Level of perceived social support, and associated factors, in combat-exposed (ex-)military personnel: a systematic review and meta-analysis

PURPOSE

Combat deployment increases exposure to potentially traumatic events. Perceived social support (PSS) may promote health and recovery from combat trauma. This systematic review and meta-analysis aimed to synthesize studies investigating the level of PSS and associated factors among (ex-)military personnel who served in the Iraq/Afghanistan conflicts.

METHODS

Five electronic databases were searched in August 2023 and searches were restricted to the beginning of the Iraq/Afghanistan conflicts in 2001. The search was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A quality assessment was carried out, and a meta-analysis and narrative synthesis were performed.

RESULTS

In total, 35 papers consisting of 19,073 participants were included. Of these, 31 studies were conducted in the United States (US) and 23 were cross-sectional. The pooled mean PSS score was 54.40 (95% CI: 51.78 to 57.01). Samples with probable post-traumatic stress disorder had a lower mean PSS score (44.40, 95% CI: 39.10 to 49.70). Approximately half of the included studies (n = 19) investigated mental health in relation to PSS, whilst only four explored physical health. The most frequently reported risk factors for low PSS included post-traumatic stress disorder, depression and anxiety, whilst post-traumatic growth and unit support were protective factors.

CONCLUSION

Higher levels of PSS were generally associated with more positive psychosocial and mental health-related outcomes following deployment. PSS should be targeted in psychosocial interventions and education programmes. Future research should investigate PSS in (ex-)military personnel across other countries and cultures, based on the lack of studies that focused on PSS in countries outside of the US.

Fifty Years After Nigerian Civil War: Social Support Is Associated with PTSD Symptoms Through Increased Self-Efficacy Among Biafran Veterans

The Nigerian Civil War (or Nigerian-Biafran War, 1967-1970) was fought between the Nigerian federal government and the defunct Republic of Biafra. Biafra recruited young men and boys (child soldiers) to fight the war, but little attention has been given to understanding the mental health outcomes of the War on Biafran veterans. Although there are few studies on social support in relation to post-traumatic stress disorder (PTSD) symptoms in this older veteran population, the mechanism through which social support influences PTSD has not received much attention. Hence, we investigated whether self-efficacy explains the association between social support and PTSD symptoms in a sample of Biafran War veterans. They were recruited from the Veterans' association in south-east Nigeria (N = 250; Mage = 71.33 years, SD = 7.11), and completed self-report measures of social support, self-efficacy, and PTSD symptoms. Results showed that veterans with greater social support (β = -.49, p < .001) and high self-efficacy reported less PTSD symptoms (β = -.55, p < .001). Above all, social support predicted decreased PTSD symptoms risk through increased self-efficacy, 95% CI [-0.53, -0.29]. By implication, social support may be associated with lower PTSD symptoms because it enhances efficacy beliefs, and thereby leads to less PTSD symptoms.

Big ideas series: self-regulation shift theory: trauma, suicide, and violence

BACKGROUND

Traumatic stress, suicide, and impulsive violence arguably are three of the most consequential problems facing societies today. Self-regulation shift theory is introduced to capture the underlying coping dynamics involved in these three grave challenges.

OBJECTIVES

Self-regulation shift theory, based in a nonlinear dynamical systems framework, focuses on critical psychological self-regulation thresholds and the role of cognitive self-appraisals in human adaptation to help understand these three significant societal challenges.

METHODS

This essay reviews existing evidence within the posttraumatic adaptation process utilizing SRST for understanding dynamic self-regulation. This is followed by integrating SRST within existing current theoretical models for suicidal behaviors and violent outbursts.

CONCLUSIONS

The essay concludes with methodological suggestions for future research applying SRST and how this research offers important opportunities to develop early warning systems that promote hope when hope seems impossible.

The mediating role of coping self-efficacy on social support and PTSD symptom severity among injury survivors

BACKGROUND

Social support confers a protective effect against elevated PTSD symptomatology following injury. However, little is known about the mechanisms through which social support conveys this protective mental health effect in injury survivors. Coping self-efficacy is linked to both social support and PTSD symptomatology but has not been examined.

