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Bekesiene S, Smaliukienė R, Vaičaitienė R, Bagdžiūnienė D, Kanapeckaitė R, Kapustian O, Nakonechnyi O. Prioritizing competencies for soldier's mental resilience: an application of integrative fuzzy-trapezoidal decision-making trial and evaluation laboratory in updating training program. Front Psychol 2024; 14:1239481. [PMID: 38374929 PMCID: PMC10875136 DOI: 10.3389/fpsyg.2023.1239481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 12/07/2023] [Indexed: 02/21/2024] Open
Abstract
Background The development of resilience is of the utmost importance in military training due to the demanding and high-stress nature of combat situations. Although there have been numerous studies on resilience competencies in the military, there is a research gap when it comes to identifying the most essential competencies that should be prioritized in training programs, particularly within compressed timeframes. With the current geopolitical landscape and ongoing military conflicts in Europe, it is necessary to expedite training of soldiers, including resilience training, without compromising the effectiveness of the program. This study aims to address this research gap by using a reductionist approach to resilience training and identifying the critical competencies that senior soldiers need to be trained to coach younger soldiers to maintain psychological strength during deployment. By filling this research gap, the study will contribute to the development of more efficient and targeted resilience training programs that optimize the ability of soldiers to adapt and excel in challenging military environments. Methods To address the issue, this study assessed the competencies comprising the master resilience training (MRT) program, widely recognized as one of the most effective military resilience training programs. Two groups of military experts, totaling 16 individuals, were involved in the evaluation process, representing two military contexts. The first group consisted of Ukrainian military experts whose experiences primarily focused on defending their own country's territory. The second group comprised Lithuanian military experts who had greater expertise in conducting military missions abroad. The assessment of resilience competencies was carried out using a deep analysis approach through the application of effective multi-criteria decision making (MCDM). Specifically, the decision-making trial and evaluation laboratory (DEMATEL) method was used, which is a significant multicriteria technique used to determine relationships among criteria and assign weight coefficients. In this study, the DEMATEL model was extended using trapezoidal fuzzy numbers (TrFN-DEMATEL) to accommodate decision-making under uncertainty conditions. Results The research findings highlight the critical importance of three core resilience competencies: self-regulation, mental agility and strength of character. The importance of each competency varies depending on the specific military context. When defending one's own country's territory, strength of character emerges as the key factor in enhancing soldiers' mental resilience. Conversely, during military operations abroad, self-regulation is the primary factor that promotes psychological resilience. Furthermore, the results show that these three primary competencies form a 'cause group' that influences other competencies through a cause-and-effect dependency. Conclusion Based on the findings, the theoretical conclusion is drawn that the importance of resilience competencies is contextually differentiated. Furthermore, each resilience competency is associated with a set of causes or effects. These are valuable insights for improving resilience competency training programs.
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Affiliation(s)
- Svajone Bekesiene
- General Jonas Zemaitis Military Academy of Lithuania, Vilnius, Lithuania
| | - Rasa Smaliukienė
- General Jonas Zemaitis Military Academy of Lithuania, Vilnius, Lithuania
| | - Ramutė Vaičaitienė
- General Jonas Zemaitis Military Academy of Lithuania, Vilnius, Lithuania
| | - Dalia Bagdžiūnienė
- General Jonas Zemaitis Military Academy of Lithuania, Vilnius, Lithuania
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Ackerman A. The effect of combat exposure on sexually transmitted diseases. ECONOMICS AND HUMAN BIOLOGY 2022; 46:101142. [PMID: 35525101 DOI: 10.1016/j.ehb.2022.101142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 04/14/2022] [Accepted: 04/19/2022] [Indexed: 06/14/2023]
Abstract
Traumatic exposures can affect beliefs and behaviors related to the spread of sexually transmitted diseases (STDs), a persistent public health problem. I leverage a natural experiment created by variation in US military deployment location assignments to estimate how combat exposure changes a surviving deployed male veteran's probability of acquiring a sexually transmitted disease. I analyze longitudinal data from 1994 to 2008 on 485 deployed veterans with information theoretic methods to reduce the sensitivity of estimates to small samples, an infrequently observed outcome, and highly correlated covariates. For veterans assigned to a combat zone, I estimate combat exposure results in a 5.4 percentage point increase in the probability of acquiring an STD. Additional estimations provide evidence suggesting risky behaviors involving substance use or multiple sexual partners may serve as pathways from combat exposure to STDs. My results are relevant to discussions regarding STD screening and care needs for trauma exposed individuals.
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Affiliation(s)
- Adam Ackerman
- American University, Department of Economics, Kreeger Building, Washington DC 20016, USA.
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Hawn SE, Wolf EJ, Neale Z, Miller MW. Conceptualizing traumatic stress and the structure of posttraumatic psychopathology through the lenses of RDoC and HiTOP. Clin Psychol Rev 2022; 95:102177. [PMID: 35690042 DOI: 10.1016/j.cpr.2022.102177] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 04/14/2022] [Accepted: 06/01/2022] [Indexed: 11/03/2022]
Abstract
Trauma-related psychopathology, most notably posttraumatic stress disorder (PTSD), poses unique challenges for psychiatric nosology due to the wide range of symptoms and diagnoses associated with trauma and challenges representing the impact of trauma exposure on psychopathology. In this paper, we review the literature on categorical (i.e., Diagnostic and Statistical Manual of Mental Disorders and International Classification of Diseases systems) versus dimensional conceptualizations of trauma-related symptoms with an emphasis on the Research Domain Criteria (RDoC) and the Hierarchical Taxonomy of Psychopathology (HiTOP) frameworks. We identify strengths of each approach and challenges in accommodating the full range of trauma-related psychopathology and the clinical implications thereof. We discuss several potential approaches for improving the representation of traumatic stress, including the use of PTSD subtypes, trauma-related specifiers for psychiatric diagnoses, and the development of a dimension that we call the traumatic stress spectrum, which spans both adaptive and adverse reactions to trauma. These approaches to representing traumatic stress can be evaluated empirically and further refined. We also discuss how the use of an integrated RDoC-HiTOP approach to reconceptualize traumatic stress might maximize the ability to model valid and reliable trauma-related phenotypes, which would aid in the investigation of clinically relevant biological correlates.
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Affiliation(s)
- Sage E Hawn
- National Center for PTSD at VA Boston Healthcare System, Boston, MA, USA; Boston University School of Medicine, Department of Psychiatry, Boston, MA, USA
| | - Erika J Wolf
- National Center for PTSD at VA Boston Healthcare System, Boston, MA, USA; Boston University School of Medicine, Department of Psychiatry, Boston, MA, USA
| | - Zoë Neale
- National Center for PTSD at VA Boston Healthcare System, Boston, MA, USA; Boston University School of Medicine, Department of Psychiatry, Boston, MA, USA
| | - Mark W Miller
- National Center for PTSD at VA Boston Healthcare System, Boston, MA, USA; Boston University School of Medicine, Department of Psychiatry, Boston, MA, USA.
