Intimate partner aggression perpetrated and sustained by male Afghanistan, Iraq, and Vietnam veterans with and without posttraumatic stress disorder

Relationship conflict and partner violence by UK military personnel following return from deployment in Iraq and Afghanistan

PURPOSE

Risk of violence by UK military personnel, both towards non-family and family, has been found to be higher post-deployment. However, no UK research to date has attempted to examine relationship conflict and intimate partner violence (IPV) in this period. This study estimated the prevalence of and risk factors for post-deployment relationship conflict and partner violence in UK military personnel.

METHODS

We utilised data on military personnel who had deployed to Iraq and/or Afghanistan (n = 5437), drawn from a large cohort study into the health and well-being of UK military personnel.

RESULTS

34.7% reported relationship conflict (arguing with partner) and 3.4% reported perpetrating physical IPV post-deployment. Males were more likely than females to report relationship conflict. There were similar rates of self-reported physical IPV perpetration among males and females. Among our male sample, factors associated with both relationship conflict and physical IPV perpetration post-deployment included being in the Army compared with the Royal Air Force, higher levels of childhood adversity, higher levels of military trauma exposure and recent mental health and alcohol misuse problems. Being over 40 at time of deployment (vs being under 25) and having deployed in a combat role were also associated with relationship conflict, but not physical IPV perpetration.

CONCLUSIONS

Deployment-related variables and mental health and alcohol misuse problems were found to be key factors associated with post-deployment relationship conflict and IPV. Services providing health or welfare support to military personnel must collaborate with mental health services and consider history of deployment, and particularly deployment-related trauma, in their assessments to improve identification and management of intimate partner violence and abuse in military communities.

Early trauma and associations with altruistic attitudes and behaviours among young adults

BACKGROUND

Childhood and adolescent traumas are exceptionally prevalent worldwide. Despite their high prevalence and substantial impact, little research has investigated the rates and specific types of early trauma by gender. It is also unknown whether the types of early trauma are differentially associated with heightened or hindered prosocial attitudes and behaviours.

OBJECTIVE

To address this gap, this study aims to explore the rates of different types of early trauma (i.e., abuse: sexual, physical, and emotional; neglect: physical and emotional) among young Australian adults and investigate whether these differ according to participant gender (female, male and transgender/gender diverse). The study will also examine the associations between the different types of early trauma and current altruistic attitudes and behaviours (including the affective, behavioural and cognitive altruism domains), among a young adult Australian cohort.

METHODS

Cross-sectional data was collected from 511 young Australians aged 18-20 years using an online self-report survey.

RESULTS

Multiple regression analyses revealed that transgender/gender diverse individuals were over 3-times more likely to experience all types of maltreatment than females and over 3-times more likely to experience emotional and sexual abuse and emotional neglect than males. Experiencing one or more trauma types was negatively associated with the cognitive domain of altruism, experiencing physical neglect was associated with the affective domain, and having a family member involved in domestic violence was associated with the behavioural domain, after controlling for gender.

CONCLUSIONS

Findings show how early traumatic experiences can influence individuals' attitudes and behaviours during the pivotal developmental period of young adulthood.

PTSD and Attitudes Toward Guns Following Interpersonal Trauma

Gun violence is a serious public health concern that is currently grossly understudied. Gun attitudes are a potential risk factor for gun violence; however, factors related to gun attitudes have not been identified. Mental illness such as posttraumatic stress disorder (PTSD) is commonly discussed as a key factor in gun violence, despite research lacking in this area, and it is unknown whether symptoms of PTSD and probable PTSD are associated with more positive attitudes toward guns. The aim of the current study was to investigate the relations between PTSD symptoms and gun attitudes among 265 undergraduate students who experienced at least one interpersonal traumatic event (M_age = 24.69 years, SD = 7.15 years, 75.6% female, 61.1% White). Path analysis revealed that individuals with PTSD symptoms above clinical cutoff were not more likely to have more positive gun attitudes. However, the PTSD symptom clusters evinced distinct relations with gun attitudes. Intrusion and avoidance symptoms were related to gun beliefs regarding protection, with intrusion symptoms being linked to a stronger belief that guns provide protection from crime and victimization (β = .23), whereas avoidance symptoms were inversely associated with this belief (β = -.22). Interestingly, neither trauma related in feelings and thoughts nor arousal and reactivity corresponded with gun attitudes. Certain PTSD symptom clusters may be relevant in understanding gun beliefs, with specific symptoms exhibiting distinct ties to gun attitudes.

A Dyadic Analysis of PTSD and Psychological Partner Aggression Among U.S. Iraq and Afghanistan Veterans: The Impact of Gender and Dual-Veteran Couple Status

Posttraumatic stress disorder (PTSD) symptoms have been repeatedly linked to intimate partner aggression (IPA), and previous research has suggested that this association may be stronger among veterans and men. However, few studies have examined veteran status and gender as moderators of the association between PTSD and psychological IPA, taking both partners' perspectives into account (i.e., within a dyadic framework). The current study aimed to address this limitation by using dyadic multilevel modeling to examine the association between PTSD symptoms and psychological IPA perpetration among a sample of 159 Operation Iraqi Freedom and Operation Enduring Freedom veterans and their partners (N = 318 participants). Findings revealed that both one's own and one's partner's PTSD symptoms were positively associated with greater psychological IPA. In addition, the effects of partner PTSD symptoms on psychological IPA perpetration differed across gender and veteran status. Results suggested that the association of partner PTSD and IPA perpetration may be stronger for male veterans than for female veterans. Findings from the current study are consistent with previous research showing associations between PTSD and IPA, and have clinical implications for treatment of PTSD and IPA among Operation Iraqi Freedom and Operation Enduring Freedom veterans.