OBJECTIVE

To test coping self-efficacy as a mechanism for the relationship between social support and PTSD symptom severity among injury survivors.

METHOD AND DESIGN

Participants consisted of 61 injury survivors (62.3% male, 72.1% White) admitted to a Level-1 Trauma Center. Social support was assessed at 2-weeks post-injury; coping self-efficacy at 6-weeks post-injury; and PTSD symptom severity at 3-months post-injury.

RESULTS

A statistically significant indirect effect was found for the social support - coping self-efficacy - PTSD symptomatology pathway, providing evidence of mediation even after controlling for age, sex, race, and education (B = -0.51, SE = 0.18, CI = -0.92, -0.20).

CONCLUSIONS

Social support may exert an effect on PTSD symptom severity post-injury through its connection with coping self-efficacy. Coping self-efficacy represents an important intervention target following injury for those survivors with lower social support who are at risk for elevated PTSD symptom severity levels.

PTSD as a Moderator of the Relationship Between the Distribution of Personal Resources and Spiritual Change Among Participants of Hostilities in Ukraine

The theory of conservation of resources (COR) can be used to search for mechanisms that explain spiritual changes caused by trauma. The present study aimed to verify whether PTSD could be a potential moderator between the distribution of personal resources and spiritual changes. The study included a total of 324 adults (75 women and 243 men) aged 18-74. The mean age was 34.3 (SD = 9.9). The Polish adaptation of Hobfoll's Conservation of Resources-Evaluation (COR-E), the posttraumatic stress disorder (PTSD) Checklist-Civilian Version and the Posttraumatic Growth Inventory were employed in the research. This study analyzed the spiritual change, which is one of the five domains of posttraumatic growth. The outcomes indicated the significant role of PTSD as a moderator of the relationships between 1) personal resources gain and spiritual change and 2) personal resources loss and spiritual change. PTSD is not a moderator in the relationship between assigning value to personal resources and spiritual change.

Image of a Junior Officer in Military Personnel Participating in Combat Operations with Symptoms of Post-traumatic Stress Disorder

"According to the results of the conducted study there were distinguished the peculiarities of perception of the image of a junior officer by servicemen who participated in hostilities and had various PTSD symptoms. The study included 233 male servicemen with combat experience. The age of the participants varied from 20 to 55 years. It was determined that the image perception of the direct commander by the servicemen who did not have any PTSD symptoms had been influenced by both the key features of the modern way of fighting and the way a protective mechanism of consciousness acted, which gave the possibility to maintain mental health under combat conditions. These servicemen considered the awareness, kindness, and physical strength of their commander to be not important. The first stage was occupied by his/her ability to adequately fulfill his/her leadership function and the power of his/her spirit – the courage and love of the Motherland, which formed his/her reliability. Servicemen who had PTSD symptoms were less satisfied with the role of a junior officer and considered him/her to be less capable of meeting their expectations. They were less interested in commanders who could involve them in situations that required quick, brave action and complete responsibility for the entrusted part of common affairs. The most important factors in the structure of the direct commander image in both studied groups were the power of personality (the ability of self-regulation); however, the servicemen with PTSD symptoms had a specific orientation of these factors – to help their subordinates. They were quite selfishly aimed at using their direct commanders as a way of getting help. "

Chronic stressors and burnout in Dutch police officers: Two studies into the complex role of coping self-efficacy

Introduction

Burnout complaints are high for Dutch police officers. According to Hobfoll's Conservation of Resources theory, resources such as coping self-efficacy can play an important role in the burnout process. The aim of this study was to investigate the buffering effect of coping self-efficacy on burnout, as well as a possible depletion effect of burnout on coping self-efficacy.

Methods

As such, this research consists of two studies namely, a two-wave study (N = 166) and three-wave study (N = 95) on Dutch police officers. They expand on previous research regarding coping resources and police burnout.

Results

Both studies show that the chronic stressor, work scheduling, was positively associated with burnout. Also, coping self-efficacy weakened the effect of work scheduling (Study 1) and workload (Study 2) on burnout. Moreover, there was a direct negative relationship between burnout and coping self-efficacy.

