple.

Incidence of and risk for post-traumatic stress disorder and depression in a representative sample of US Reserve and National Guard

PURPOSE

We aim to determine the incidence rates (IR) of first-ever post-traumatic stress disorder (PTSD) and depression in a population-based cohort of US Reserve and National Guard service members.

METHODS

We used data from the US Reserve and National Guard Study (n = 2003) to annually investigate incident and recurrent PTSD and depression symptoms from 2010 to 2013. We estimated the IR and recurrence rate over 4 years and according to several sociodemographic and military characteristics.

RESULTS

From 2010 to 2013, IRs were 4.7 per 100 person-years for both PTSD and depression symptoms using the sensitive criteria, 2.9 per 100 person-years using the more specific criteria, recurrence rates for both PTSD and depression were more than 4 times as high as IRs, and IRs were higher among those with past-year civilian trauma, but not past-year deployment.

CONCLUSIONS

The finding that civilian trauma, but not past-year military deployment, is associated with an increased risk of PTSD and depression incidence suggest that Reserve National Guard psychopathology could be driven by other, nonmilitary, traumatic experiences.

Examining Spouse/Partner Presence as a Moderator in the Relationship between Mental Health Symptoms and Alcohol Use in OEF/OIF Veterans

Veterans from the conflicts in Afghanistan (Operation Enduring Freedom; OEF) and Iraq (Operation Iraqi Freedom; OIF) have reported elevated rates of alcohol consumption, and greater depression and posttraumatic stress disorder (PTSD) symptoms are associated with increased alcohol use. Presence of a spouse/partner, which has been associated with reduced drinking, may buffer the relationship between mental health symptoms and alcohol consumption. To examine this hypothesis, the current study utilized baseline survey data from OEF/OIF veterans (N=325) enrolled in a brief alcohol intervention. Spouse/partner presence moderated the relationship between depression symptoms and alcohol consumption such that depression was positively associated with drinking for veterans without a spouse/partner. Exploratory analyses indicated that the relationship between depression and alcohol use may be particularly salient for veterans without a spouse/partner and a lower number of deployments. Spouse/partner presence did not moderate the relationship between PTSD symptoms and alcohol consumption. Implications of the findings are discussed.

Examining posttraumatic stress disorder's latent structure between treatment-seeking and non-treatment-seeking Filipinos

BACKGROUND

The discourse of latent structure of posttraumatic stress disorder (PTSD) has been extensive in trauma literature. Although findings have been consistent in rejecting DSM-IV-TR's three-factor model, alternative models are still fervently argued. This study contributes to the discussion by examining and comparing PTSD factor structure of the three most validated models—numbing model (King et al., 1998), dysphoria model (Simms et al., 2002), and dysphoric arousal model (Elhai et al., 2011b)—and determining if these are generalizable across treatment-seeking and non-treatment-seeking Filipinos with exposure to trauma events.

METHODS

Filipino-Tagalog version of Harvard Trauma Questionnaire (HTQ; Mollica et al., 1992) was administered to a sample of 737 treatment-seeking (n=526) and non-treatment-seeking (n=211) Filipinos who experienced and witnessed varied trauma events. Confirmatory factor analysis (CFA) was conducted involving the three models in order to determine the best-fitting model and generalizability across samples.

RESULTS

Results showed that all three models achieved excellent fit, with dysphoric arousal model slightly fitting better than numbing and dysphoria models in both treatment-seeking and non-treatment-seeking samples. Series of invariance testing, however, indicated that although dysphoric arousal model fits significantly better than dysphoria model, it did not significantly differ from numbing model. Results revealed that aside from the factor loadings, the two groups are noninvariant in all parameters. Treatment-seeking sample had larger intercepts, factor variances and covariances and factor means than non-treatment-seeking group.

DISCUSSION

The findings strongly contribute to the literature by showing how the type of groupings (treatment-seeking vs. non-treatment-seeking) moderates PTSD latent structure. It affirms the suggestion of Biehn et al. (2012) to be cautious in concluding the generalizability of PTSD models in the context that type of participants moderates PTSD's factor structure.

Sexual functioning in military personnel: preliminary estimates and predictors

INTRODUCTION

Although the military is a young and vigorous force, service members and veterans may experience sexual functioning problems (SFPs) as a result of military service. Sexual functioning can be impaired by physical, psychological, and social factors and can impact quality of life (QOL) and happiness.

AIMS

This study aims to estimate rates and correlates of SFPs in male military personnel across demographic and psychosocial characteristics, to examine the QOL concomitants, and to evaluate barriers for treatment seeking.

METHODS

This exploratory cross-sectional study was conducted using data from a larger nationwide study conducted between October 2013 and November 2013. This sample consists of 367 male active duty service members and recent veterans (military personnel) age 40 or younger.

MAIN OUTCOME MEASURES

Erectile dysfunction (ED) was determined using the five-item International Index of Erectile Function, sexual dysfunction (SD) was determined using the Arizona Sexual Experiences Scale, Male, and QOL was determined using the World Health Organization Quality of Life, Brief.