Parameters of Aggressive Behavior in a Treatment-Seeking Sample of Military Personnel: A Secondary Analysis of Three Randomized Controlled Trials of Evidence-Based PTSD Treatments

Aggressive behavior is prevalent among veterans of post-9/11 conflicts who have posttraumatic stress disorder (PTSD). However, little is known about whether PTSD treatments reduce aggression or the direction of the association between changes in PTSD symptoms and aggression in the context of PTSD treatment. We combined data from three clinical trials of evidence-based PTSD treatment in service members (N = 592) to: (1) examine whether PTSD treatment reduces psychological (e.g., verbal behavior) and physical aggression, and; (2) explore temporal associations between aggressive behavior and PTSD. Both psychological (Estimate = -2.20, SE = 0.07) and physical aggression (Estimate = -0.36, SE = 0.05) were significantly reduced from baseline to posttreatment follow-up. Lagged PTSD symptom reduction was not associated with reduced reports of aggression; however, higher baseline PTSD scores were significantly associated with greater reductions in psychological aggression (exclusively; ß = -0.67, 95% CI = -1.05, -0.30, SE = -3.49). Findings reveal that service members receiving PTSD treatment report substantial collateral changes in psychological aggression over time, particularly for participants with greater PTSD symptom severity. Clinicians should consider cotherapies or alternative ways of targeting physical aggression among service members with PTSD and alternative approaches to reduce psychological aggression among service members with relatively low PTSD symptom severity when considering evidence-based PTSD treatments.

Sexual Assault, Posttraumatic Stress Symptoms, and Indices of Aggression Among Women

Sexual assault is associated with many adverse outcomes, including a higher risk for developing posttraumatic stress symptoms (PTSS). Although nonsexual trauma exposure has been linked to aggression, the associations between sexual assault and aggression are understudied. Further, the DSM-5 conceptualization of posttraumatic stress disorder (PTSD) includes a symptom related to aggression, and associations between symptom clusters and aggression with regard to the new criteria are underexplored. The present study aimed to (a) examine the relations between sexual assault and indices of aggression (i.e., physical/verbal aggression, anger, and hostility) after accounting for PTSS and (b) investigate PTSD symptom clusters in relation to aggression among 263 women (M_age = 29.03 years, SD = 11.71; 67.6% white). Path analysis revealed that sexual assault was unrelated to indices of aggression, βs = .003-.08; however, PTSS was consistently linked with increased aggression, βs = .22-.49. Results indicated specificity in the associations between the symptom clusters and aspects of aggression. Negative alterations in cognitions and mood corresponded with increased physical aggression, β = .28, and hostility, β = .38, and avoidance was related to verbal aggression, β = .19. Hyperarousal was also tied to higher levels of anger, hostility, and verbal aggression, βs = .21-.33. Nonetheless, lower levels of intrusion symptoms were associated with increased anger and hostility, β = -.26. With regard to understanding women's risk for aggression, PTSS may be more relevant than sexual assault. Further, there may be specificity related to the type of PTSD symptoms and aspects of aggression.

Manage Emotions to Reduce Aggression: A Pilot Study of a Brief Treatment to Help Veterans Reduce Impulsive Aggression

Veterans with posttraumatic stress disorder (PTSD) report more aggression than civilians with PTSD. Because emotion regulation difficulties mediated the relationship between PTSD symptoms and impulsive aggression in veterans, we developed an intervention to increase emotion regulation skills. This pilot study tested the feasibility and acceptability of a three-session treatment, Manage Emotions to Reduce Aggression (MERA), and examined its effectiveness at reducing aggression and emotion dysregulation. Male combat veterans with PTSD and impulsive aggression completed assessments before and 4 weeks after MERA. Overt Aggression Scale measured frequency of aggression; Difficulties in Emotion Regulation Scale assessed emotion dysregulation. Most veterans (95%) who completed MERA and the posttreatment assessment (n = 20) reported MERA was helpful. Veterans in the intent-to-treat sample demonstrated a significant decrease in their frequency of aggression (Cohen's d = -0.55) and emotion dysregulation (Cohen's d = -0.55). MERA may be an innovative treatment that helps veterans reduce aggression.

Associations of warzone veteran mental health with partner mental health and family functioning: Family Foundations Study

INTRODUCTION

Warzone participation is associated with increased risk of stress-related psychopathology, including posttraumatic stress disorder (PTSD) and depression. Prior research suggests that the mental health of spouses of warzone veterans (WZVs) is linked to that of their partners. Additionally, PTSD among WZVs has been associated with marital dysfunction. Less is known about the effects of depression among WZVs on partner mental health and family relationships. We sought in this study to examine associations between WZV PTSD and depression and partner mental health and relationship outcomes.

METHODS

Using a nationally dispersed sample of Iraq and Afghanistan veterans and their married and unmarried intimate partners, 245 dyads completed structured psychiatric interviews and psychometric surveys assessing family functioning and relationship aggression.

RESULTS

Adjusted regression analyses indicated that depression among WZVs was associated with partner depression and anxiety disorders. WZV PTSD and depression were also associated with partner-reported relationship dysfunction, dissatisfaction, and communication issues, and higher rates of intimate partner aggression victimization and perpetration.

CONCLUSIONS

Mental health consequences of war extend beyond WZVs to the mental health of their intimate partners and their relationships with intimate partners.

Examining the DSM-5 latent structures of posttraumatic stress disorder in a national sample of student veterans

To date, no studies have examined the latent structures of posttraumatic stress disorder (PTSD) within a sample of student veterans. To examine these constructs in a student veteran sample (n = 297), confirmatory factor analysis (CFA) was conducted on six different models of PTSD, including a one-factor model, based on the 20 symptoms found in the DSM-5; PTSD was assessed using the PCL-5. Global fit statistics suggest that fit across all models, including the 1-factor model, were good [RMSEAs(0.054-0.056); CFIs(0.928-0.940); SRMRs(0.043-0.045)], and the AIC was lowest for the seven-factor hybrid model. Statistical tests and fit guidelines for nested models suggest there is no quantitative advantage of a five, six, or seven-factor model over the existing DSM-5 four-factor model. Given the high percentage of student veterans that screened positive for a probable PTSD diagnosis (53 %) in this study compared to non-student veterans (11-20 %) and the general student population (11-15 %) found in other studies, further research is needed to assess the clinical utility of these symptoms and model structures.