Discussion

The results indicate that burnout can lead to lower coping resources, initiating a potential cycle of resource loss and burnout. Further investigation into this depletion effect is required to provide police officers and organisations with tools to prevent burnout.

Sexual and physical revictimization in U.S. military veterans

The present study examined revictimization, defined as sexual or physical assault in adulthood that followed a history of childhood maltreatment. We aimed to identify factors associated with revictimization over time in a group of U.S. military veterans deployed following the September 11, 2001, terrorist attacks (9/11). As revictimization is associated with multiple negative mental health outcomes in the literature, identifying risk and protective factors can aid in the prevention of revictimization and associated poor health outcomes among veterans. In this sample, the proportion of adult revictimization was 2.7% for men, 95% CI [2.0, 3.6] and 22.9% for women, 95% CI [20.5, 25.8]. Using multilevel logistic models, we found that women, β = 2.2, p < .001; Navy veterans, β = 1.5, p < .001; and participants who reported posttraumatic stress symptoms, β = 0.2, p = .028, were at significantly higher risk of revictimization across time compared to nonrevictimized counterparts. Social support while in the military was protective, β = -0.1, p < .001, against revictimization. In addition, childhood abuse experiences combined with characteristics such as female gender were related to an increased risk of revictimization during and following military service. The findings highlight opportunities for intervention and areas of strength within this population; social connection garnered during military service may serve as a protective factor against revictimization. Future research is needed to examine the role of social support in possibly lowering veterans' risk of revictimization over time, particularly for post-9/11 veterans struggling with transitioning from military to civilian life.

Social cognitive mechanisms in healthcare worker resilience across time during the pandemic

PURPOSE

Healthcare workers are at increased risk for mental health problems during disasters such as the COVID-19 pandemic. Identifying resilience mechanisms can inform development of interventions for this population. The current study examined pathways that may support healthcare worker resilience, specifically testing enabling (social support enabled self-efficacy) and cultivation (self-efficacy cultivating support) models.

METHODS

Healthcare workers (N = 828) in the Rocky Mountain West completed self-report measures at four time points (once per month from April to July of 2020). We estimated structural equation models to explore the potential mediating effects that received social support and coping self-efficacy had (at time 2 and time 3) between traumatic stress symptom severity (at time 1 and time 4). Models included covariates gender, age, minority status, and time lagged co-variations between the proposed mediators (social support and coping self-efficacy).

RESULTS

The full model fit the data well, CFI = .993, SRMR = .027, RMSEA = .036 [90% CIs (0.013, 0.057)]. Tests of sequential mediation supported enabling model dynamics. Specifically, the effects of time 1 traumatic stress severity were mediated through received social support at time 2 and time 3 coping self-efficacy, in sequential order to reduce time 4 traumatic stress severity.

CONCLUSIONS

Findings show the importance of received social support and coping self-efficacy in mitigating psychopathology risk. Interventions can support mental health by focusing on social resource engagement that facilitates coping empowerment, which may decrease risk for mental health job-related problems among frontline healthcare workers exposed to highly stressful events.

Characteristics of Responders and Nonresponders in a Military Postconcussion Rehabilitation Program

OBJECTIVE

To characterize treatment responders and nonresponders as measured by the Neurobehavioral Symptom Inventory (NSI) in order to understand whether certain traits in our patient population would characterize favorable response.

SETTING

Brain Injury Rehabilitation Service at Brooke Army Medical Center, Fort Sam Houston, San Antonio, Texas.

PATIENTS

In total, 655 active duty military patients with a diagnosis of mild traumatic brain injury (mTBI) who received treatment between 2007 and 2020 and completed self-report measures as part of routine care.

DESIGN

Observational retrospective analysis of outpatient clinical outcomes data.

MAIN MEASURES

The primary outcome measure was the NSI, divided into the responder and nonresponder groups. Responders were defined by reliable change in NSI total score (decrease of ≥8 points from intake to discharge).