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Kaysen D, Rhew IC, Bittinger J, Bedard-Gilligan M, Garberson LA, Hodge KA, Nguyen AJ, Logan DE, Dworkin ER, Lindgren K. Prevalence and Factor Structure of PTSD in DSM-5 Versus DSM-IV in a National Sample of Sexual Minority Women. JOURNAL OF INTERPERSONAL VIOLENCE 2021; 36:NP12388-NP12410. [PMID: 31833796 PMCID: PMC7292760 DOI: 10.1177/0886260519892960] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
The impact of changes to posttraumatic stress disorder (PTSD) diagnostic criteria from Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV) to Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5) within diverse communities is unclear. Young adult sexual minority women are at high risk for interpersonal violence and other forms of trauma exposure compared with heterosexual populations and sexual minority men. They are also at heightened risk of PTSD. As a result, young adult sexual minority women are a key population of interest when examining the impact of diagnostic criteria changes. The goal of the current study was to evaluate the impact of changes to PTSD diagnostic criteria in sexual minority women. Using an online survey, we administered both the original PTSD Symptom Checklist-S (based on DSM-IV criteria) and a version adapted to assess DSM-5 criteria to a national, nonclinical sample of young adult sexual minority women (N = 767). The DSM-5 symptom criteria fit the data well in confirmatory factor analysis. Current PTSD prevalence was higher under the DSM-5 diagnostic algorithm compared with DSM-IV (18.6% vs. 22.9%; d = 0.15). Compared with DSM-IV, associations between PTSD and depression were stronger using DSM-5 criteria, whereas associations between PTSD and high-risk drinking were reduced. Findings suggest that changes to PTSD diagnostic criteria do not have a major impact on prevalence of PTSD among sexual minority women but may have some impact on observed comorbidities.
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Goldner L, Shelef L, Goldstein BA, Scharf M. Understanding processes that advance suicidal behavior among Israeli active duty soldiers: A mediation model. J Clin Psychol 2021; 78:590-601. [PMID: 34380174 DOI: 10.1002/jclp.23237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 06/08/2021] [Accepted: 07/28/2021] [Indexed: 11/08/2022]
Abstract
OBJECTIVES The current study was aimed to identify the factors and mechanisms that promote nonsuicidal self-injury and suicidal ideation (SI) as precursors of suicidal behaviors in a sample of 553 Israeli active-duty soldiers. METHODS A mediation model was used to examine the contribution of posttraumatic stress disorder (PTSD) symptoms, emotion-regulation difficulties, habituation, and risk-taking behaviors to soldiers' self-injury and SI. RESULTS Results indicated direct effects between PTSD symptoms and self-injury and SI, as well as between emotion regulation difficulties and self-injury. Indirect effects were found between PTSD symptoms and nonsuicidal self-injury (NSSI) through the mechanisms of habituation and risk-taking behavior and between difficulties in emotion regulation and NSSI through the mechanism of risk-taking behaviors. CONCLUSION To tackle soldiers' suicidal behaviors, clinicians might assess soldiers' PTSD symptoms and difficulties in emotion regulation and intervene by lessening their access to thrill-seeking situations and situations that increase habituation to pain and death.
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Affiliation(s)
- Limor Goldner
- School of Creative Arts Therapies, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
| | - Leah Shelef
- Mental Health Unit, Medical Corps, Israel Defense Forces, Ramat Gan, Israel
| | - Becky Amit Goldstein
- Mental Health Unit, Medical Corps, Israel Defense Forces, Ramat Gan, Israel.,Department of Counseling and Human Development, University of Haifa, Haifa, Israel
| | - Miri Scharf
- Department of Counseling and Human Development, University of Haifa, Haifa, Israel
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Vest BM, Brady LA, Brimmer MJ, Homish GG. Variations in Risk and Motivations for Substance Use over the Course of Military Service. Subst Use Misuse 2021; 56:559-566. [PMID: 33616468 PMCID: PMC8108137 DOI: 10.1080/10826084.2021.1887257] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Epidemiological data identify risk factors related to substance use among military service members to inform prevention and treatment. Less is known about how motivations and risks for substance use vary over a military service career. The study goal was to explore substance use patterns and motivations among a sample of United States undergraduate student veterans in order to identify periods of risk. Methods: Qualitative interviews were conducted (n = 31) between December 2018 and April 2019. Transcripts were coded in ATLAS.ti using thematic content analysis. Results: Interviews revealed complex motivations around substance use and identified key periods of risk. 1) Pre-service: Participants reported using alcohol and marijuana, primarily during social activities. 2) During service: Participants described a culture of heavy alcohol and tobacco use in social contexts, but little use of other substances. Post-deployment was a notable exception, when some reported heavier alcohol use and use of other drugs, including opiates, cocaine, and ecstasy. 3) Post-service: Transitioning out of the military was described as difficult; some participants reported heavier use of substances during this period. Some participants quit smoking after military service, or switched to vaping. Others reported use of alcohol and/or marijuana to calm themselves, relieve stress, and enable sleep. Conclusions: These data indicate that the periods immediately following deployment and transition out of the military may be especially high-risk for heavy substance use and use of a broader range of substances. This highlights the need for tailored interventions and messaging at different points of military service, particularly during periods of greatest risk.
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Affiliation(s)
- Bonnie M Vest
- Primary Care Research Institute, Department of Family Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
| | - Laura A Brady
- Primary Care Research Institute, Department of Family Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
| | - Maximilian J Brimmer
- Primary Care Research Institute, Department of Family Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
| | - Gregory G Homish
- Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo, Buffalo, New York, USA
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7
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Silverstein MW, Petri JM, Kramer LB, Weathers FW. An item response theory analysis of the PTSD checklist for DSM-5: Implications for DSM-5 and ICD-11. J Anxiety Disord 2020; 70:102190. [PMID: 32106024 DOI: 10.1016/j.janxdis.2020.102190] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 12/05/2019] [Accepted: 01/15/2020] [Indexed: 01/05/2023]
Abstract
The PTSD Checklist (PCL) is a widely used, extensively validated questionnaire for posttraumatic stress disorder (PTSD). The PCL was revised for Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5; Friedman, 2013), and the updated version, the PCL-5, has continued the strong psychometric performance of the original version. To further explore the PCL-5's psychometric properties, we used item response theory (IRT) to examine item difficulty and discrimination parameters in separate samples of trauma-exposed undergraduates (N = 1213) and community members (N = 367). Considering item difficulty, nightmares, flashbacks, and reckless or self-destructive behavior emerged among the most difficult items across samples and internal avoidance emerged as the least difficult items across samples. In terms of item discrimination, inability to experience positive emotions, detachment from others, diminished interest, and negative emotions emerged as highly discriminating items in both samples, and traumatic amnesia and reckless or self-destructive behavior emerged as the least discriminating items in both samples. These results have implications for the divergent conceptualizations of PTSD in DSM-5 versus International Classification of Diseases, 11th Edition (ICD-11; WHO, 2018). Future research should employ IRT in a clinical population.
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8
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Rice VJB, Schroeder PJ. Self-Reported Sleep, Anxiety, and Cognitive Performance in a Sample of U.S. Military Active Duty and Veterans. Mil Med 2019; 184:488-497. [PMID: 30901421 DOI: 10.1093/milmed/usy323] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Revised: 10/16/2018] [Indexed: 01/14/2023] Open
Abstract
Unhealthy sleep can interfere with U.S. military service members affective and cognitive functioning, and increase accident and injury risks. This study examined the relationship between U.S. active duty and veterans' (n = 233) self-reported sleep (Pittsburgh Sleep Quality Index), anxiety (Zung Self-Rating Anxiety Scale), and cognitive performance (Automated Neuropsychological Assessment Metric). Statistical analyses included Pearson product moment correlations and multivariate analysis of variance, with Tukey-b post-hoc tests, with a p < 0.05 significance level. Higher education, abstinence from sleep aids, longer time in active duty service, and being on active duty were correlated with better sleep and lower anxiety. Greater sleep disturbance, poor sleep quality, and sleepiness-related daytime dysfunction were associated with greater anxiety and slower response times, and lower response accuracy. Statistically controlling for anxiety diminished the magnitude and significance of the correlations between sleep and cognitive performance, suggesting that reducing anxiety will improve sleep and diminish cognitive performance effects. These findings suggest the need for addressing both sleep and anxiety for those with diagnosed sleep disorders, as well as using a procedural systems approach to decrease anxiety during missions that demand outstanding cognitive performance.