Prevalence of intimate partner violence perpetration among military populations: A systematic review and meta-analysis

Intimate partner violence (IPV) is a global health issue that impacts both civilian and military populations. Factors associated with military service may result in increased risk of IPV perpetration among Veterans and Active Duty military personnel. Six bibliographic databases were searched to identify studies that estimated the prevalence of IPV perpetration among military populations by sociodemographic and military characteristics. Where possible, random effect meta-analyses were conducted to determine pooled prevalence estimates. 42 studies were eligible for inclusion in this systematic review. 28 of these studies met the requirements for inclusion in subsequent meta-analyses. Among studies that measured past-year physical IPV perpetration, the pooled prevalence was higher among men compared to women (26% and 20% respectively). Among Veterans, there were consistently higher prevalences compared to Active Duty samples. Similarly, higher prevalences were found among studies in general military settings compared to clinical settings. Further research that considers the impact of the act(s) of IPV perpetration on the victims is needed. This, along with the use of a consistent measurement tools across studies will help to develop a stronger evidence base to inform prevention and management programs for all types of IPV perpetration among military personnel.

The path to couples therapy: A descriptive analysis on a Veteran sample

The current study uses descriptive data from a sample of Veterans and their partners (N = 97 opposite-sex couples) presenting to a Veterans Affairs Medical Center (VAMC). The purpose of this investigation was to examine 1) the problems couples face prior to seeking treatment; 2) how long it took couples to seek treatment; 3) what attempts couples made to improve their relationship prior to couples therapy. We also examined how these treatment initiation factors were related to relationship distress and expectations for therapy. Results suggest the relationship problems that precede Veteran couples seeking treatment are varied (e.g., stressors outside of relationship, communication problems, lack of trust) and agreement between partners on type of relationship problem is not predictive of relationship satisfaction, perception of relationship problem severity, nor expectations for therapy. Partners tend to wait approximately 4-7 years before pursuing couples therapy to resolve relational concerns. The length of time partners wait to pursue therapy is positively associated with optimistic expectations for therapy. In addition, prior to treatment initiation, partners tend to make multiple attempts to improve their relationship (M = 1.79 attempts for men; M = 2.40 attempts for women) and the number of unique attempts made to improve the relationship is associated with greater distress and more negative perceptions of relationship problem severity. Findings have implications for identifying Veteran couples who may be more or less receptive to intervention and informing the development of a stepped-care approach for couples treatment referral and planning.

Physical Fighting Among Male and Female Adolescents of Military Families: Results From a Representative Sample of High School Students

The impact of family military involvement on adolescent mental health and substance abuse is well established, but little is known about other behavioral health outcomes such as physical fighting. We assessed the relationship between family military involvement and physical fighting in a representative sample of 3,928 high school students. Weighted logistic regression was used to determine whether adolescents from military families had higher odds of fighting and fighting on school property compared with adolescents of non-military families after controlling for demographics, substance use, depressive symptoms, and bullying victimization. We also assessed the cumulative impact of multiple risk factors on fighting outcomes. Overall, 23.5% of high school students reported physical fighting and 7.0% reported physical fighting at school. Youth from military families had higher odds of physical fighting (adjusted odds ratios [AOR] = 1.69; 95% confidence interval [CI] = [1.27, 2.25]) and physical fighting on school property (AOR = 1.98; 95% CI = [1.16, 3.39]). In models stratified by gender, family military involvement remained independently associated with physical fighting and physical fighting at school for males (AOR = 1.74; 95% CI = [1.15, 2.65] and AOR = 2.21; 95% CI = [1.03, 4.74]) and females (AOR = 1.65; 95% CI = [1.11, 2.45] and AOR = 1.88; 95% CI = [1.01, 3.50]). The odds of engaging in each physical fighting outcome increased as the cumulative number of risk factors increased. School-based interventions aimed at addressing fighting should be tailored to fit the unique needs of adolescents in military families, particularly those with additional risk factors.

Cognitive Reframing of Intimate Partner Aggression: Social and Contextual Influences

Intimate partner aggression violates U.S. culturally-accepted standards regarding how partners should treat each other. Victims must reconcile the dissonance associated with being in what should be a loving and supportive relationship, while being in the same relationship that is personally and deeply harmful. To manage these clashing cognitions, victims consciously and unconsciously adopt perceptions to reframe their partner’s aggression, minimizing and reinterpreting the occurrence or impact of aggressive acts, and justifying remaining in their relationship. The paper examines the multiple and nested influences that shape such perceptions, including individual, partner, relationship, and cultural factors. Each type of influence is discussed by reviewing previous research and including accounts from women who had experienced aggression. Greater awareness of such perceptions may afford greater control in changing harmful relationship patterns.

Association of posttraumatic stress disorder and traumatic brain injury with aggressive driving in Iraq and Afghanistan combat veterans

PURPOSE

Aggressive driving contributes to the high rates of postdeployment motor vehicle-related injury and death observed among veterans, and veterans cite problems with anger, aggressive driving, and road rage as being among their most pressing driving-related concerns. Both posttraumatic stress disorder (PTSD) and traumatic brain injury (TBI) have been associated with driving-related deficits in treatment-seeking samples of veterans, but the relative contribution of each of these conditions to problems with aggressive driving in the broader population of combat veterans is unclear.

METHOD

χ2 and logistic regression analyses were used to examine the relative association of PTSD, TBI, and co-occurring PTSD and TBI to self-reported problems with road rage in a sample of 1,102 veterans living in the mid-Atlantic region of the United States who had served in Afghanistan or Iraq.

RESULTS

Results indicate that controlling for relevant demographic variables, PTSD without TBI (odds ratio = 3.44, p < .001), and PTSD with co-occurring TBI (odds ratio = 4.71, p < .001) were associated with an increased risk of road rage, but TBI without PTSD was not.