FINDINGS

Responders (n = 395) reported a higher level of symptom burden at intake on the NSI. Women responded proportionally more (70%) than men (58%). After treatment, responders reported improvements on all measures evaluated while nonresponders reported no change or slightly worse symptoms. Logistic regression analysis showed that posttraumatic stress symptoms at intake decreased odds of favorable treatment response while satisfaction with social relationships increased odds of favorable treatment response.

CONCLUSION

The results from this process improvement project suggested that posttraumatic symptoms warrant programmatic attention in TBI clinics while social relationships may be a protective factor that can be capitalized to enhance troop readiness. Systematic examination of these characteristics should be conducted on a larger population within the military health system.

People who need people: the relationship between adverse childhood experiences and mental health among college students

ObjectiveThis study investigates the association between adverse childhood experiences (ACEs) and mental health among a sample of college students. It also explores whether health behaviors and social support may help to explain the link between ACEs and mental health. Participants: Participants were students at a large public university in the Southwest (n = 404). Methods: A survey captured ACEs, diet, exercise, smoking, binge drinking, perceived social support, depression, anxiety, and demographics. Results: Respondents with four or more ACEs had significantly higher rates of depression and anxiety than respondents with lower ACE scores. We found significant differences in social support, but not health behaviors for the two groups. Finally, social support emerged as a strong predictor of depression/anxiety and a mediator between childhood adversity and mental health outcomes. Conclusions: Our findings confirm the importance of adverse childhood experiences for college student health and indicate a need for interventions for socially isolated students.

Trauma Coping Self-Efficacy Mediates Associations Between Adult Attachment and Posttraumatic Stress Symptoms

Attachment orientations reflect individuals' expectations for interpersonal relationships and influence emotion regulation strategies and coping. Previous research has documented that anxious and avoidant attachment orientations have deleterious effects on the trauma recovery process leaving these survivors vulnerable to posttraumatic stress disorder (PTSD) symptoms. However, avoidant attachment may be more complicated. Prior work has also found those high in avoidant attachment but also low in anxious attachment (i.e., dismissing) may not experience such vulnerabilities. Further, avoidant attachment individuals often report higher self-efficacy than their anxiously attached counterparts. The present study examined trauma coping self-efficacy (CSE-T) as a previously unexamined mechanism of action between adult attachment and PTSD symptoms. Structural equation modeling results showed that anxious attachment was associated with lower CSE-T and greater PTSD symptoms six weeks later. Further, a significant indirect effect of anxious attachment on PTSD symptoms through CSE-T was found. Contrary to hypotheses, avoidant attachment also exhibited an indirect effect on PTSD symptoms through CSE-T, such that avoidant attachment was associated with lower CSE-T, which in turn, was associated with greater PTSD symptoms. Also contrary to hypotheses, the interaction between anxious and avoidant attachment was not significantly associated with either CSE-T or PTSD symptoms. Results suggest that both anxious and avoidant attachment orientations contribute to poor self-regulation following trauma, as they undermine perceptions of trauma coping self-efficacy.

Social engagement, self-efficacy, and posttraumatic stress symptoms across 6 months of psychotherapy

OBJECTIVE

The current study was conducted in a naturalistic treatment setting to examine whether and how perceptions about social engagement, trauma coping self-efficacy, and posttraumatic stress symptoms (PTS) influence one another across 6 months of psychotherapy for trauma survivors.

METHOD

The sample included 183 clients who reported exposure to traumatic events and significant PTS (PCL-5 ≥ 33). Participants (M_age  = 37.8, 53.6% female) completed surveys at intake, 3 months, and 6 months into treatment. A cross-lagged panel analysis was used to test the relationships among perceived social engagement, coping self-efficacy, and PTS across three assessment points.

RESULTS

PTS at 3-months was a mediator in the relationship between intake perceived social engagement and 6-month coping self-efficacy and between intake perceived social engagement and 6-month perceived social engagement.

CONCLUSIONS

PTS several months into treatment may serve as a mechanism between intake perceived social engagement and functional outcomes such as coping self-efficacy.