RESULTS

SFPs were associated with various demographic, physical, and psychosocial risk factors. The rates of SD and ED were 8.45% and 33.24%, respectively, for male military personnel aged 21-40. Those who were 36-40, nonmarried, nonwhite, and of lower educational attainment reported the highest rates of SFPs. Male military personnel with poor physical and psychosocial health presented the greatest risk for ED and SD. SFPs were associated with reduced QOL and lower happiness, and barriers for treatment were generally related to social barriers.

CONCLUSIONS

SFPs in young male military personnel are an important public health concern that can severely impact QOL and happiness.

Long-term trajectories and service needs for military families

The deployment of US military personnel to recent conflicts has been a significant stressor for their families; yet, we know relatively little about the long-term family effects of these deployments. Using data from prior military service eras, we review our current understanding of the long-term functioning and needs of military families. These data suggest that overseas deployment, exposure to combat, experiencing or participating in violence during war deployment, service member injury or disability, and combat-related post-traumatic stress disorder (PTSD) all have profound impacts on the functioning of military families. We offer several recommendations to address these impacts such as the provision of family-centered, trauma-informed resources to families of veterans with PTSD and veterans who experienced high levels of combat and war violence. Recent efforts to address the needs of caregivers of veterans should be evaluated and expanded, as necessary. We should also help military families plan for predictable life events likely to challenge their resilience and coping capacities. Future research should focus on the following: factors that mediate the relationship between PTSD, war atrocities, caregiver burden, and family dysfunction; effective family-centered interventions that can be scaled-up to meet the needs of a dispersed population; and system-level innovations necessary to ensure adequate access to these interventions.

Towards a unitary perspective between post-traumatic stress disorder and substance use disorder. Heroin use disorder as case study

BACKGROUND

Genetic, neurobiological, environmental and psychosocial mechanisms have received considerable attention in exploring the mechanisms that underlie comorbid PTSD and SUD. PTSD and SUD are not necessarily linked by a causal relationship, as the self-medication hypothesis had supposed. They might, in fact, both be caused by a third factor that predisposes these subjects to develop the two disorders (so allowing a unitary perspective).

METHODS

Using a conceptualization of the PTSD spectrum, we studied the PTSD-SUD unitary perspective by testing the correlation between severity of heroin addiction, dose of opioid medication and severity of PTSD spectrum in 82 methadone-treated, heroin-dependent patients.

RESULTS

Canonical correlation analysis (Wilks Lambda=0.125F=1.41 p=0.014), univariate and multivariate comparisons between subgroups, identified on the basis of addiction severity, showed a highly positive correlation between the PTSD spectrum and the severity of heroin addiction. In addition, negative correlations were found between PTSD spectrum severity and methadone dose (r=0.225; p=0.042).

CONCLUSIONS

This strength and breadth of the correlations encourage us to move towards a unified vision of the two disorders.

Racial differences in sexual dysfunction among postdeployed Iraq and Afghanistan veterans

This study examined the racial/ethnic differences in prevalence and risk factors of sexual dysfunction among postdeployed Iraqi/Afghanistan veterans. A total of 3,962 recently deployed veterans were recruited from Houston Veterans Affairs medical center. The authors examined sociodemographic, medical, mental-health, and lifestyle-related variables. Sexual dysfunction was diagnosed by ICD9-CM code and/or medicines prescribed for sexual dysfunction. Analyses included chi-square, analysis of variance, and multivariate logistic regression. Sexual dysfunction was observed 4.7% in Whites, 7.9% in African Americans, and 6.3% in Hispanics. Age, marital status, smoking, and hypertension were risk factors for Whites, whereas age, marital status, posttraumatic stress disorder and hypertension were significant for African Americans. For Hispanics, only age and posttraumatic stress disorder were significant. This study identified that risk factors of sexual dysfunction varied by race/ethnicity. All postdeployed veterans should be screened; and psychosocial support and educational materials should address race/ethnicity-specific risk factors.

Assessment and documentation of sexual health issues of recent combat veterans seeking VHA care

INTRODUCTION

Sexual health is an important aspect of human existence associated with disease and overall health. Despite these associations and the existence of medical treatments to improve sexual function, sexual health is often overlooked in health care. Recent combat veterans may be particularly vulnerable to sexual health issues due to their deployment-related health issues such as mental health conditions, prescription medications use, and psychosocial challenges.

AIM

This study assesses the sexual health issues of recent combat veterans seeking care at a Veterans Affairs Medical Center (VAMC) documented in the primary care and mental health notes from the first 6 months of care.

MAIN OUTCOME MEASURES

Documentation of sexual health issues in the progress notes (coded into categories), primary care vs. mental health care visit note, initial vs. follow-up visit notes, and templated vs. non-templated text.

METHODS

This is a retrospective chart review of the first 158 consecutive patients seen for an initial assessment in the VAMC post-deployment clinic. Medical records were reviewed and text of sexual health issues and relevant patient and care characteristics were abstracted and coded into variables.

