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Forbush KT, Swanson TJ, Gaddy M, Oehlert M, Doan A, Morgan RW, O’Brien C, Chen Y, Christian K, Song QC, Watson D, Wiese J. Design and methods of the Longitudinal Eating Disorders Assessment Project research consortium for veterans. Int J Methods Psychiatr Res 2023; 32:e1941. [PMID: 36251947 PMCID: PMC10242201 DOI: 10.1002/mpr.1941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 06/06/2022] [Accepted: 07/22/2022] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION Military service members must maintain a certain body mass index and body fat percentage. Due to weight-loss pressures, some service members may resort to unhealthy behaviors that place them at risk for the development of an eating disorder (ED). OBJECTIVES To understand the scope and impact of EDs in military service members and veterans, we formed the Longitudinal Eating Disorders Assessment Project (LEAP) Consortium. LEAP aims to develop novel screening, assessment, classification, and treatment tools for veterans and military members with a focus on EDs and internalizing psychopathology. METHODS We recruited two independent nationally representative samples of post-9/11 veterans who were separated from service within the past year. Study 1 was a four-wave longitudinal survey and Study 2 was a mixed-methods study that included surveys, structured-clinical interviews, and qualitative interviews. RESULTS Recruitment samples were representative of the full population of recently separated veterans. Sample weights were created to adjust for sources of non-response bias to the baseline survey. Attrition was low relative to past studies of this population, with only (younger) age predicting attrition at 1-week follow-up. CONCLUSIONS We expect that the LEAP Consortium data will contribute to improved information about EDs in veterans, a serious and understudied problem.
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Affiliation(s)
| | | | - Melinda Gaddy
- VA Eastern Kansas Health Care SystemLeavenworthKansasUSA
| | - Mary Oehlert
- VA Eastern Kansas Health Care SystemLeavenworthKansasUSA
| | | | | | | | | | | | | | | | - Joanna Wiese
- 20th Medical GroupShaw Air Force BaseSouth CarolinaUSA
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Resilience to mental health problems and the role of deployment status among U.S. Army Reserve and National Guard Soldiers. Soc Psychiatry Psychiatr Epidemiol 2021; 56:1299-1310. [PMID: 32556425 PMCID: PMC7746625 DOI: 10.1007/s00127-020-01899-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Accepted: 06/09/2020] [Indexed: 01/19/2023]
Abstract
PURPOSE Research suggests that interpersonal and intrapersonal resiliency factors protect against poor post-deployment mental health outcomes among Reserve/Guard soldiers who have been deployed. There is increasing awareness that never-deployed soldiers are also at risk. The purpose of this study was to examine the relationships between resiliency factors and a range of mental health outcomes among a sample of United States Army Reserve and National Guard (USAR/NG) soldiers who have and have not experienced deployment. METHODS A subset of data was drawn from Operation: SAFETY (N = 360), an ongoing study examining the health and well-being of USAR/NG soldiers. We used a multivariate path analysis approach to examine the simultaneous effects of unit support, marital satisfaction, and psychological hardiness on the following mental health outcomes, concurrently: anger, anxiety, depression, and posttraumatic stress disorder (PTSD) symptomatology. We also examined interaction effects between resiliency factors and deployment status on mental health outcomes. RESULTS Greater unit support (ps < 0.01), marital satisfaction (ps < 0.001), and psychological hardiness (ps < 0.001) were associated with less anger, anxiety, depression, and PTSD symptomatology. Psychological hardiness had significant interactions with deployment status on anxiety, depression, and PTSD, such that the protective effects of psychological hardiness were even stronger among never-deployed soldiers than previously deployed solders. CONCLUSION Resiliency factors can be targeted for intervention to prevent poor mental health outcomes among USAR/NG soldiers, regardless of deployment status. Further, psychological hardiness may be an even more important protective factor among soldiers who have never been deployed.
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Lawrence KA, Vogt D, Dugan AJ, Nigam S, Slade E, Smith BN. Mental Health and Psychosocial Functioning in Recently Separated U.S. Women Veterans: Trajectories and Bi-Directional Relationships. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18030935. [PMID: 33498982 PMCID: PMC7908492 DOI: 10.3390/ijerph18030935] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 01/11/2021] [Accepted: 01/15/2021] [Indexed: 11/16/2022]
Abstract
Prior research on the relationship between veterans’ mental health and psychosocial functioning has primarily relied on male samples. Here, we investigated prospective longitudinal relationships between mental health and psychosocial functioning in 554 female Iraq and Afghanistan War veterans who were surveyed three times between two- and seven-years following separation from service. Mixed effects modeling revealed that increasing depression and posttraumatic stress disorder (PTSD) severity predicted declines in work functioning. Increasing PTSD severity predicted declining parental functioning and worsening depression predicted a decline in relationship functioning. In turn, decreased work and intimate relationship functioning predicted increased PTSD and depression symptom severity suggesting bi-directional effects between mental health and psychosocial functioning. An examination of the effect of deployment stressors on psychosocial functioning revealed that deployment sexual harassment was the strongest predictor of decreased psychosocial functioning across all domains. Evidence for the reciprocal nature of relationships between mental health and psychosocial functioning underscore the need for treatment targeted at PTSD and depression, as well as work and relationship functioning to improve outcomes for women veterans.