Rejection Sensitivity Mediates the Relationship Between Social-Interpersonal Stressors and Depressive Symptoms in Military Context

BACKGROUND

Depression is pervasive in the military context and is likely to elicit lasting negative effects on health. Based on interpersonal models, social-interpersonal stressors are significantly associated with the development and maintenance of depression. However, little is known about the mechanisms by which these stressors increase the risk of depression in terms of social relationships. Rejection sensitivity, which refers to people who are sensitive to social rejection and tend to anxiously expect, readily perceive, and overreact to it, may play an underlying role in this process, as it is formed through social-interpersonal stressors and then aggravates further symptoms of depression.

OBJECTIVES

The current study aimed to examine the mediating effects on the relationship between social-interpersonal stressors and depressive symptoms in the military context.

METHODS

This study recruited 600 soldiers aged from 17 to 36 (M = 21.80; SD = 2.99; 100% males) with a cluster sampling method who completed Social-Interpersonal Stressors subscale, Rejection Sensitivity Questionnaire (RSQ), and Self-Rating Depression Scale (SDS). Mediation analyses examined the underlying mechanism between social-interpersonal stressors and depressive symptoms.

RESULTS

The results support the hypothesis and indicate that rejection sensitivity mediates the association between social-interpersonal stressors and depressive symptoms (B indirect = 0.02, p < 0.001, 95% CI= 0.005 to 0.044).

CONCLUSIONS

The findings suggest that interventions designed to desensitize individuals' high levels of rejection sensitivity may help to decrease their risk of depressive symptoms in the military environment. Rejection sensitivity is an important mechanism underpinning the development of depressive symptoms. Other theoretical and applied implications for prevention of depressive symptoms in the military context are discussed.

Preliminary efficacy and mediators of interpersonal psychotherapy for reducing posttraumatic stress symptoms in an incarcerated population

AbstractObjective: Incarcerated individuals have high rates of trauma exposure. IPT reduces posttraumatic stress disorder (PTSD) symptoms in non-incarcerated adults, but has not been examined in prison populations. Moreover, little is known about the mechanisms through which IPT reduces PTSD symptoms. The current study investigated the direct and indirect effects of IPT on PTSD symptoms. We hypothesized that IPT would decrease PTSD symptoms by enhancing social support and decreasing loneliness (theorized IPT mechanisms). Method: A sub-sample of trauma-exposed participants (n = 168) were drawn from a larger randomized trial (n = 181) of IPT for major depressive disorder among prisoners. We examined a series of mediation models using non-parametric bootstrapping procedures to evaluate the indirect effect of IPT on PTSD symptoms. Results: Contrary to hypotheses, the relation between IPT and PTSD symptoms was significantly mediated through improvements in hopelessness and depressive symptoms (mechanisms of cognitive behavioral interventions), rather than through social support and loneliness. Increased social support and decreased loneliness were associated with decreased PTSD symptoms, but IPT did not predict changes in social support or loneliness. Conclusions: IPT may reduce PTSD symptoms in depressed prisoners by reducing hopelessness and depression. (ClinicalTrials.gov number NCT01685294).

Self-Regulation Shift Theory: A Dynamic Personal Agency Approach to Recovery Capital and Methodological Suggestions

Recovery capital highlights person and environmental resources associated with overcoming significant life challenges. This paper utilizes social cognitive theory as a framework for understanding how recovery capital functions in trauma adaptation. This theory outlines the bidirectional, dynamic interactions among person (e.g., cognitive and affective), behavioral (e.g., problem focused coping), and environmental variables (i.e., triadic reciprocal determinism). The value of this approach to understanding human adaptation to trauma is that it targets the self-regulatory processes that unfold for trauma survivors as they attempt to put their lives back together. Self-regulation shift theory (SRST), as an extension to social cognitive theory, is offered to explain how self-regulation is involved in both positive and negative adjustment. The theory uses a dynamical systems approach and highlights the mechanisms related to non-linear shifts in both positive and negative trauma recovery. According to SRST, trauma recovery may not be linear with threshold shifts (i.e., bifurcations) from one organized state (broken self) to another (empowered self). Coping self-efficacy perceptions are a critical factor influencing these threshold shifts. This paper concludes with a brief review of study designs and analytic procedures that can facilitate the application of non-linear dynamic research in this area.