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Affiliation(s)
- Valerie J B Rice
- HRED AMEDD Field Element, 2950 Koehler Rd, Suite 1099, Fort Sam Houston, San Antonio, TX
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9
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Kemp E, Sadeh N, Baskin-Sommers A. A Latent Profile Analysis of Affective Triggers for Risky and Impulsive Behavior. Front Psychol 2019; 9:2651. [PMID: 30662421 PMCID: PMC6328440 DOI: 10.3389/fpsyg.2018.02651] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2018] [Accepted: 12/10/2018] [Indexed: 11/13/2022] Open
Abstract
Common theoretical models of risky and impulsive behaviors suggest that individuals engage in risky behavior to avoid negative affect or enhance positive affect. However, little research has been done to identify person-centered affective profiles of risky and impulsive behavior, and delineate the individual differences across these profiles. The present study used the Risky, Impulsive, and Self-destructive Behavior Questionnaire in community (N = 439) and incarcerated (N = 262) samples to examine latent affect profiles for risky and impulsive behavior. Four affective profiles emerged: low avoidance and low approach, average avoidance and average approach, high avoidance, and high approach. Conditional probability correlations revealed meaningful differences across these profiles in psychiatric symptomatology, personality characteristics, and behavior. Consideration of affective triggers provides an important framework for dissociating the underlying reasons why individuals engage in risky behavior.
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Affiliation(s)
- Emily Kemp
- Department of Psychiatry, Yale University, New Haven, CT, United States
| | - Naomi Sadeh
- Department of Psychological and Brain Sciences, University of Delaware, Newark, DE, United States
| | - Arielle Baskin-Sommers
- Department of Psychiatry, Yale University, New Haven, CT, United States
- Department of Psychology, Yale University, New Haven, CT, United States
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10
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Traumatic Brain Injury in the General Population: Incidence, Mental Health Comorbidity, and Functional Impact. J Nerv Ment Dis 2019; 207:38-42. [PMID: 30575707 DOI: 10.1097/nmd.0000000000000915] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Traumatic brain injury (TBI) is a relatively prevalent and burdensome condition with significant public health cost; however, epidemiological studies of TBI in the United States have rarely used nationally representative samples or included measures of functioning. Data were obtained from the third wave of the National Epidemiological Survey on Alcohol and Related Conditions. Of the 36,309 individuals surveyed, 193 (0.53% weighted) reported a past-year TBI. Results from weighted logistic regression modeling indicated that prior active duty military status, mood disorders, posttraumatic stress disorder, and nicotine use disorders were associated with greater odds of TBI. Annual household income greater than $20,000 was associated with lower odds of TBI. Regarding functioning, TBI was associated with greater impairment on SF-12 scales measuring mental and physical health and the organization subscale of the Executive Function Index. Results suggest that many individuals in the US population experience TBI each year and that such injuries are associated with impairment across multiple domains.
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11
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Black AC, McMahon TJ, Brecht ML, Rosen MI. Tailoring and testing an event history calendar of lifetime sexual partnerships for military Veterans. MILITARY PSYCHOLOGY 2018. [DOI: 10.1080/08995605.2018.1478560] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Anne C. Black
- VA Connecticut Healthcare System, West Haven, Connecticut
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut
| | - Thomas J. McMahon
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut
| | - Mary-Lynn Brecht
- Semel Institute, David Geffen School of Medicine, University of California Los Angeles Integrated Substance Abuse Programs (ISAP), Los Angeles, California
| | - Marc I. Rosen
- VA Connecticut Healthcare System, West Haven, Connecticut
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut
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12
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Ponce de León B, Andersen S, Karstoft KI, Murphy S, Elklit A. Sensation seeking as a predictor of psychopathology in Danish soldiers deployed to Afghanistan. MILITARY PSYCHOLOGY 2018. [DOI: 10.1080/08995605.2018.1478544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Beatriz Ponce de León
- Department of Psychology, University of Southern Denmark
- Psychiatry, Afdeling for Traume- og Torturoverlevere, Region of Southern Denmark
| | - Søren Andersen
- Research and Knowledge Centre, The Danish Veteran Centre, Ringsted, Denmark
| | | | - Siobhan Murphy
- Department of Psychology, University of Southern Denmark
| | - Ask Elklit
- Department of Psychology, University of Southern Denmark
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13
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Silverstein MW, Dieujuste N, Kramer LB, Lee DJ, Weathers FW. Construct validation of the hybrid model of posttraumatic stress disorder: Distinctiveness of the new symptom clusters. J Anxiety Disord 2018; 54:17-23. [PMID: 29421368 DOI: 10.1016/j.janxdis.2017.12.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2017] [Revised: 10/31/2017] [Accepted: 12/13/2017] [Indexed: 11/29/2022]
Abstract
Despite the factor analytic support for the seven-factor hybrid model (Armour et al., 2015) of posttraumatic stress disorder (PTSD), little research has examined the degree to which newly established symptom clusters (i.e., negative affect, anhedonia, dysphoric arousal, anxious arousal, externalizing behavior) functionally and meaningfully differ in their associations with other clinical phenomena. The aim of the current study was to examine the degree to which newly established PTSD symptom clusters differentially relate to co-occurring psychopathology and related clinical phenomena through Wald testing using latent variable modeling. Participants were 535 trauma-exposed undergraduates who completed the Posttraumatic Stress Disorder Checklist for DSM-5 (PCL-5; Weathers et al., 2013) and Personality Assessment Inventory (PAI; Morey, 1991). As expected and in line with results from previous studies, significant heterogeneity emerged for dysphoric arousal, anxious arousal, and externalizing behavior. However, there was less evidence for the distinctiveness of negative affect and anhedonia. Results indicate that only some of the newly established symptom clusters significantly differ in their associations with related clinical phenomena and that the hybrid model might not provide a meaningful framework for understanding which PTSD symptoms relate to associated features. Limitations include a non-clinical sample and reliance on retrospective self-report assessment measures.
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Affiliation(s)
| | - Nathalie Dieujuste
- VISN 19 Rocky Mountain MIRECC, Denver Veterans Affairs Medical Center, United States
| | | | - Daniel J Lee
- Veterans Affairs Boston Healthcare System, Boston University School of Medicine, United States
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14
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Sadeh N, Spielberg JM, Hayes JP. Impulsive responding in threat and reward contexts as a function of PTSD symptoms and trait disinhibition. J Anxiety Disord 2018; 53:76-84. [PMID: 29220694 DOI: 10.1016/j.janxdis.2017.11.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Revised: 09/22/2017] [Accepted: 11/01/2017] [Indexed: 11/29/2022]
Abstract
We examined current posttraumatic stress disorder (PTSD) symptoms, trait disinhibition, and affective context as contributors to impulsive and self-destructive behavior in 94 trauma-exposed Veterans. Participants completed an affective Go/No-Go task (GNG) with different emotional contexts (threat, reward, and a multidimensional threat/reward condition) and current PTSD, trait disinhibition, and risky/self-destructive behavior measures. PTSD interacted with trait disinhibition to explain recent engagement in risky/self-destructive behavior, with Veterans scoring high on trait disinhibition and current PTSD symptoms reporting the highest levels of these behaviors. On the GNG task, commission errors were also associated with the interaction of PTSD symptoms and trait disinhibition. Specifically, PTSD symptoms were associated with greater commission errors in threat vs. reward contexts for individuals who were low on trait disinhibition. In contrast, veterans high on PTSD and trait disinhibition exhibited the greatest number of commission errors in the multidimensional affective context that involved both threat and reward processing. Results highlight the interactive effects of PTSD and disinhibited personality traits, as well as threat and reward systems, as risk factors for impulsive and self-destructive behavior in trauma-exposed groups. Findings have clinical implications for understanding heterogeneity in the expression of PTSD and its association with disinhibited behavior.