CONCLUSIONS

Our findings suggest that PTSD, with or without comorbid TBI, may be associated with an increased risk of aggressive driving in veterans. Clinical implications for treating problems with road rage are discussed, including use of interventions targeting hostile interpretation bias and training in emotional and physiological arousal regulation skills. (PsycINFO Database Record

A Qualitative Study of Male Veterans' Violence Perpetration and Treatment Preferences

Prevention and treatment of intimate partner violence (IPV) has increasingly focused on engaging men; however, very little work has examined how men manage the negative emotions associated with relationship conflict, as well as their preferences for and perceived barriers to treatment. Given the overrepresentation of IPV among men with post-traumatic stress disorder, the perspectives of male veterans with and without post-traumatic stress disorder are critical to informing IPV prevention and treatment within the Veterans Administration (VA) healthcare system. This qualitative study involved interviews with 25 male veterans who reported recent IPV perpetration. Interview themes included coping with emotions associated with violence and preferences and barriers to seeking treatment related to IPV. Results found the participants were interested in receiving IPV treatment at the Veterans Administration, and interviews offered several suggestions for developing or adapting prevention and treatment options for male veterans and their families to take into account violence in their relationships.

The Role of PTSD in Bi-directional Intimate Partner Violence in Military and Veteran Populations: A Research Review

Evidence supporting the higher prevalence of PTSD linked to combat-related trauma in military personnel and veteran populations is well-established. Consequently, much research has explored the effects that combat related trauma and the subsequent PTSD may have on different aspects of relationship functioning and adjustment. In particular, PTSD in military and veterans has been linked with perpetrating intimate partner violence (IPV). New research and theoretical perspectives suggest that in order to respond effectively to IPV, a more accurate understanding of the direction of the violence experienced within each relationship is critical. In both civilian and military populations, research that has examined the direction of IPV's, bi-directional violence have been found to be highly prevalent. Evidence is also emerging as to how these bi-directional violence differ in relation to severity, motivation, physical and psychological consequences and risk factors. Of particular importance within military IPV research is the need to deepen understanding about the role of PTSD in bi-directional IPV not only as a risk factor for perpetration but also as a vulnerability risk factor for victimization, as findings from recent research suggest. This paper provides a timely, critical review of emergent literature to disentangle what is known about bi-directional IPV patterns in military and veteran populations and the roles that military or veterans' PTSD may play within these patterns. Although, this review aimed to identify global research on the topic, the majority of research meeting the inclusion criteria was from US, with only one study identified from outside, from Canada. Strengths and limitations in the extant research are identified. Directions for future research are proposed with a particular focus on the kinds of instruments and designs needed to better capture the complex interplay of PTSD and bi-directional IPV in military populations and further the development of effective interventions.

Predictors of well-being in the lives of student service members and veterans

OBJECTIVE

The current study examined predictors of well-being, including quality of life and academic engagement, in a sample of student service members and veteran college students.

METHODS

Eighty-seven student service members/veterans (SSM/V) completed an online survey containing questions about post-deployment social support, emotion regulation skills, psychological distress, academic engagement, quality of life, and demographics. Participants were recruited from September 2012 through May 2014.

RESULTS

Results provided partial support for the proposed bi-directional mediational relations between post-deployment social support and emotion regulation predicting to quality of life and academic engagement. Path models indicated that both post-deployment social support and emotion regulation skills partially mediated the relation with quality of life while accounting for the effect of psychological distress, and that emotion regulation skills fully mediated the relation between social support and academic engagement.

CONCLUSIONS

These findings suggest that both social support and emotion regulation skills may be useful targets for health promotion and intervention efforts for this population. Limitations and clinical implications for the development of on-campus SSM/V focused health promotion services are discussed.

The Role of Impulsivity Dimensions in the Relation Between Probable Posttraumatic Stress Disorder and Aggressive Behavior Among Substance Users

OBJECTIVE

Individuals with co-occurring posttraumatic stress disorder (PTSD) and substance use disorder report heightened levels of numerous risky and health-compromising behaviors, including aggressive behaviors. Given evidence that aggressive behavior is associated with negative substance use disorder treatment outcomes, research is needed to identify the factors that may account for the association between PTSD and aggressive behavior among patients with substance use disorder. Thus, the goal of this study was to examine the role of impulsivity dimensions (i.e., negative urgency, lack of premeditation, lack of perseverance, and sensation seeking) in the relations between probable PTSD status and both verbal and physical aggression.

METHODS

Participants were 92 patients in residential substance use disorder treatment (75% male; 59% African American; M age = 40.25) who completed self-report questionnaires.

RESULTS

Patients with co-occurring PTSD-substance use disorder (vs. substance use disorder alone) reported significantly greater verbal and physical aggression as well as higher levels of negative urgency and lack of premeditation. Lack of premeditation and lack of perseverance were significantly positively associated with verbal aggression, whereas negative urgency, lack of premeditation, and lack of perseverance were significantly positively associated with physical aggression. The indirect relation of probable PTSD status to physical aggression through negative urgency was significant.

CONCLUSIONS

Results highlight the potential utility of incorporating skills focused on controlling impulsive behaviors in the context of negative emotional arousal in interventions for physical aggression among patients with co-occurring PTSD-substance use disorder.

Associations between PTSD and intimate partner and non-partner aggression among substance using veterans in specialty mental health

BACKGROUND

Risk factors of violence perpetration in veterans include substance use and posttraumatic stress disorder (PTSD); however, it is unknown whether these factors are associated with greater risk for partner or non-partner violence. This study investigated the associations between probable PTSD, heavy drinking, marijuana use, cocaine use, and partner and non-partner violence perpetration.

METHODS

Self-report questionnaires assessing past-year partner and non-partner aggression (CTS2) as well as past-month substance use (SAOM), probable PTSD (PCL-C), and probable depression (PHQ-9) were administered to 810 substance using veterans entering VA mental health treatment.