A randomized controlled trial of three smartphone apps for enhancing public mental health

Many smartphone applications (apps) for mental health (MHapps) are available to the public. However, few have been the subject of a randomized controlled trial (RCT), and the change processes that are hypothesized to mediate claimed effects have not been previously studied. This RCT compared the efficacy of three publicly available MHapps to a waitlist control condition in a community sample, in which no MHapp was provided. The three MHapps included cognitive behavioural therapy (CBT) toolkit app MoodKit, mood tracking app MoodPrism, and CBT strategy app MoodMission. Participants were randomly allocated to each condition, completed a baseline assessment, downloaded their allocated MHapp, and completed a second assessment 30 days later, with n = 226 included in final analyses (81% female; M age = 34 years). Compared to the control condition, all MHapp groups experienced increases in mental wellbeing, MoodKit and MoodMission groups experienced decreases in depression, and no groups experienced effects on anxiety. Mediated regressions revealed that increasing coping self-efficacy, rather than emotional self-awareness or mental health literacy, was the underlying process contributing to effects on mental health for all three MHapps. MHapps appear to be an effective solution for improving public mental health, notably by improving users' confidence in their ability to cope.

Supportive Mental Health Self-Monitoring among Smartphone Users with Psychological Distress: Protocol for a Fully Mobile Randomized Controlled Trial

Mobile health (mHealth) could be widely used in the population to improve access to psychological treatment. In this paper, we describe the development of a mHealth intervention on the basis of supportive self-monitoring and describe the protocol for a randomized controlled trial to evaluate its effectiveness among smartphone users with psychological distress. Based on power analysis, a representative quota sample of N = 186 smartphone users will be recruited, with an over-sampling of persons with moderate to high distress. Over a 4-week period, the intervention will be compared to a self-monitoring without intervention group and a passive control group. Telephone interviews will be conducted at baseline, post-intervention (4 weeks), and 12-week follow-up to assess study outcomes. The primary outcome will be improvement of mental health. Secondary outcomes will include well-being, intentions toward help-seeking and help-seeking behavior, user activation, attitudes toward mental-health services, perceived stigmatization, smartphone app quality, user satisfaction, engagement, and adherence with the intervention. Additionally, data from the user's daily life as collected during self-monitoring will be used to investigate risk and protective factors of mental health in real-world settings. Therefore, this study will allow us to demonstrate the effectiveness of a smartphone application as a widely accessible and low-cost intervention to improve mental health on a population level. It also allows to identify new assessment approaches in the field of psychiatric epidemiology.

Interpersonal styles, peer relationships, and outcomes in residential substance use treatment

Interpersonal relationships play a key role in recovery from substance use disorders (SUDs). We examined the associations between problematic interpersonal styles, peer relationships, and treatment outcomes in a sample of U.S. military veterans in residential SUD treatment. Participants were 189 veterans enrolled in a residential SUD treatment program at a Department of Veterans Affairs medical center. Participants were interviewed at the time of treatment entry (baseline), one month into treatment, and 12months following discharge from treatment. More problematic interpersonal styles at treatment entry, measured by the Inventory of Interpersonal Problems-Circumplex (IIP-C), predicted more SUD symptoms 12months post-discharge (r=0.29, P<0.01). Results of a principal components analysis of the IIP-C subscales revealed three main factors of interpersonal styles: Passive, Cruel/Aloof, and Controlling. With the exception of the Passive factor, the relationship between these interpersonal styles and SUD symptoms 12months after discharge was mediated by relationship quality with peers one month in treatment: i.e., more problematic interpersonal styles at baseline predicted poorer relationship quality with peers at 1month, which in turn predicted more SUD symptoms at 12months. Results demonstrate the importance of assessing interpersonal styles among patients in residential SUD treatment, as well as potentially augmenting existing evidence-based psychosocial treatments with a focus on interpersonal styles.