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Affiliation(s)
- Naomi Sadeh
- University of Delaware, Department of Psychological and Brain Sciences, Newark, DE, United States; National Center for PTSD at VA Boston Healthcare System, Boston, MA, United States.
| | - Jeffrey M Spielberg
- University of Delaware, Department of Psychological and Brain Sciences, Newark, DE, United States
| | - Jasmeet P Hayes
- National Center for PTSD at VA Boston Healthcare System, Boston, MA, United States; Boston University School of Medicine, Boston, MA, United States
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15
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Betthauser LM, Allen E, Grigsby J, Brenner LA. A Qualitative Analysis of Adventurous Activities Among OEF/OIF Veterans. ACTA ACUST UNITED AC 2017. [DOI: 10.1080/21635781.2017.1337596] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Lisa M. Betthauser
- VISN 19 Mental Illness Research, Education, and Clinical Center, Denver Veterans Affairs Medical Center, Denver, Colorado
- Department of Psychology, University of Colorado Denver, Denver, Colorado
| | - Elizabeth Allen
- Department of Psychology, University of Colorado Denver, Denver, Colorado
| | - Jim Grigsby
- Department of Psychology, University of Colorado Denver, Denver, Colorado
| | - Lisa A. Brenner
- VISN 19 Mental Illness Research, Education, and Clinical Center, Denver Veterans Affairs Medical Center, Denver, Colorado
- School of Medicine, University of Colorado Denver, Denver, Colorado
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16
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Lusk JD, Sadeh N, Wolf EJ, Miller MW. Reckless Self-Destructive Behavior and PTSD in Veterans: The Mediating Role of New Adverse Events. J Trauma Stress 2017; 30:270-278. [PMID: 28471014 PMCID: PMC5482753 DOI: 10.1002/jts.22182] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Revised: 01/24/2017] [Accepted: 02/04/2017] [Indexed: 11/05/2022]
Abstract
The addition of self-destructive and reckless behavior as a symptom of posttraumatic stress disorder (PTSD) in DSM-5 has stimulated renewed interest in understanding relationships between these behaviors and trauma-related psychopathology. This study examined the relationship between reckless and self-destructive behaviors (RSDB), intervening exposure to new adverse events, and later PTSD severity in a sample of trauma-exposed veterans. At baseline, participants were assessed for RSDB (past 5 years) and current PTSD severity (N = 222). PTSD severity was then reassessed approximately 4 years later (N = 148). Overall, RSDB were reported by 74.4% of the sample, with 61.3% engaging in multiple forms of RSDB. The most commonly endorsed behaviors included alcohol/drug abuse (42.8%), driving while intoxicated (29.4%), gambling (24.7%), and aggression (23.1%). There was a positive correlation between RSDB and PTSD severity at both the baseline (r = .16, p = .031) and follow-up assessment (r = .24, p = .005). Path models indicated that exposure to new adverse events fully mediated the effect of Time 1 RSDB on PTSD symptoms at Time 2 (indirect association: β = .05, p = .046). Results suggest that RSDB are common among trauma-exposed veterans and may perpetuate PTSD symptoms by increasing exposure to new adverse events.
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Affiliation(s)
- Joanna D. Lusk
- National Center for PTSD at VA Boston Healthcare System
- Boston University School of Medicine, Department of Psychiatry
| | - Naomi Sadeh
- National Center for PTSD at VA Boston Healthcare System
- Boston University School of Medicine, Department of Psychiatry
- University of Delaware, Department of Psychological and Brain Sciences
| | - Erika J. Wolf
- National Center for PTSD at VA Boston Healthcare System
- Boston University School of Medicine, Department of Psychiatry
| | - Mark W. Miller
- National Center for PTSD at VA Boston Healthcare System
- Boston University School of Medicine, Department of Psychiatry
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Bullman TA, Kang HK, Smolenski DJ, Skopp NA, Gahm GA, Reger MA. Risk of motor vehicle accident death among 1.3 million veterans of the Iraq and Afghanistan wars. TRAFFIC INJURY PREVENTION 2017; 18:369-374. [PMID: 27589092 DOI: 10.1080/15389588.2016.1206201] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Accepted: 06/21/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVE We conducted a cohort study of recent wartime veterans to determine the postservice mortality risk due to motor vehicle accidents (MVAs). METHODS Veterans were identified from the Defense Manpower Data Center records. Deployment to te Iraq or Afghanistan war zone was determined from the Contingency Tracking System. Vital status of 317,581 deployed and 964,493 nondeployed veterans was followed from their discharge dates between 2001 to 2007 until earlier of date of death or December 31, 2009. Underlying causes of death were obtained from the National Death Index Plus. RESULTS Based on 9,353 deaths (deployed, 1,650; nondeployed, 7,703), of which 779 were MVA deaths as drivers (166; 613), both cohorts had 25 to 24% lower mortality risk from all causes but had 44 to 45% higher risk of MVA deaths relative to the U.S. general population. The higher MVA mortality risk was not associated with deployment to the war zone. After controlling for age, sex, race, marital status, branch of service, and rank, the risk for deployed veterans was comparable to that of nondeployed veterans (hazard ratio = 0.91; 95% confidence interval, 0.77-1.09). CONCLUSIONS Veterans exhibit significantly higher risk of MVA deaths compared to the U.S. general population. However, deployment to the Iraq or Afghanistan war was not associated with the excess risk.
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Affiliation(s)
- Tim A Bullman
- a Office of Public Health , U.S. Department of Veterans Affairs , Washington , D.C
| | - Han K Kang
- b Institute for Clinical Research , Washington , D.C
| | - Derek J Smolenski
- c National Center for Telehealth and Technology , U.S. Department of the Army , Tacoma , Washington
| | - Nancy A Skopp
- c National Center for Telehealth and Technology , U.S. Department of the Army , Tacoma , Washington
| | - Gregory A Gahm
- c National Center for Telehealth and Technology , U.S. Department of the Army , Tacoma , Washington
| | - Mark A Reger
- c National Center for Telehealth and Technology , U.S. Department of the Army , Tacoma , Washington
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Richardson D, King L, Shnaider P, Elhai JD. Adverse combat experiences, feeling responsible for death, and suicidal ideation in treatment-seeking Veterans and actively serving Canadian Armed Forces members. JOURNAL OF MILITARY, VETERAN AND FAMILY HEALTH 2017. [DOI: 10.3138/jmvfh.4105] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Don Richardson
- Parkwood Operational Stress Injury Clinic, London, Ontario, Canada
| | - Lisa King
- Parkwood Operational Stress Injury Clinic, London, Ontario, Canada
| | - Philippe Shnaider
- Anxiety Treatment and Research Clinic, St. Joseph's Healthcare, Hamilton, Ontario, Canada
| | - Jon D. Elhai
- Department of Psychology, University of Toledo, Toledo, Ohio, USA
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Barth KS, Ball S, Adams RS, Nikitin R, Wooten NR, Qureshi ZP, Larson MJ. Development and Feasibility of an Academic Detailing Intervention to Improve Prescription Drug Monitoring Program Use Among Physicians. THE JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS 2017; 37:98-105. [PMID: 28562498 PMCID: PMC5521811 DOI: 10.1097/ceh.0000000000000149] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
INTRODUCTION South Carolina (SC) ranks 10th in opioid prescriptions per capita-33% higher than the national average. SC is also home to a large military and veteran population, and prescription opioid use for chronic pain is alarmingly common among veterans, especially those returning from Afghanistan and Iraq. This article describes the background and development of an academic detailing (AD) educational intervention to improve use of a Prescription Drug Monitoring Program among SC physicians who serve military members and veterans. The aim of this intervention was to improve safe opioid prescribing practices and prevent prescription opioid misuse among this high-risk population. METHODS A multidisciplinary study team of physicians, pharmacists, psychologists, epidemiologists, and representatives from the SC's Prescription Monitoring Program used the Medical Research Council complex interventions framework to guide the development of the educational intervention. The theoretical and modeling phases of the AD intervention development are described and preliminary evidence of feasibility and acceptability is provided. RESULTS Ninety-three physicians consented to the study from 2 practice sites. Eighty-seven AD visits were completed, and 59 one-month follow-up surveys were received. Participants rated the AD intervention high in helpfulness of information, intention to use information, and overall satisfaction with the intervention. The component of the intervention felt to be most helpful was the AD visit itself. Characteristics of the participants and the intervention, as well as anticipated barriers to behavior change are detailed. DISCUSSION Preliminary results support the feasibility of AD delivery to veteran and community patient settings, the feasibility of facilitating Prescription Drug Monitoring Program registration during an AD visit, and that AD visits were generally found satisfying to participants and helpful in improving knowledge and confidence about safe opioid prescribing practices. The component of the intervention felt to be most helpful to the participants was the actual AD visit, and most participants rated their intentions high to use the information and tools from the visit. Intervention key messages, preliminary outcome measures, and successes and challenges in developing and delivering this intervention are discussed to advance best practices in developing educational interventions in this important area of public health.