RESULTS

In bivariate analyses, probable PTSD in substance using veterans was associated with violence perpetration (partner physical, χ²=11.46, p=0.001, φ=0.12; non-partner physical, χ²=50.64, p<0.001, φ=0.25; partner injury, χ²=6.41, p=0.011, φ=0.09; non-partner injury, χ²=42.71, p<0.001, φ=0.23). In multiple logistic regression analyses that adjusted for sociodemographic characteristics, probable PTSD was independently associated with non-partner physical (odds ratio [OR], 2.82; 95% confidence interval [CI], 1.97-4.05) and injury aggression (OR, 3.96; CI, 2.56-6.13). Cocaine and heavy drinking were independently associated with non-partner physical and injury aggression and non-partner injury aggression respectively.

CONCLUSIONS

The results provide evidence that probable PTSD, heavy drinking, and cocaine use are associated with increased risk of non-partner violence perpetration in substance using veterans. These results underscore the importance of screening for PTSD symptoms and violence perpetration towards non-partners in substance using veterans presenting for treatment.

Military/Civilian Risk Markers for Physical Intimate Partner Violence: A Meta-Analysis

This meta-analysis compared risk markers for perpetration of physical intimate partner violence (IPV) among military and civilian males. We also examined strength of risk markers among male and female service members. In total, 36 military studies and 334 civilian studies, which reported 883 effect sizes, were included in the analyses. Results revealed more similarities than differences in risk markers for IPV among military and civilian males and among military males and females. Of the risk markers examined, relationship satisfaction and alcohol problems were significantly stronger risk markers for IPV among civilian males compared to military males. Perpetrating emotional abuse was a significantly stronger risk marker for IPV perpetration among military females compared to military males. Recommendations for IPV prevention and intervention are discussed.

The Relationship Between Emotion Dysregulation and Impulsive Aggression in Veterans With Posttraumatic Stress Disorder Symptoms

While Veterans in general are no more dangerous than the civilian population, Veterans with posttraumatic stress disorder (PTSD) have stronger associations with anger and hostility and certain forms of aggression, such as intimate partner violence, than civilians with PTSD. This is alarming because up to 21% of Veterans seeking Veterans Affairs (VA) health care are diagnosed with PTSD. Emotion regulation difficulties (emotion dysregulation) are also related to increased PTSD symptom severity and may play a role in aggressive behavior. Because the predominant form of aggression in PTSD appears to be the impulsive subtype, the authors sought to clarify the relationship between PTSD, emotion dysregulation, and impulsive aggression. We examined how emotion dysregulation influenced impulsive aggression in a Veteran sample (N = 479) seeking treatment for trauma sequelae. All Veterans completed measures that assessed demographic information, emotion dysregulation, aggression frequency and subtype, and PTSD symptoms. Men generally reported more aggression than women. The emotion dysregulation, aggression, and PTSD measures were significantly correlated. Two cross-sectional mediation models showed emotion dysregulation fully accounted for the relationship between PTSD and impulsive aggression (indirect path for men: b = .07, SE = .026, bias-correct and accelerated confidence interval [BCa CI] = [0.02, 0.13]; indirect path for women: b = .08, SE = .022, BCa CI = [0.05, 0.13]). PTSD can increase negative emotions yet does not always lead to aggressive behaviors. The ability to regulate emotions may be pivotal to inhibiting aggression in those with PTSD. PTSD interventions may benefit from augmentation with emotion regulation skills training.

Intimate Partner Violence Between Male Iraq and Afghanistan Veterans and Their Female Partners Who Seek Couples Therapy

The current study has three aims: (1) to describe the frequency, gender differences, and agreement in couples' reports of male-to-female and female-to-male intimate partner violence (IPV) reported by male veterans and their female partners who were seeking couples therapy; (2) to describe the pattern of violence reported by these couples (e.g., one-sided, mutual) and determine if frequency of violence varied based on patterns; and (3) to examine whether frequency of violence or pattern of violence were associated with veteran diagnosis of posttraumatic stress disorder (PTSD). One hundred heterosexual couples (male Iraq/Afghanistan veteran, female civilian) seeking couples therapy at a Veterans Affairs (VA) clinic completed self-report measures of violence in their relationship. Almost all couples reported verbal aggression. Men reported perpetrating more frequent sexual coercion, and women reported perpetrating more frequent physical aggression. Correspondence in partners' reports of violence varied based on type of violence from high correspondence on verbal aggression to low correspondence on sexual coercion. Three patterns of violence were identified: verbally aggressive (n = 45), one-sided physically aggressive (n = 27), and mutually physically aggressive (n = 26). Mutually physically aggressive couples generally reported the most frequent violence. Frequency and pattern of violence were not associated with veteran diagnosis of PTSD. Findings underscore the need for clinicians to assess both partners for violence perpetration and the need for effective prevention strategies and treatments for IPV among veterans.

Symmetrical and asymmetrical outcomes of leader anger expression: A qualitative study of army personnel

Recent studies have highlighted the utility of anger at work, suggesting that anger can have positive outcomes. Using the Dual Threshold Model, we assess the positive and negative consequences of anger expressions at work and focus on the conditions under which expressions of anger crossing the impropriety threshold are perceived as productive or counterproductive by observers or targets of that anger. To explore this phenomenon, we conducted a phenomenological study (n = 20) to probe the lived experiences of followers (as observers and targets) associated with anger expressions by military leaders. The nature of task (e.g. the display rules prescribed for combat situations) emerged as one condition under which the crossing of the impropriety threshold leads to positive outcomes of anger expressions. Our data reveal tensions between emotional display rules and emotional display norms in the military, thereby fostering paradoxical attitudes toward anger expression and its consequences among followers. Within this paradoxical space, anger expressions have both positive (asymmetrical) and negative (symmetrical) consequences. We place our findings in the context of the Dual Threshold Model, discuss the practical implications of our research and offer avenues for future studies.

Psychosocial Equine Program for Veterans

Nearly half of all combat veterans suffer from serious psychological disorders and reintegration issues. Veterans shy away from typical talk therapy and are seeking alternative treatments. Equine-facilitated mental health therapy has shown promise in treating veterans with depressive and anxiety disorders and reintegration issues. This article reports on an institutional review board-approved pilot program designed to address the mental health needs of veterans. Furthermore, this article discusses future directions for evolving development of equine treatment programming.