Protective Factors, Coping Appraisals, and Social Barriers Predict Mental Health Following Community Violence: A Prospective Test of Social Cognitive Theory

This study tested social cognitive theory of posttraumatic adaptation in the context of mass violence, hypothesizing that pre-event protective factors (general self-efficacy and perceived social support) would reduce posttraumatic stress symptoms (PTSS) and depression severity through boosting post-event coping self-efficacy appraisals (mediator). We qualified hypotheses by predicting that post-event social support barriers would disrupt (moderate) the health-promoting indirect effects of pre-event protective factors. With a prospective longitudinal sample, we employed path models with bootstrapping resampling to test hypotheses. Participants included 70 university students (71.4% female; 40.0% White; 34.3% Asian; 14.3% Hispanic) enrolled during a mass violence event who completed surveys one year pre-event and 5-6 months post-event. Results revealed significant large effects in predicting coping self-efficacy (mastery model, R² = .34; enabling model, R² = .36), PTSS (mastery model, R² = .35; enabling model, R² = .41), and depression severity (mastery model, R² = .43; enabling model, R² = .46). Overall findings supported study hypotheses, showing that at low levels of post-event social support barriers, pre-event protective factors reduced distress severity through boosting coping self-efficacy. However, as post-event social support barriers increased, the indirect, distress-reducing effects of pre-event protective factors were reduced to nonsignificance. Study implications focus on preventative and responsive intervention.

Social Support, Help-Seeking, and Mental Health Outcomes Among Veterans in Non-VA Facilities: Results from the Veterans' Health Study

Using a stress process model, the authors examined social and psychological resources to better understand mental health outcomes among veterans. For this study, we surveyed 700 U.S. veterans who were outpatients in the Geisinger Health System. Independent variables included demographic factors, stressful and traumatic events, social support measures, and psychosocial factors. Using logistic regression, the authors examined 4 types of social connections: social support, help-seeking support, social capital, and other mental health support to predict mental health outcomes, including posttraumatic stress disorder, depression, suicide ideation, alcohol misuse, mental health service use, and Veterans Affairs service use. Results suggested that help-seeking support since deployment was a risk factor for 5 adverse outcomes, whereas social support was protective for 1 outcome. We concluded that high levels of help-seeking support since deployment among veterans was associated with a higher prevalence of mental health problems. These findings were unexpected and suggest the need for additional social support-related research among veterans.

The Longitudinal Effects of Network Characteristics on the Mental Health of Mothers of Children with ASD: The Mediating Role of Parent Cognitions

Employing a cohort sequential design, the effects of network characteristics on maternal cognitions (perceived social support and parenting self-efficacy) and mental health (depression and well-being) were assessed over 7 years when children with ASD of mothers in the study were age 7-14. Findings indicated that network size, network emotional support, and network instrumental support were positively related to perceived support, while network availability and emotional support were positively linked to self-efficacy. In addition, network support exerted direct and indirect effects on maternal depression and well-being, with cognitive resources mediating the social network-mental health relationship. Finally, consistent with the support-efficacy model, parenting efficacy partially mediated the effects of perceived support on maternal mental health outcomes. Study findings and implications are discussed.

The Influence of Social Support on Dyadic Functioning and Mental Health Among Military Personnel During Postdeployment Reintegration

OBJECTIVES

Although many service members successfully cope with exposure to stress and traumatic experiences, others have symptoms of depression, posttraumatic stress disorder (PTSD), and anxiety; contextual factors may account for the variability in outcomes from these experiences. This work sought to understand mechanisms through which social support influences the mental health of service members and whether dyadic functioning mediates this relationship.

METHODS

We collected cross-sectional data as part of a larger study conducted in 2013; 321 military personnel who had at least 1 deployment were included in these analyses. Surveys were completed online; we collected data on demographic characteristics, social support, mental health measures (depression, PTSD, and anxiety), and dyadic functioning. We performed process modeling through mediation analysis.