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Affiliation(s)
- Kelly S Barth
- Barth: Associate Professor, Department of Psychiatry and Behavioral Sciences, College of Medicine, Medical University of South Carolina, Charleston, SC. Ball: Research Assistant Professor, Division of General Internal Medicine and Geriatrics, Medical University of South Carolina, Charleston, SC. Adams: Scientist, Institute for Behavioral Health, The Heller School for Social Policy and Management, Brandeis University, Waltham, MA. Nikitin: Research Associate, Institute for Behavioral Health, Heller School for Social Policy and Management, Brandeis University, Waltham, MA. Wooten: Assistant Professor, College of Social Work, University of South Carolina, and Chair, Military Specialization, Lieutenant Colonel, Army National Guard. Qureshi: Assistant Professor, Department of Health Services Policy and Management, University of South Carolina, Columbia, SC, and Adjunct Professor, Clinical Pharmacy and Outcomes Sciences, South Carolina College of Pharmacy, Columbia, SC. Larson: Senior Scientist and Lecturer, Heller School for Social Policy and Management, Brandeis University, Waltham, MA
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Pugh MJ, Finley EP, Wang CP, Copeland LA, Jaramillo CA, Swan AA, Elnitsky CA, Leykum LK, Mortensen EM, Eapen BA, Noel PH, Pugh JA. A retrospective cohort study of comorbidity trajectories associated with traumatic brain injury in veterans of the Iraq and Afghanistan wars. Brain Inj 2016; 30:1481-1490. [DOI: 10.1080/02699052.2016.1219055] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Sadeh N, Baskin-Sommers A. Risky, Impulsive, and Self-Destructive Behavior Questionnaire (RISQ): A Validation Study. Assessment 2016; 24:1080-1094. [PMID: 27002123 DOI: 10.1177/1073191116640356] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Risky behaviors increase the likelihood of premature death, long-term disability, and poor mental health outcomes. Most current measures of risky behavior only assess behaviors within a single domain, fail to evaluate affective triggers for engaging in these behaviors, do not index the consequences of these behaviors, and are often limited to a narrow developmental period. The present study developed and evaluated a new 38-item questionnaire-based measure, the Risky, Impulsive, and Self-Destructive Behavior Questionnaire (RISQ), designed to address each of these limitations by expanding the breadth and depth of previous questionnaires. A bifactor model with a general factor and eight domain-specific factors (measuring drug use, aggression, self-harm, gambling, risky sexual behavior, impulsive eating, heavy alcohol use, and reckless behavior) best fit the RISQ, and indicators of internal consistency, as well as, construct validity were strong. Results provide initial validation for the RISQ as a broad, yet relatively brief, measure that quantifies and qualifies risky behaviors by assessing the severity, chronicity, and triggers for a range of harmful behaviors.
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Affiliation(s)
- Naomi Sadeh
- 1 National Center for PTSD, Behavioral Science Division, VA Boston Healthcare System, Boston, MA, USA.,2 Boston University School of Medicine, Department of Psychiatry, Boston, MA, USA
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22
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Delgado AJ, Gordon D, Schnarrs P. The effect of discrimination and stress on sexual and behavioral health among sexual minority servicemen. JOURNAL OF GAY & LESBIAN MENTAL HEALTH 2016. [DOI: 10.1080/19359705.2016.1141344] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Regasa LE, Thomas DM, Gill RS, Marion DW, Ivins BJ. Military Deployment May Increase the Risk for Traumatic Brain Injury Following Deployment. J Head Trauma Rehabil 2016; 31:E28-35. [DOI: 10.1097/htr.0000000000000155] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Type of army service and decision to engage in risky behavior among young people in Israel. JUDGMENT AND DECISION MAKING 2015. [DOI: 10.1017/s1930297500005155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
AbstractPrevious studies have examined the impact of military service on the decision to engage in risky behavior. Yet most of these studies focused on voluntary recruits, did not distinguish between legal and illegal risky activities and did not compare combat and non-combat soldiers during and after service according to gender. The current study is unique because of the nature of Israeli compulsory army service. It examines the relationship between type of army service and five legal and illegal risky behaviors for three groups: non-combat, combat without fighting experience, and combat with fighting experience. We also examine differences in the propensity for risky behavior between men, most of whom are assigned to combat units due to the army’s needs, and women, who serve in combat units on a voluntary basis only. A questionnaire survey was randomly distributed at train stations and central bus stations in Israel among 413 soldiers and ex-soldiers between the ages of 18-30. The predictor variables include type of service or battle experience, the Evaluation of Risks scale and socio-demographic characteristics. In general, we found that high percentages of young people engage in risky behavior, especially illegal behavior. The results indicate that fighting experience is significantly and positively correlated with the consumption of illegal substances for currently serving men soldiers (but not for women) and this effect is mitigated after discharge from the army. Importantly, the use of illegal substances is not a result of the individual’s preferences for engaging in various risky behaviors. Thus, our results suggest that the effect of the increased propensity toward risky behavior following the experience of fighting overrides the combat unit’s discipline for men when it comes to the consumption of illegal substances. In addition, our findings indicate that serving in a combat unit as opposed to a non-combat unit affects the tendency of women ex-combat soldiers to travel to risky destinations, though this is probably related to their original higher risk attitude, since women must volunteer for combat units.
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Weiss NH, Williams DC, Connolly KM. A Preliminary Examination of Negative Affect, Emotion Dysregulation, and Risky Behaviors among Military Veterans in Residential Substance Abuse Treatment. ACTA ACUST UNITED AC 2015; 3:212-218. [PMID: 27088056 DOI: 10.1080/21635781.2015.1038405] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Substance use disorder (SUD) is highly prevalent among military populations and associated with a wide range of negative outcomes. The goal of the present study was to explicate the relations among negative affect, emotion dysregulation, and urges to engage in risky behaviors among military veterans in residential SUD treatment. Emotion dysregulation (overall and three dimensions: access to emotion regulation strategies, impulse control, and emotional awareness) mediated the relation between negative affect and urges to engage in risky behaviors. Findings highlight the potential utility of treatments targeting emotion dysregulation in reducing risky behaviors among military veterans with SUD.