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Affiliation(s)
- Karen A. Lawrence
- College of Social Work, University of Kentucky, Lexington, KY 40506, USA
- Correspondence: ; Tel.: +1-859-323-7407
| | - Dawne Vogt
- National Center for PTSD Women’s Health Sciences Division, VA Boston Healthcare System, Boston, MA 02130, USA; (D.V.); (B.N.S.)
- Department of Psychiatry, Boston University School of Medicine, Boston, MA 02118, USA
| | - Adam J. Dugan
- Department of Biostatistics, College of Public Health, University of Kentucky, Lexington, KY 40536, USA; (A.J.D.); (S.N.); (E.S.)
| | - Shawn Nigam
- Department of Biostatistics, College of Public Health, University of Kentucky, Lexington, KY 40536, USA; (A.J.D.); (S.N.); (E.S.)
| | - Emily Slade
- Department of Biostatistics, College of Public Health, University of Kentucky, Lexington, KY 40536, USA; (A.J.D.); (S.N.); (E.S.)
| | - Brian N. Smith
- National Center for PTSD Women’s Health Sciences Division, VA Boston Healthcare System, Boston, MA 02130, USA; (D.V.); (B.N.S.)
- Department of Psychiatry, Boston University School of Medicine, Boston, MA 02118, USA
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Rugo KF, Leifker FR, Drake-Brooks MM, Snell MB, Bryan CJ, Bryan AO. Unit Cohesion and Social Support as Protective Factors Against Suicide Risk and Depression Among National Guard Service Members. JOURNAL OF SOCIAL AND CLINICAL PSYCHOLOGY 2020. [DOI: 10.1521/jscp.2020.39.3.214] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Introduction: Suicide and depression continue to be pervasive problems across military populations, including within the National Guard. Existing literature highlights the protective effects of social support and unit cohesion for both suicide risk and depression, yet to our knowledge, these associations have never been confirmed in National Guard populations. Thus, the aim of this study was to investigate the impacts of social support resources (i.e., general social support and unit cohesion) on depression and suicide risk among a large sample (n = 877) of National Guard service members. Methods: Multilevel modeling was used to examine the impact of social support resources on depression and suicide ideation at both the individual and unit level. Results: Results indicated that higher levels of perceived social support were associated with lower levels of depression and suicide ideation at both the individual and unit levels. Additionally, higher levels of perceived unit cohesion significantly predicted lower levels of depression and suicide ideation at the individual, but not unit level. Discussion: Limitations include self-report measurement and cross-sectional nature of the data. These findings hold implications for improvement of operational climate within military units and reduction of suicide risk and depressive symptoms among National Guard service members.
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Rakesh G, Morey RA, Zannas AS, Malik Z, Clausen A, Marx CE, Kritzer MD, Szabo ST. Resilience as a translational endpoint in the treatment of PTSD. Mol Psychiatry 2019; 24:1268-1283. [PMID: 30867558 PMCID: PMC6713904 DOI: 10.1038/s41380-019-0383-7] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Revised: 01/24/2019] [Accepted: 02/14/2019] [Indexed: 12/31/2022]
Abstract
Resilience is a neurobiological entity that shapes an individual's response to trauma. Resilience has been implicated as the principal mediator in the development of mental illness following exposure to trauma. Although animal models have traditionally defined resilience as molecular and behavioral changes in stress responsive circuits following trauma, this concept needs to be further clarified for both research and clinical use. Here, we analyze the construct of resilience from a translational perspective and review optimal measurement methods and models. We also seek to distinguish between resilience, stress vulnerability, and posttraumatic growth. We propose that resilience can be quantified as a multifactorial determinant of physiological parameters, epigenetic modulators, and neurobiological candidate markers. This multifactorial definition can determine PTSD risk before and after trauma exposure. From this perspective, we propose the use of an 'R Factor' analogous to Spearman's g factor for intelligence to denote these multifactorial determinants. In addition, we also propose a novel concept called 'resilience reserve', analogous to Stern's cognitive reserve, to summarize the sum total of physiological processes that protect and compensate for the effect of trauma. We propose the development and application of challenge tasks to measure 'resilience reserve' and guide the assessment and monitoring of 'R Factor' as a biomarker for PTSD.