A systematic literature review of PTSD's latent structure in the Diagnostic and Statistical Manual of Mental Disorders: DSM-IV to DSM-5

The factor structure of posttraumatic stress disorder (PTSD) has been widely researched, but consensus regarding the exact number and nature of factors is yet to be reached. The aim of the current study was to systematically review the extant literature on PTSD's latent structure in the Diagnostic and Statistical Manual of Mental Disorders (DSM) in order to identify the best-fitting model. One hundred and twelve research papers published after 1994 using confirmatory factor analysis and DSM-based measures of PTSD were included in the review. In the DSM-IV literature, four-factor models received substantial support, but the five-factor Dysphoric arousal model demonstrated the best fit, regardless of gender, measurement instrument or trauma type. The recently proposed DSM-5 PTSD model was found to be a good representation of PTSD's latent structure, but studies analysing the six- and seven-factor models suggest that the DSM-5 PTSD factor structure may need further alterations.

Weapon carrying, physical fighting and gang membership among youth in Washington state military families

To examine associations between parental military service and school-based weapon carrying, school-based physical fighting and gang membership among youth. We used cross-sectional data from the 2008 Washington State Healthy Youth Survey collected in 8th, 10th, and 12th grades of public schools (n = 9,987). Parental military service was categorized as none (reference group), without combat zone deployment, or deployed to a combat zone. Multivariable logistic regression was used to test associations between parental military service and three outcomes: school-based weapon carrying, school-based physical fighting and gang membership. Standard errors were adjusted for the complex survey design. In 8th grade, parental deployment was associated with higher odds of reporting gang membership (OR = 1.8) among girls, and higher odds of physical fighting (OR = 1.6), and gang membership (OR = 1.9) among boys. In 10th/12th grade, parental deployment was associated with higher odds of reporting physical fighting (OR = 2.0) and gang membership (OR = 2.2) among girls, and physical fighting (OR = 2.0), carrying a weapon (OR = 2.3) among boys. Parental military deployment is associated with increased odds of reporting engagement in school-based physical fighting, school-based weapon carrying, and gang membership, particularly among older youth. Military, school, and public health professionals have a unique, collaborative opportunity to develop school- and community-based interventions to prevent violence-related behaviors among youth and, ultimately, improve the health and safety of youth in military families. Ideally, such programs would target families and youth before they enter eighth grade.

Posttraumatic Stress Disorder Symptom Clusters and Perpetration of Intimate Partner Violence: Findings From a U.S. Nationally Representative Sample

Associations between posttraumatic stress disorder (PTSD) and perpetration of intimate partner violence (IPV) have not been extensively studied in nonveteran samples. Secondary analysis was conducted using a nationally representative U.S. sample and limited to those who reported being in a relationship in the past year (N = 25,652). This sample was mostly White (72.0%), the majority had completed high school/ general educational development (GED; 87.8%), about half were female (49.2%), and the mean age was 46.44 years (SD = 15.92). We hypothesized that a diagnosis of PTSD in the past year would be associated with greater perpetration of IPV and that the arousal/reactivity and intrusion symptom clusters would evidence the strongest associations with IPV. Consistent with expectations, a PTSD diagnosis in the past year was associated with greater perpetration of IPV, OR = 2.07, 95% CI [1.89, 2.26]. Among those with a PTSD diagnosis in the past year (n = 1,742), arousal/reactivity symptom cluster scores were associated with greater perpetration of IPV for both men and women, AOR = 1.27, 95% CI [1.11, 1.44]; intrusion symptom cluster scores were associated with perpetration of IPV for men only, AOR = 1.56, 95% CI [1.20, 2.04]; whereas negative cognitions/mood symptom cluster scores were only significant among women, AOR = 1.12, 95% CI [1.01, 1.24]. Results suggested that theoretical and empirical work linking PTSD and perpetration of IPV in military samples extends to the general population.

"Strength at Home" Intervention for Male Veterans Perpetrating Intimate Partner Aggression: Perceived Needs Survey of Therapists and Pilot Effectiveness Study

Veteran and active duty populations evidence higher rates of intimate partner aggression (IPA) than comparable civilian groups, perhaps due in part to their unique service-related experiences. IPA offender treatment programs that take military background into consideration are not widely available, and it is unclear to what extent there is a perceived need for them among clinicians who serve service members and Veterans. Strength at Home (SAH) is a promising 12-session cognitive-behavioral group intervention designed to address IPA perpetration in military populations. While clinical support for SAH is emerging, the extent to which service members and Veterans find it appropriate and helpful is not yet known. Goals of the current study were threefold: (a) assess the perceived need for a military-specific IPA program among Veterans Administration and community domestic violence (DV) program providers; (b) conduct a pilot study to examine the feasibility and preliminary effectiveness of SAH in a sample drawn from a diverse, multicultural community; and (c) conduct focus groups to obtain participant feedback on the SAH protocol. Findings from the provider survey suggested a need for specialty programs to treat military personnel who perpetrate IPA of mildtomoderate severity. Results of the SAH pilot study (n = 6) indicated decreased psychological aggression and increased anger control from baseline to 6-month follow-up. Focus group feedback indicated participants found the program to be helpful and appropriate across a wide variety of ethno-cultural variables. As more service members and Veterans of the Iraq/Afghanistan war era reintegrate into our communities, it will become increasingly important for providers in both private and public sectors of care to understand the unique needs of this treatment population, and to have access to effective IPA treatment programs.