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Affiliation(s)
- Nicole H Weiss
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, 06511, USA
| | - Daniel C Williams
- G. V. (Sonny) Montgomery VAMC, 1500 E. Woodrow Wilson Ave., Jackson, MS, 39216, USA. University of Mississippi Medical Center, 2500 N. State St., Jackson, MS, 39216, USA
| | - Kevin M Connolly
- G. V. (Sonny) Montgomery VAMC, 1500 E. Woodrow Wilson Ave., Jackson, MS, 39216, USA. University of Mississippi Medical Center, 2500 N. State St., Jackson, MS, 39216, USA
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Lewandowski-Romps L, Peterson C, Berglund PA, Collins S, Cox K, Hauret K, Jones B, Kessler RC, Mitchell C, Park N, Schoenbaum M, Stein MB, Ursano RJ, Heeringa SG. Risk factors for accident death in the U.S. Army, 2004-2009. Am J Prev Med 2014; 47:745-53. [PMID: 25441238 PMCID: PMC4254526 DOI: 10.1016/j.amepre.2014.07.052] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2013] [Revised: 06/20/2014] [Accepted: 07/29/2014] [Indexed: 11/19/2022]
Abstract
BACKGROUND Accidents are one of the leading causes of death among U.S. active-duty Army soldiers. Evidence-based approaches to injury prevention could be strengthened by adding person-level characteristics (e.g., demographics) to risk models tested on diverse soldier samples studied over time. PURPOSE To identify person-level risk indicators of accident deaths in Regular Army soldiers during a time frame of intense military operations, and to discriminate risk of not-line-of-duty from line-of-duty accident deaths. METHODS Administrative data acquired from multiple Army/Department of Defense sources for active duty Army soldiers during 2004-2009 were analyzed in 2013. Logistic regression modeling was used to identify person-level sociodemographic, service-related, occupational, and mental health predictors of accident deaths. RESULTS Delayed rank progression or demotion and being male, unmarried, in a combat arms specialty, and of low rank/service length increased odds of accident death for enlisted soldiers. Unique to officers was high risk associated with aviation specialties. Accident death risk decreased over time for currently deployed, enlisted soldiers and increased for those never deployed. Mental health diagnosis was associated with risk only for previous and never-deployed, enlisted soldiers. Models did not discriminate not-line-of-duty from line-of-duty accident deaths. CONCLUSIONS Adding more refined person-level and situational risk indicators to current models could enhance understanding of accident death risk specific to soldier rank and deployment status. Stable predictors could help identify high risk of accident deaths in future cohorts of Regular Army soldiers.
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Affiliation(s)
| | | | | | - Stacey Collins
- Institute for Social Research, University of Michigan, Ann Arbor, Michigan
| | - Kenneth Cox
- U.S. Army Institute of Public Health, Aberdeen Proving Ground
| | - Keith Hauret
- U.S. Army Institute of Public Health, Aberdeen Proving Ground
| | - Bruce Jones
- U.S. Army Institute of Public Health, Aberdeen Proving Ground
| | - Ronald C Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
| | - Colter Mitchell
- Institute for Social Research, University of Michigan, Ann Arbor, Michigan
| | - Nansook Park
- Department of Psychology, University of Michigan, Ann Arbor, Michigan
| | - Michael Schoenbaum
- National Institute of Mental Health, Uniformed Services University School of Medicine, Bethesda, Maryland
| | - Murray B Stein
- Department of Psychiatry, University of California San Diego, La Jolla; Veterans Affairs San Diego Healthcare System, San Diego, California
| | - Robert J Ursano
- Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University School of Medicine, Bethesda, Maryland
| | - Steven G Heeringa
- Institute for Social Research, University of Michigan, Ann Arbor, Michigan.
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The cumulative effect of different childhood trauma types on self-reported symptoms of adult male depression and PTSD, substance abuse and health-related quality of life in a large active-duty military cohort. J Psychiatr Res 2014; 58:46-54. [PMID: 25139009 DOI: 10.1016/j.jpsychires.2014.07.014] [Citation(s) in RCA: 90] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2014] [Revised: 07/02/2014] [Accepted: 07/17/2014] [Indexed: 12/26/2022]
Abstract
History of childhood trauma (CT) is highly prevalent and may lead to long-term consequences on physical and mental health. This study investigated the independent association of CT with symptoms of adult depression and posttraumatic stress disorder (PTSD), mental and physical health-related quality of life (HRQoL), as well as current tobacco consumption and alcohol abuse in a large homogenous cohort of 1254 never-deployed, young male Marines enrolled in the Marine Resiliency Study. Independent effects of CT history, number and type of CT on outcomes were analyzed using hierarchical multivariate logistic regression models. Our results suggested dose-dependent negative effect of an increasing number of trauma types of CT on depression, PTSD and HRQoL. Experience of single CT type demonstrated overall weak effects, while history of multiple CT types distinctively increased the likelihood of adult PTSD symptomology (OR: 3.1, 95% CI: 1.5-6.2), poor mental (OR: 2.3, 95% CI: 1.7-3.1) and physical HRQoL (OR: 1.4, 95% CI: 1.1-1.9). Risk for depression symptoms was similar for both single and multiple CT (OR: 2.2, 95% CI: 1.3-3.8 and OR: 2.1, 95% CI: 1.2-3.5 respectively). CT history had no effects on current tobacco use and alcohol abuse. Our study thus provides evidence for substantial additive effect of different CT types on adult mental and physical health with increasing levels of exposure.
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Hoggatt KJ, Prescott MR, Goldmann E, Tamburrino M, Calabrese JR, Liberzon I, Galea S. The prevalence and correlates of risky driving behavior among National Guard soldiers. TRAFFIC INJURY PREVENTION 2014; 16:17-23. [PMID: 25260973 DOI: 10.1080/15389588.2014.896994] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVE Previous studies have reported that risky driving is associated with deployment and combat exposure in military populations, but there is limited research on risky driving among soldiers in the National Guard and Reserves, a group increasingly deployed to active international conflicts. The goal of this analysis was to assess the prevalence of risky driving and its demographic, mental health, and deployment-related correlates among members of the Ohio Army National Guard (OHARNG). METHODS The study group comprised 2,616 eligible OHARNG soldiers enlisted as of June 2008, or who enlisted between June 2008 and February 2009. The main outcome of interest was the prevalence of risky driving behavior assessed using six questions: "How often do you use seat belts when you drive or ride in a car?"; "In the past 30 days, how many times have you driven when you've had perhaps too much to drink?"; "In the past year, have you ever become impatient with a slow driver in the fast lane and passed them on the right?"; "In the past year have you crossed an intersection knowing that the traffic lights have already changed from yellow to red?"; "In the past year have you disregarded speed limits late at night or early in the morning?"; and "In the past year have you underestimated the speed of an oncoming vehicle when attempting to pass a vehicle in your own lane?" We fit multiple logistic regression models and derived the adjusted prevalence of risky driving behavior for soldiers with mental health conditions, deployment experience, exposure to combat or trauma, and psychosocial stressors or supports. RESULTS The prevalence of risky driving was higher in soldiers with a history of mental health conditions, deployment to a conflict area, deployment-related traumatic events, and combat or post-combat stressors. In contrast, the prevalence of risky driving was lower for soldiers who reported high levels of psychosocial support. CONCLUSIONS Efforts to mitigate risky driving in military populations may be more effective if they incorporate both targeted messages to remediate dangerous learned driving behaviors and psychosocial interventions to build resilience and address underlying stressors and mental health symptoms.