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Affiliation(s)
- Gopalkumar Rakesh
- Duke-UNC Brain Imaging and Analysis Center (BIAC), Durham, NC, 27710, USA. .,Durham VA Health Care System, Durham, NC, 27705, USA. .,VISN 6 VA Mid-Atlantic Mental Illness Research Education and Clinical Center (MIRECC), 3022 Croasdaile Drive, Durham, NC, 27705, USA.
| | - Rajendra A Morey
- Duke-UNC Brain Imaging and Analysis Center, Duke University, Durham NC, Duke University School of Medicine, Durham, NC 27710,VISN 6 VA Mid-Atlantic Mental Illness Research Education and Clinical Center (MIRECC), 3022 Croasdaile Drive, Durham, NC 27705
| | | | - Zainab Malik
- Child and Adolescent Psychiatry, University of California, Davis, CA 95616
| | - Ashley Clausen
- Duke-UNC Brain Imaging and Analysis Center (BIAC), Durham VA Health Care System, VISN 6 VA Mid-Atlantic Mental Illness Research Education and Clinical Center, 3022 Croasdaile Drive, Durham, NC 27705
| | - Christine E Marx
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina, 27710, USA,Division of Translational Neurosciences, Duke University Medical Center, Durham, North Carolina, 27710, USA
| | - Michael D Kritzer
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina, 27710, USA
| | - Steven T Szabo
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina, 27710, USA,Veterans Affairs Medical Center, Mental Health Service Line, Durham, North Carolina, 27710, USA
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Gross GM, Laws H, Park CL, Hoff R, Hoffmire CA. Meaning in life following deployment sexual trauma: Prediction of posttraumatic stress symptoms, depressive symptoms, and suicidal ideation. Psychiatry Res 2019; 278:78-85. [PMID: 31158725 DOI: 10.1016/j.psychres.2019.05.037] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Revised: 05/22/2019] [Accepted: 05/24/2019] [Indexed: 11/25/2022]
Abstract
Deployment sexual trauma (DST; i.e., sexual harassment or assault during deployment in the military) is associated with physical and mental health consequences, including posttraumatic stress disorder (PTSD), depression, and suicidal ideation (SI). Less attention has been placed on factors that may offer protection from deleterious mental health outcomes following DST. Global meaning in life (i.e., purpose, beliefs, goals, and subjective feelings) has been shown to be a protective factor against PTSD, depression, and SI following combat trauma; however, the extent to which meaning in life may affect outcomes following DST has not been investigated. Cross-sectional associations and Hayes mediation models were examined using baseline interview data from the Survey of Experiences of Returning Veterans sample (SERV; 850 recently returned veterans, 352 women). DST was associated with post-deployment posttraumatic stress symptoms (PTSS), depressive symptoms, and SI severity, and with decreased sense of meaning in life. Further, meaning in life was a significant mediator between DST and each of the three outcomes, even after controlling for demographic variables and combat experiences. The mediation models did not differ by gender. Findings suggest meaning in life may be an important clinical factor, both for the identification of risk and as a point of intervention.
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Affiliation(s)
- Georgina M Gross
- VA Connecticut Healthcare System, West Haven, CT, USA; Yale University School of Medicine, New Haven, CT, USA.