RESULTS

The direct effects of social support on the mental health of military personnel were limited; however, across all types of support networks, greater social support was significantly associated with better dyadic functioning. Dyadic functioning mediated the relationships between social support and depression/PTSD only when social support came from nonmilitary friends or family; dyadic functioning mediated social support and anxiety only when support came from family. We found no indirect effects of support from military peers or military leaders.

CONCLUSION

Findings here highlight the need to continue to explore ways in which social support, particularly from family and nonmilitary-connected peers, can bolster healthy intimate partner relationships and, in turn, improve the well-being of military service members who are deployed.

Mental Health Smartphone Apps: Review and Evidence-Based Recommendations for Future Developments

BACKGROUND

The number of mental health apps (MHapps) developed and now available to smartphone users has increased in recent years. MHapps and other technology-based solutions have the potential to play an important part in the future of mental health care; however, there is no single guide for the development of evidence-based MHapps. Many currently available MHapps lack features that would greatly improve their functionality, or include features that are not optimized. Furthermore, MHapp developers rarely conduct or publish trial-based experimental validation of their apps. Indeed, a previous systematic review revealed a complete lack of trial-based evidence for many of the hundreds of MHapps available.

OBJECTIVE

To guide future MHapp development, a set of clear, practical, evidence-based recommendations is presented for MHapp developers to create better, more rigorous apps.

METHODS

A literature review was conducted, scrutinizing research across diverse fields, including mental health interventions, preventative health, mobile health, and mobile app design.

RESULTS

Sixteen recommendations were formulated. Evidence for each recommendation is discussed, and guidance on how these recommendations might be integrated into the overall design of an MHapp is offered. Each recommendation is rated on the basis of the strength of associated evidence. It is important to design an MHapp using a behavioral plan and interactive framework that encourages the user to engage with the app; thus, it may not be possible to incorporate all 16 recommendations into a single MHapp.

CONCLUSIONS

Randomized controlled trials are required to validate future MHapps and the principles upon which they are designed, and to further investigate the recommendations presented in this review. Effective MHapps are required to help prevent mental health problems and to ease the burden on health systems.

Social Support, Emotional Intelligence, and Posttraumatic Stress Disorder Symptoms

Abstract. Exposure to traumatic events and the associated risk of developing Posttraumatic stress disorder (PTSD) symptoms is a significant and overlooked concern in the college population. It is important for current research to identify potential protective factors associated with the development and maintenance of PTSD symptoms unique to this population. Emotional intelligence and perceived social support are two identified protective factors that influence the association between exposure to traumatic events and PTSD symptomology. The current study examined the mediating role of social support in the relationship between emotional intelligence and PTSD symptoms. Participants included 443 trauma-exposed university students who completed online questionnaires. The results of this study indicated that social support mediates the relationship between emotional intelligence and reported PTSD symptoms. Thus, emotional intelligence is significantly associated with PTSD symptoms and social support may play an integral role in the relationship between emotional intelligence and PTSD. The current study is the first to investigate the role of social support in the relationship between emotional intelligence and PTSD symptoms. These findings have important treatment and prevention implications with regard to PTSD.

Portuguese War Veterans: Moral Injury and Factors Related to Recovery From PTSD

This study explored the factors to which a sample of Portuguese war veterans attributed their recovery from posttraumatic stress disorder (PTSD). Participants were a sample of veterans (N = 60) with mental sequelae of the Portuguese Colonial War: 30 suffered from chronic PTSD (unrecovered) and 30 veterans with remission from PTSD (recovered). Two semistructured interviews were conducted. Analysis of the interviews was conducted using the Thematic and Categorical Analysis. Results showed that unrecovered participants reported higher postwar betrayal, appraisal of hostile societal homecoming, social stigmatization, lack of personal resources (mental fatigue and restriction of coping strategies), and reduced perceived social support. Recovered participants verbalized some capability for self-awareness of their own mental states and/or awareness of others' mental states (mentalization ability), a wider repertoire of coping strategies, and higher perceived social support. The authors discussed that recovery from PTSD among veterans can be related to the assimilation of moral injury by developing higher mentalization abilities.