RESULTS

Almost 25% of patients had documented sexual health issues in the first 6 months of care. We coded 52 separate sexual health issues into 13 distinct categories. Overall, most sexual health issues were documented in mental health care notes, in non-templated text, and at follow-up visits. The use of templated text appeared to drive the documentation of low libido (the most common sexual health issue) in mental health care notes.

CONCLUSIONS

Sexual health issues are prevalent in recent combat veterans seeking care at a VAMC, but patterns of documentation suggest that they may be under-reported or incompletely addressed. A more systematic and provider-initiated approach to assessment of sexual health may promote fuller discussion of sexual health issues and optimize management.

Sexual dysfunction among male veterans returning from Iraq and Afghanistan: prevalence and correlates

INTRODUCTION

Sexual dysfunction (SD) is not well described in the Iraq/Afghanistan veteran population despite high prevalence of multiple risk factors for this issue.

AIM

To estimate the prevalence and examine the association of various sociodemographic, mental health, comorbid conditions and life style factors with sexual dysfunction in Iraq/Afghanistan veterans.

METHODS

This exploratory cross-sectional study was conducted using data from the VA administrative database. A total of 4,755 Iraq/Afghanistan veterans were identified who sought treatment from the Michael E. DeBakey Veterans Affairs Medical Center inpatient and outpatient clinic between September 2007 and August 2009.

MAIN OUTCOME MEASURES

Sexual dysfunction was determined by ICD9-CM codes related to sexual health issues and/or by specific medications, primarily phosphodiesterase-5 inhibitors (PDE5i), prescribed for erectile dysfunction.

RESULTS

The overall prevalence of sexual dysfunction was 5.5% (N = 265). By age category, it was 3.6% (N = 145) for Iraq/Afghanistan veterans aged 18-40 years and 15.7% (N = 120) for Iraq/Afghanistan veterans aged > 40 years, respectively. A multivariate logistic-regression model revealed that annual income, marital status, post-traumatic stress disorder, and hypertension were significant risk factors of SD (all P < 0.05) among younger Iraq/Afghanistan veterans, whereas among the older Iraq/Afghanistan veterans, being African American and having PTSD and hypertension were significant risk factors of SD (all P < 0.05). There was marked discrepancy between documented erectile dysfunction and prescription of a PDE5i.

CONCLUSIONS

These data demonstrate that a significant proportion of Iraq/Afghanistan veterans have SD and that the risk factors differ between younger and older veterans. Our findings also suggest that SD is likely under-coded. To better identify the scope of the problem, systematic screening for sexual dysfunction may be appropriate perhaps as part of an initial post-deployment health evaluation.

Suicide and war: the mediating effects of negative mood, posttraumatic stress disorder symptoms, and social support among army National Guard soldiers

The mediating effects of posttraumatic stress disorder (PTSD) symptoms, negative mood, and social support on the relationship of war experiences to suicidality were examined. The research literature suggested a sequence among study scales representing these constructs, which was then tested on survey data obtained from a sample of National Guard soldiers (N=4,546). Results from structural equation modeling suggested that war experiences may precipitate a sequence of psychological consequences leading to suicidality. However, suicidality may be an enduring behavioral health condition. War experiences showed no direct effects on postdeployment suicidality, rather its effect was indirect through PTSD symptoms and negative mood. War experiences were, however, predictive of PTSD symptoms, as would be expected. PSTD symptoms showed no direct effect on postdeployment suicidality, but showed indirect effects through negative mood. Results also suggested that suicidality is relatively persistent, at least during deployment and postdeployment. The percentage of those at risk for suicide was low both during and after deployment, with little association between suicidality and time since returning from deployment. Additionally, few soldiers were initially nonsuicidal and then reported such symptoms at postdeployment. Implications of relationships of both negative mood and combat trauma to suicidality are discussed, as well as possible mediating effects of both personal dispositions and social support on relationships of war experiences to PTSD, negative mood, and suicidality.

The impact of deployment to Iraq or Afghanistan on partners and wives of military personnel

Deployment has well documented psychological consequences for military personnel. To fully understand the human cost of war, the psychosocial impact of separation and homecoming of military personnel on their families must also be considered. Recent arduous conflicts in Iraq and Afghanistan make understanding the impact of war on spouses topical and pertinent. Widespread psychological morbidity and social dysfunction have been reported in spouses of military personnel who have been deployed to combat zones such as Vietnam, with difficulties most acute for spouses of military personnel with post-traumatic stress disorder (PTSD). A review of the literature published between 2001 and 2010 assessing the impact of deployments to Iraq and Afghanistan on spouses of military personnel was conducted. A total of 14 US-based studies were identified which examined psychological morbidity, help seeking, marital dysfunction and stress in spouses. Longer deployments, deployment extensions and PTSD in military personnel were found to be associated with psychological problems for the spouse. Methodological differences in the studies limit direct comparisons. Recommendations for future research are outlined. The needs of spouses of military personnel remain an important issue with implications for service provision and occupational capability of both partners.