| | - Holly Laws
- VA Connecticut Healthcare System, West Haven, CT, USA; Yale University School of Medicine, New Haven, CT, USA; University of Massachusetts Amherst, Amherst, MA, USA
| | | | - Rani Hoff
- VA Connecticut Healthcare System, West Haven, CT, USA; Yale University School of Medicine, New Haven, CT, USA
| | - Claire A Hoffmire
- VA Rocky Mountain Mental Illness Research, Education and Clinical Center for Suicide Prevention, Denver, CO, USA; Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
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Hoopsick RA, Benson KR, Homish DL, Homish GG. Resiliency factors that protect against post-deployment drug use among male US Army Reserve and National Guard soldiers. Drug Alcohol Depend 2019; 199:42-49. [PMID: 30981048 PMCID: PMC7370314 DOI: 10.1016/j.drugalcdep.2019.02.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 02/05/2019] [Accepted: 02/07/2019] [Indexed: 01/22/2023]
Abstract
BACKGROUND Service members who have been deployed are at risk for substance use, especially Reserve/Guard troops. However, it is unclear what modifiable factors protect against substance use in this at-risk population. Our objective was to examine the effects of pre-, peri-, and post-deployment resiliency factors on post-deployment drug use. METHODS Data were drawn from Operation: SAFETY (Soldiers and Families Excelling Through the Years), an ongoing study examining the health of US Army Reserve/National Guard (USAR/NG) soldiers. This sample consisted of male USAR/NG soldiers with at least one combat deployment (N = 228). At baseline, we assessed the following as potential protective factors: deployment preparation, unit support and support from family/friends during soldiers' most recent deployment, and marital satisfaction. We examined the relations between each of these resiliency factors with drug use at the first follow-up assessment using the NIDA modified ASSIST 2.0. RESULTS Greater unit support (AOR = 0.56, 95% CI: 0.34, 0.92; p < 0.05) and support from family/friends during deployment (AOR = 0.64, 95% CI: 0.43, 0.96; p < 0.05) were associated with lower odds of drug use, controlling for age, rank, years of military service, combat exposure, traumatic brain injury, time since last deployment, and baseline drug use. Deployment preparation and marital satisfaction were not associated with drug use (ps > 0.05). CONCLUSIONS Social support provided to soldiers during deployment, either by his unit or his family/friends, showed evidence of protection against post-deployment drug use. In addition to existing post-deployment efforts, we recommend interventions that facilitate stronger interpersonal relationships during deployment.
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Affiliation(s)
- Rachel A. Hoopsick
- Department of Community Health & Health Behavior, University at Buffalo, The State University of New York, Buffalo, NY, USA,Corresponding Author: Rachel A. Hoopsick, MS, MPH, CHES, Department of Community Health & Health Behavior, University at Buffalo, The State University of New York, 3435 Main Street, 335 Kimball Tower, Buffalo, NY 14214, USA. Phone: 716-829-4731,
| | - Katelyn R. Benson
- Department of Community Health & Health Behavior, University at Buffalo, The State University of New York, Buffalo, NY, USA
| | - D. Lynn Homish
- Department of Community Health & Health Behavior, University at Buffalo, The State University of New York, Buffalo, NY, USA
| | - Gregory G. Homish
- Department of Community Health & Health Behavior, University at Buffalo, The State University of New York, Buffalo, NY, USA
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Campbell-Sills L, Kessler RC, Ursano RJ, Sun X, Taylor CT, Heeringa SG, Nock MK, Sampson NA, Jain S, Stein MB. Predictive validity and correlates of self-assessed resilience among U.S. Army soldiers. Depress Anxiety 2018; 35:122-131. [PMID: 29095544 PMCID: PMC6013057 DOI: 10.1002/da.22694] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Revised: 09/11/2017] [Accepted: 10/01/2017] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Self-assessment of resilience could prove valuable to military and other organizations whose personnel confront foreseen stressors. We evaluated the validity of self-assessed resilience among U.S. Army soldiers, including whether predeployment perceived resilience predicted postdeployment emotional disorder. METHODS Resilience was assessed via self-administered questionnaire among new soldiers reporting for basic training (N = 35,807) and experienced soldiers preparing to deploy to Afghanistan (N = 8,558). Concurrent validity of self-assessed resilience was evaluated among recruits by estimating its association with past-month emotional disorder. Predictive validity was examined among 3,526 experienced soldiers with no lifetime emotional disorder predeployment. Predictive models estimated associations of predeployment resilience with incidence of emotional disorder through 9 months postdeployment and with marked improvement in coping at 3 months postdeployment. Weights-adjusted regression models incorporated stringent controls for risk factors. RESULTS Soldiers characterized themselves as very resilient on average [M = 14.34, SD = 4.20 (recruits); M = 14.75, SD = 4.31 (experienced soldiers); theoretical range = 0-20]. Demographic characteristics exhibited only modest associations with resilience, while severity of childhood maltreatment was negatively associated with resilience in both samples. Among recruits, resilience was inversely associated with past-month emotional disorder [adjusted odds ratio (AOR) = 0.65, 95% CI = 0.62-0.68, P < .0005 (per standard score increase)]. Among deployed soldiers, greater predeployment resilience was associated with decreased incidence of emotional disorder (AOR = 0.91; 95% CI = 0.84-0.98; P = .016) and increased odds of improved coping (AOR = 1.36; 95% CI = 1.24-1.49; P < .0005) postdeployment. CONCLUSIONS Findings supported validity of self-assessed resilience among soldiers, although its predictive effect on incidence of emotional disorder was modest. In conjunction with assessment of known risk factors, measurement of resilience could help predict adaptation to foreseen stressors like deployment.