DSM-5 personality traits discriminate between posttraumatic stress disorder and control groups

The relevance of personality traits to the study of psychopathology has long been recognized, particularly in terms of understanding patterns of comorbidity. In fact, a multidimensional personality trait model reflecting five higher-order personality dimensions-negative affect, detachment, antagonism, disinhibition, and psychoticism-is included in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) and represented in the Personality Inventory for DSM-5 (PID-5). However, evaluation of these dimensions and underlying personality facets within clinical samples has been limited. In the present study, we utilized the PID-5 to evaluate the personality profile elevation and composition of 150 control veterans and 35 veterans diagnosed with posttraumatic stress disorder (PTSD). Results indicated that veterans with PTSD endorsed significantly more personality pathology than control veterans, with scores on detachment and psychoticism domains most clearly discriminating between the two groups. When personality domain scores were considered as parts of each subject's personality profile, a slightly different picture emerged. Specifically, the PTSD composition was primarily characterized by detachment and negative affect, followed by disinhibition, psychoticism, and antagonism in that order of relative importance. The profile of the control group was significantly different, mostly accounted for differences in antagonism and psychoticism. Using these complementary analytic strategies, the findings demonstrate the relevance of personality pathology to PTSD, highlight internalizing features of PTSD, and pave the way for future research aimed at evaluating the role of shared maladaptive personality traits in underlying the comorbidity of PTSD and related disorders.

Problems in sexual functioning among male OEF/OIF veterans seeking treatment for posttraumatic stress

OBJECTIVE

Few studies have examined sexual dysfunction among Operations Enduring/Iraqi Freedom (OEF/OIF) veterans with posttraumatic stress disorder (PTSD). The present study investigated predictors of erectile dysfunction [ED] and self-reported sexual problems among 150 male combat veterans seeking outpatient treatment for PTSD within the Veterans Affairs healthcare system.

METHOD

Participants completed clinical interviews and several questionnaires including measures of sexual arousal and sexual desire. A medical records review was also conducted to document evidence of an ED diagnosis or associated medication use.

RESULTS

An ED diagnosis was present for 12% of the sample, and 10% were taking associated medications. Sexual arousal problems were reported by sixty-two percent of partnered veterans. Sexual desire problems were endorsed by 63% of the total sample, and by 72% of partnered veterans. Age was the only significant predictor of ED diagnosis or medication use. Age, race, PTSD diagnosis (versus subclinical symptoms), depression, and social support predicted self-reported sexual arousal problems; while race, combat exposure, social support, and avoidance/numbing symptoms of PTSD predicted self-reported sexual desire problems.

CONCLUSIONS

Sexual problems are common among male OEF/OIF combat veterans seeking treatment for PTSD. Moreover, avoidance/numbing symptoms robustly predicted sexual desire problems. These findings highlight the importance of expanding assessment of sexual dysfunction and support the need for additional research in this area.

Emotion dysregulation mediates the relationship between traumatic exposure and aggression in healthy young women

Research has linked trauma-sequelae, such as posttraumatic stress disorder, to aggression. However, not all who experience a trauma become violent, suggesting non-trauma factors, such as emotion dysregulation, influence aggression expression and if confirmed, may influence treatment approaches. Aggression can be considered a multifaceted construct with Impulsive Aggression (IA) as emotional, reactive, and uncontrolled and Premeditated Aggression (PA) as deliberate, planned, and instrumental. We hypothesized that parceling apart IA and PA may further refine predictors of aggression in the context of trauma exposure. We tested this hypothesis in undergraduate women (N = 208) who completed trauma, emotion, and aggression measures. Path analysis indicated that Borderline Features, including emotion dysregulation, mediated the relationship between trauma exposure and IA and PA. The finding extends clinical literature by providing evidence that emotion dysregulation influences both IA and PA in a non-clinical sample, while clinical sample research shows emotion dysregulation more specifically mediated the relationship between trauma and IA. Factors responsible for these differences are discussed.

Peeking into the black box: mechanisms of action for anger management treatment

We investigated potential mechanisms of action for anger symptom reductions, specifically, the roles of anger regulation skills and therapeutic alliance on changes in anger symptoms, following group anger management treatment (AMT) among combat veterans with posttraumatic stress disorder (PTSD). Data were drawn from a published randomized controlled trial of AMT conducted with a racially diverse group of 109 veterans with PTSD and anger symptoms residing in Hawaii. Results of latent growth curve models indicated that gains in calming skills predicted significantly larger reductions in anger symptoms at post-treatment, while the development of cognitive coping and behavioral control skills did not predict greater symptom reductions. Therapeutic alliance had indirect effects on all outcomes mostly via arousal calming skills. Results suggest that generalized symptom reduction may be mediated by development of skills in calming physiological arousal. In addition, arousal reduction skills appeared to enhance one's ability to employ other anger regulation skills.

Relationship of PTSD Symptoms With Combat Exposure, Stress, and Inflammation in American Soldiers

Posttraumatic stress disorder (PTSD) is of great concern in veterans. PTSD usually occurs after a person is exposed to death, threatened death, actual or threatened serious injury, or actual or threatened sexual violence. Active duty soldiers deployed to war zones are at risk for PTSD. Psychoneuroimmunological theory predicts that PTSD, depression, and stress can lead to low-grade, chronic inflammation. We asked whether there were relationships between PTSD symptoms and chronic stress, depression and inflammation in active duty U.S. soldiers. We enrolled 52 active duty enlisted and reservist soldiers in a cross-sectional study while they participated in a week of military training in fall 2011. They completed a demographic questionnaire, the Center for Epidemiological Studies-Depression Scale, the Combat Exposure Scale, and the PTSD symptom Checklist-Military version (PCL-M). Blood samples were taken for analysis of cytokines and C-reactive protein (CRP). Hair samples shaved from the forearm were measured for cortisol. Of the soldiers, 11 had PCL-M scores in the moderate to severe range. Regression analysis demonstrated that depression and war zone deployment were strong predictors of PTSD symptoms. CRP and hair cortisol were correlated with each other and with depression and PTSD symptoms. These results suggest relationships among war zone deployment, depression, and PTSD. Chronic stress associated with depression, PTSD, and war zone experiences may be related to inflammation in active duty soldiers.

Prospective study of police officer spouse/partners: a new pathway to secondary trauma and relationship violence?

INTRODUCTION

It has been reported that posttraumatic stress disorder (PTSD) is associated with secondary spouse/partner (S/P) emotional distress and relationship violence.

OBJECTIVE

To investigate the relationships between PTSD, S/P emotional distress and relationship violence among police recruits using a prospective design.