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Affiliation(s)
- Katherine J Hoggatt
- a VA Greater Los Angeles Healthcare System, VA Health Services Research & Development (HSR&D) Center for the Study of Healthcare Innovation , Implementation & Policy (CSHIIP) , Sepulveda , California
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Gilman SE, Bromet EJ, Cox KL, Colpe LJ, Fullerton CS, Gruber MJ, Heeringa S, Lewandowski-Romps L, Millikan-Bell A, Naifeh JA, Nock MK, Petukhova MV, Sampson NA, Schoenbaum M, Stein MB, Ursano RJ, Wessely S, Zaslavsky A, Kessler RC. Sociodemographic and career history predictors of suicide mortality in the United States Army 2004-2009. Psychol Med 2014; 44:2579-92. [PMID: 25055175 PMCID: PMC4113022 DOI: 10.1017/s003329171400018x] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND The US Army suicide rate has increased sharply in recent years. Identifying significant predictors of Army suicides in Army and Department of Defense (DoD) administrative records might help focus prevention efforts and guide intervention content. Previous studies of administrative data, although documenting significant predictors, were based on limited samples and models. A career history perspective is used here to develop more textured models. METHOD The analysis was carried out as part of the Historical Administrative Data Study (HADS) of the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS). De-identified data were combined across numerous Army and DoD administrative data systems for all Regular Army soldiers on active duty in 2004-2009. Multivariate associations of sociodemographics and Army career variables with suicide were examined in subgroups defined by time in service, rank and deployment history. RESULTS Several novel results were found that could have intervention implications. The most notable of these were significantly elevated suicide rates (69.6-80.0 suicides per 100 000 person-years compared with 18.5 suicides per 100 000 person-years in the total Army) among enlisted soldiers deployed either during their first year of service or with less than expected (based on time in service) junior enlisted rank; a substantially greater rise in suicide among women than men during deployment; and a protective effect of marriage against suicide only during deployment. CONCLUSIONS A career history approach produces several actionable insights missed in less textured analyses of administrative data predictors. Expansion of analyses to a richer set of predictors might help refine understanding of intervention implications.
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Affiliation(s)
- S. E. Gilman
- Departments of Social and Behavioral Sciences, and Epidemiology, Harvard School of Public Health, Boston, MA, USA
| | - E. J. Bromet
- Department of Psychiatry and Behavioral Science, Stony Brook School of Medicine, Stony Brook, NY, USA
| | - K. L. Cox
- US Army Public Health Command, Aberdeen Proving Ground, MD, USA
| | - L. J. Colpe
- Division of Services and Intervention Research, National Institute of Mental Health, Bethesda, MD, USA
| | - C. S. Fullerton
- Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University School of Medicine, Bethesda, MD, USA
| | - M. J. Gruber
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
| | - S.G. Heeringa
- Institute for Social Research, University of Michigan, Ann Arbor, MI, USA
| | | | | | - J. A. Naifeh
- Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University School of Medicine, Bethesda, MD, USA
| | - M. K. Nock
- Department of Psychology, Harvard University, Cambridge, MA, USA
| | - M. V. Petukhova
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
| | - N. A. Sampson
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
| | - M. Schoenbaum
- Office of Science Policy, Planning and Communications, National Institute of Mental Health, Bethesda, MD, USA
| | - M. B. Stein
- Departments of Psychiatry and Family and Preventive Medicine, University of California San Diego, La Jolla, CA, USA
- VA San Diego Healthcare System, San Diego, CA, USA
| | - R. J. Ursano
- Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University School of Medicine, Bethesda, MD, USA
| | - S. Wessely
- King’s Centre for Military Health Research, King’s College London, London, UK
| | - A.M. Zaslavsky
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
| | - R. C. Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
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Abstract
Suicides in the military have increased over the last ten years. Much effort has been focused on suicide prevention and treatment, as well as understanding the reasons for the sharp increase in military suicides. Despite this effort, the definitive causes of military suicides remain elusive. Further, highly effective suicide prevention and treatment approaches have not yet been developed. The purpose of this article is to present a short review of the current state of suicide prevention interventions within the context of the military. The root causes of suicidal behavior and the role of combat in the military are each discussed. Interpersonal-psychological theory of suicide and the military transition theory are introduced as guiding frameworks for understanding suicides and suicidal behavior amongst active military personnel and military veterans. The article concludes with a set of recommendations for moving forward in understanding and addressing suicides in the military.
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Affiliation(s)
- Carl Andrew Castro
- School of Social Work, Center for Innovation and Research on Veterans and Military Families, University of Southern California, 1150 South Olive, Suite 1400, Los Angeles, CA, 90015-2211, USA,
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Rogers CM, Mallinson T, Peppers D. High-Intensity Sports for Posttraumatic Stress Disorder and Depression: Feasibility Study of Ocean Therapy With Veterans of Operation Enduring Freedom and Operation Iraqi Freedom. Am J Occup Ther 2014; 68:395-404. [DOI: 10.5014/ajot.2014.011221] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Abstract
In this study, we conducted a pretest–posttest investigation of a sports-oriented occupational therapy intervention using surfing in an experiential, skills-based program to support veterans with symptoms of posttraumatic stress disorder (PTSD) in their transition to civilian life. The purpose of this feasibility study was to evaluate the intervention for attendance rates and retention in the program provided in 5 sessions over 5 wk. Fourteen veterans from a specialty postdeployment clinic at a Veterans Affairs hospital were enrolled; 11 completed the study, and 10 attended ≥3 sessions. Participants reported clinically meaningful improvement in PTSD symptom severity (PTSD Checklist—Military Version, Wilcoxon signed rank Z = 2.5, p = .01) and in depressive symptoms (Major Depression Inventory, Wilcoxon signed rank Z = 2.05, p = .04). The results of this small, uncontrolled study suggest that a sports-oriented occupational therapy intervention has potential as a feasible adjunct intervention for veterans seeking mental health treatment for symptoms of PTSD.
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Affiliation(s)
- Carly M. Rogers
- Carly M. Rogers, OTD, OTR/L, is Director of Programs, Jimmy Miller Memorial Foundation, Manhattan Beach, CA. At the time of the study, she was OTD Candidate, Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, and Occupational Therapist, Physical Medicine and Rehabilitation Services, VA Greater Los Angeles Healthcare System, Los Angeles, CA
| | - Trudy Mallinson
- Trudy Mallinson, PhD, OTR/L, FAOTA, NZROT, is Visiting Associate Professor, School of Medicine and Health Sciences, The George Washington University, Washington, DC. At the time of the study, she was Assistant Professor, Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles
| | - Dominique Peppers
- Dominique Peppers, DO, is Physiatrist, Department of Physical Medicine and Rehabilitation Services, VA Puget Sound Healthcare System, Seattle, WA. At the time of the study, she was Physiatrist, Physical Medicine and Rehabilitation Services, VA Greater Los Angeles Healthcare System, Los Angeles, CA
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Ramsawh HJ, Fullerton CS, Mash HBH, Ng THH, Kessler RC, Stein MB, Ursano RJ. Risk for suicidal behaviors associated with PTSD, depression, and their comorbidity in the U.S. Army. J Affect Disord 2014; 161:116-22. [PMID: 24751318 DOI: 10.1016/j.jad.2014.03.016] [Citation(s) in RCA: 103] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2014] [Accepted: 03/07/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND Suicide rates have risen considerably in the United States Army in the past decade. Suicide risk is highest among those with past suicidality (suicidal ideation or attempts). The incidence of posttraumatic stress disorder (PTSD) and depressive illnesses has risen concurrently in the U.S. Army. We examined the relationship of PTSD and depression, independently and in combination, and rates of past-year suicidality in a representative sample of U.S. Army soldiers. METHODS This study used the DoD Survey of Health Related Behaviors Among Active Duty Military Personnel (DoD HRB) (N=5927). Probable PTSD and depression were assessed with the PTSD Checklist (PCL) and the 10-item short form of the Center for Epidemiologic Studies Depression Scale (CES-D), respectively. Past-year suicidality was assessed via self-report. RESULTS Six percent of Army service members reported suicidality within the past year. PTSD and MDD were each independently associated with past-year suicidality. Soldiers with both disorders were almost three times more likely to report suicidality within the past year than those with either diagnosis alone. Population-attributable risk proportions for PTSD, depression, and both disorders together were 24%, 29%, and 45%, respectively. LIMITATIONS The current study is subject to the limitations of a cross-sectional survey design and the self-report nature of the instruments used. CONCLUSIONS PTSD and depression are each associated with suicidality independently and in combination in the active duty component of the U.S. Army. Soldiers presenting with either but especially both disorders may require additional outreach and screening to decrease suicidal ideation and attempts.