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Affiliation(s)
| | - Ronald C. Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
| | - Robert J. Ursano
- Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Xiaoying Sun
- Department of Family Medicine and Public Health, University of California San Diego, La Jolla, CA, USA
| | - Charles T. Taylor
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
| | - Steven G. Heeringa
- University of Michigan, Institute for Social Research, Ann Arbor, MI, USA
| | - Matthew K. Nock
- Department of Psychology, Harvard University, Cambridge, MA, USA
| | - Nancy A. Sampson
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
| | - Sonia Jain
- Department of Family Medicine and Public Health, University of California San Diego, La Jolla, CA, USA
| | - Murray B. Stein
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA,Department of Family Medicine and Public Health, University of California San Diego, La Jolla, CA, USA,VA San Diego Healthcare System, San Diego, CA, USA
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Combat exposure, emotional and physical role limitations, and substance use among male United States Army Reserve and National Guard soldiers. Qual Life Res 2017; 27:137-147. [PMID: 28921407 DOI: 10.1007/s11136-017-1706-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/12/2017] [Indexed: 12/12/2022]
Abstract
PURPOSE Combat-exposed soldiers are at an increased risk for health problems that diminish quality of life (QOL) and substance use. We explored the cross-sectional associations between combat exposure and two measures of QOL, and the effect of substance use on those associations. METHODS Data are from the baseline wave of Operation: SAFETY, an ongoing survey-based study of United States Army Reserve/National Guard (USAR/NG) soldiers and their partners. Our sample consisted of male USAR/NG soldiers with a history of deployment (N = 248). Limitations in usual activity due to physical and emotional problems were assessed using the 36-Item Short-Form Health Survey (SF-36). RESULTS Greater combat exposure was independently associated with limitations in usual activity due to physical (regression coefficient = -0.35, 95% CI -0.55 to -0.16, R 2 = 0.09; p < 0.01) and emotional (regression coefficient = -0.32, 95% CI -0.56 to -0.09, R 2 = 0.09; p < 0.01) problems. Combat exposure had a significant interaction with frequent heavy drinking on physical role limitations (regression coefficient = -0.65, 95% CI -1.18 to -0.12, R 2 = 0.12; p < 0.05) and emotional role limitations (regression coefficient = -0.83, 95% CI -1.46 to -0.19, R 2 = 0.12; p < 0.05). Combat exposure also had a significant interaction with lifetime non-medical use of prescription drugs on physical role limitations (regression coefficient = 0.81, 95% CI 0.18-1.45, R 2 = 0.11; p < 0.05). CONCLUSION Combat is an unmodifiable risk factor for poor QOL among soldiers; however, frequent heavy drinking and non-medical use of prescription drugs modifies the relationship between combat exposure and QOL. Therefore, substance use is a potential point of intervention to improve QOL among soldiers.
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Smith BN, Taverna EC, Fox AB, Schnurr PP, Matteo RA, Vogt D. The Role of PTSD, Depression, and Alcohol Misuse Symptom Severity in Linking Deployment Stressor Exposure and Post-Military Work and Family Outcomes in Male and Female Veterans. Clin Psychol Sci 2017; 5:664-682. [PMID: 28690925 DOI: 10.1177/2167702617705672] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Exposure to stressors during military deployment puts veterans at risk for reduced post-military quality of life. Stress-related mental health problems may lead to decreased well-being within work and family domains, yet few studies have explored associations in the context of gender. We examined relationships between deployment stressors and post-military functioning and satisfaction in the domains of work and family, with a focus on PTSD, depression, and alcohol misuse symptomatology as potential mediators. Participants included 522 male and female Iraq and Afghanistan War veterans assessed longitudinally. Structural equation models supported several direct and indirect pathways linking deployment stressors to work and family outcomes for both men and women. PTSD had an important role in these associations. Depression also played a significant role, particularly for women. These findings build on prior research by elucidating potential gender-specific risk, which may be applied to better tailor services to veterans' unique needs.
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Affiliation(s)
- Brian N Smith
- National Center for PTSD Women's Health Sciences Division and VA Boston Healthcare System.,Department of Psychiatry, Boston University School of Medicine
| | - Emily C Taverna
- National Center for PTSD Women's Health Sciences Division and VA Boston Healthcare System
| | - Annie B Fox
- National Center for PTSD Women's Health Sciences Division and VA Boston Healthcare System
| | - Paula P Schnurr
- National Center for PTSD, Executive Division.,Department of Psychiatry, Geisel School of Medicine at Dartmouth
| | | | - Dawne Vogt
- National Center for PTSD Women's Health Sciences Division and VA Boston Healthcare System.,Department of Psychiatry, Boston University School of Medicine
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