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Affiliation(s)
- Holly J Ramsawh
- Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University of the Health Sciences, Bethesda, MD, United States.
| | - Carol S Fullerton
- Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University of the Health Sciences, Bethesda, MD, United States
| | - Holly B Herberman Mash
- Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University of the Health Sciences, Bethesda, MD, United States
| | - Tsz Hin H Ng
- Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University of the Health Sciences, Bethesda, MD, United States
| | - Ronald C Kessler
- Harvard Medical School, Department of Health Care Policy, Boston, MA, United States
| | - Murray B Stein
- University of California, San Diego, Departments of Psychiatry & Family and Preventive Medicine, San Diego, CA, United States; Psychiatry Service, Veterans Affairs, San Diego Healthcare System, San Diego, CA, United States
| | - Robert J Ursano
- Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University of the Health Sciences, Bethesda, MD, United States
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Zoellner LA, Bedard-Gilligan MA, Jun JJ, Marks LH, Garcia NM. The Evolving Construct of Posttraumatic Stress Disorder (PTSD): DSM-5 Criteria Changes and Legal Implications. PSYCHOLOGICAL INJURY & LAW 2013; 6:277-289. [PMID: 24470838 PMCID: PMC3901120 DOI: 10.1007/s12207-013-9175-6] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
In the DSM-5, the diagnosis of posttraumatic stress disorder (PTSD) has undergone multiple, albeit minor, changes. These changes include shifting PTSD placement from within the anxiety disorders into a new category of traumatic and stressor-related disorders, alterations in the definition of a traumatic event, shifting of the symptom cluster structure from three to four clusters, the addition of new symptoms including persistent negative beliefs and expectations about oneself or the world, persistent distorted blame of self or others, persistent negative trauma-related emotions, and risky or reckless behaviors, and the addition of a dissociative specifier. The evidence or lack thereof behind each of these changes is briefly reviewed. These changes, although not likely to change overall prevalence, have the potential to increase the heterogeneity of individuals receiving a PTSD diagnosis both by altering what qualifies as a traumatic event and by adding symptoms commonly occurring in other disorders such as depression, borderline personality disorder, and dissociative disorders. Legal implications of these changes include continued confusion regarding what constitutes a traumatic stressor, difficulties with differential diagnosis, increased ease in malingering, and improper linking of symptoms to causes of behavior. These PTSD changes are discussed within the broader context of DSM reliability and validity concerns.
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Affiliation(s)
- Lori A Zoellner
- Department of Psychology, University of Washington, Seattle, Washington, USA
| | - Michele A Bedard-Gilligan
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington, USA
| | - Janie J Jun
- Department of Psychology, University of Washington, Seattle, Washington, USA
| | - Libby H Marks
- Department of Psychology, University of Washington, Seattle, Washington, USA
| | - Natalia M Garcia
- Department of Psychology, University of Washington, Seattle, Washington, USA
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Borders A, McAndrew LM, Quigley KS, Chandler HK. Rumination moderates the associations between PTSD and depressive symptoms and risky behaviors in U. S. veterans. J Trauma Stress 2012; 25:583-6. [PMID: 23073976 DOI: 10.1002/jts.21733] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Risky behaviors, including unsafe sex, aggression, rule breaking, self-injury, and dangerous substance use have become a growing issue for U.S. veterans returning from combat deployments. Evidence in nonveteran samples suggests that risky behaviors reflect efforts to cope with and alleviate depressive and/or anxious symptoms, particularly for individuals with poor emotion-regulation skills. These associations have not been studied in veterans. Rumination, or repeated thoughts about negative feelings and past events, is a coping strategy that is associated with several psychopathologies common in veterans. In this cross-sectional study, 91 recently returned veterans completed measures of trait rumination, self-reported risky behaviors, and symptoms of posttraumatic stress disorder (PTSD) and depression. Analyses revealed that veterans with more depressive and PTSD symptoms reported more risky behaviors. Moreover, rumination significantly interacted with PTSD symptoms and depressive symptoms (both β = .21, p < .05), such that psychiatric symptoms were associated with risky behaviors only for veterans with moderate to high levels of rumination. Although cross-sectional, these findings support theory that individuals with poor coping skills may be particularly likely to respond to negative mood states by engaging in risky behaviors. Implications include using rumination-focused interventions with veterans in order to prevent engagement in risky behaviors.
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Affiliation(s)
- Ashley Borders
- Department of Veterans Affairs, NJ War Related Illness & Injury Study Center, East Orange, New Jersey, USA.
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Kelley AM, Athy JR, Cho TH, Erickson B, King M, Cruz P. Risk propensity and health risk behaviors in U.S. army soldiers with and without psychological disturbances across the deployment cycle. J Psychiatr Res 2012; 46:582-9. [PMID: 22305118 DOI: 10.1016/j.jpsychires.2012.01.017] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2011] [Revised: 01/10/2012] [Accepted: 01/12/2012] [Indexed: 02/06/2023]
Abstract
Anecdotal and preliminary evidence suggests that Soldiers returning from a combat deployment engage in an increased number of health risk behaviors. Three potential factors driving this change were examined in this study; posttraumatic stress disorder (PTSD), concussion and traumatic brain injury (TBI), and perceived invincibility. We studied members of a combat arms brigade one month prior to a deployment to Iraq and approximately one month after their return (N = 319). Participants anonymously completed surveys characterizing attitudes about risk, risk propensity, invincibility, engagement in health risk behaviors, and personality. Using standardized screening instruments, participants were categorized with respect to PTSD and probable TBI. Results suggest that Soldiers engage in more alcohol use and reckless driving behaviors post-deployment. These changes were exaggerated in those who screened positive for PTSD. Perception of one's invincibility and survival skills increased post-deployment thus suggesting that participants felt less susceptible to adverse consequences and more adept at surviving dangerous situations. This study provides documentation of the pattern of health behavior in Soldiers engaged in the deployment cycle. Our findings suggest increases in the number of risks Soldiers' engage in post-deployment are not limited to those with PTSD symptomtotology. This study has implications for not only adjustment to life post-deployment at the individual level but also operational readiness.
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Affiliation(s)
- Amanda M Kelley
- United States Army Aeromedical Research Laboratory, Building 6901, Farrel Rd, PO Box 620577, Fort Rucker, AL 36362-0577, USA.
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