METHODS

Two hypotheses were tested in 71 S/Ps: (1) Police officer reports of greater PTSD symptoms after 12 months of police service will be associated with greater secondary trauma symptoms among S/Ps; (2) Greater secondary trauma symptoms among S/Ps at 12 months will be associated with S/P reports of greater relationship violence.

METHODS

71 police recruits and their S/Ps were assessed at baseline and 12 months after the start of police officer duty. Using linear and logistic regression, we analyzed explanatory variables for 12 month S/P secondary traumatic stress symptoms and couple violence, including baseline S/P variables and couple violence, as well as exposure and PTSD reports from both S/P and officer.

RESULTS

S/P perception of officer PTSD symptoms predicted S/P secondary traumatic stress. OS/P secondary trauma was significantly associated with both total couple violence (.34, p = .004) and S/P to officer violence (.35, p = .003).

CONCLUSIONS

Although results from this relatively small study of young police officers and their S/Ps must be confirmed by larger studies in general populations, findings suggest that S/P perception of PTSD symptoms may play a key role in the spread of traumatic stress symptoms across intimate partner relationships and intimate partner violence in the context of PTSD.

Differences in relationship conflict, attachment, and depression in treatment-seeking veterans with hazardous substance use, PTSD, or PTSD and hazardous substance use

Veterans (N = 133) who were seeking treatment in either the Posttraumatic Stress Program or Substance Use Disorders Program at a Veterans Affairs Medical Center (VAMC) and, based on self-report of symptoms, met clinical norms for posttraumatic stress disorder (PTSD) or hazardous substance use (HSU) completed a survey related to relationship conflict behaviors, attachment styles, and depression severity. Participants were grouped into one of three categories on the basis of clinical norm criteria: PTSD only, HSU only, and PTSD + HSU. Participants completed the PTSD Checklist-Military, Experiences in Close Relationships Scale-Short Form, Center for Epidemiologic Studies-Depression scale, Alcohol Use Disorders Identification Test, Drug Use Disorders Identification Test, and Psychological Aggression and Physical Violence subscales of the Conflict Tactics Scale. Most participants were male and Caucasian. Significant differences were found between groups on depression, avoidant attachment, psychological aggression perpetration and victimization, and physical violence perpetration and victimization. Post hoc analyses revealed that the PTSD + HSU group had significantly higher levels of depression, avoidant attachment, and psychological aggression than the HSU only group. The PTSD + HSU group had significantly higher levels of physical violence than did the PTSD only group, but both groups had similar mean scores on all other variables. Potential treatment implications are discussed.

Preliminary investigation of the roles of military background and posttraumatic stress symptoms in frequency and recidivism of intimate partner violence perpetration among court-referred men

Significant rates of intimate partner violence (IPV) perpetration have been identified among men with military backgrounds. Research indicates posttraumatic stress symptoms place military men at increased risk for IPV perpetration, but may be negatively associated with IPV among nonmilitary samples. However, no previous studies have directly compared court-referred IPV offenders with and without military experience, which may have clinical implications if posttraumatic stress symptoms are differentially associated with IPV perpetration across these two samples. Twenty court-referred IPV offenders with military background were demographically matched with 40 court-referred IPV offenders without military background. As anticipated, self- and partner-report of physically assaultive acts and injurious acts during baseline assessment showed significantly greater physical assault and injury perpetrated by offenders with military background. However, 1-year follow-up data on convictions indicated a significantly lower rate of recidivism among offenders with military background than among nonmilitary offenders. As hypothesized, symptoms of posttraumatic stress at intake showed a significant positive correlation with IPV perpetration among offenders with military background; however, this relationship showed a negative correlation among offenders without military background. Clinical implications are discussed including treatment avenues, such as Veterans Courts and other incarceration diversion programs, which may be particularly appropriate for offenders with military backgrounds.

Protective mechanisms and prevention of violence and aggression in veterans

Although a subset of Iraq and Afghanistan Veterans show aggression toward others after they return home from military service, little is known about protective mechanisms that could be bolstered to prevent violence. A national longitudinal survey was conducted between 2009 and 2011 using a random sample of veterans who served in Operation Iraqi Freedom or Operation Enduring Freedom. One thousand and ninety veterans, from 50 states representing all military branches, completed 2 waves of data collection, 1 year apart (retention rate = 79%). The final sample resembled the U.S. military post 9/11 in terms of age, sex, ethnicity, geography, and service branch. Protective mechanisms in socioeconomic (money to cover basic needs, stable employment), psychosocial (resilience, perceiving control over one's life, social support), and physical (healthy sleep, no physical pain) domains were examined. We found these protective mechanisms predicted decreased aggression and violence at follow-up, particularly among higher risk veterans. Multivariable analyses confirmed that protective mechanisms lowered violence through their interaction with risk factors. This study identifies protective mechanisms related to decreased community violence in veterans and indicates that rehabilitation aimed at improving socioeconomic, psychosocial, and physical well-being has potential promise to reduce aggression and violence among veterans after returning home from military service.

An integrative review of the mental health of partners of veterans with combat-related posttraumatic stress disorder

The aim of this article is to present an integrative review of the mental health of veteran partners living with veterans with combat-related posttraumatic stress disorder (PTSD). Living with a veteran with PTSD affects the psychological well-being and health outcomes of a veteran partner. Fourteen research articles that focused on the mental health of military partners, which directly influence the psychological well-being of veteran partners, were reviewed. Findings indicate that a range of mental health concerns exist among veteran partners living with veterans with PTSD. The mental well-being of veteran partners is affected by the emotional strain of living and caring for veterans with PTSD. For years, the partner's presence has been overlooked in the PTSD treatment. However, to promote the comprehensive health of veterans with PTSD, it is paramount to understand the mental health state of veteran partners. Understanding the mental health state of veteran partners will provide a broader perspective to the plight of veteran partners.

The Effects of Alcohol Problems, PTSD, and Combat Exposure on Nonphysical and Physical Aggression Among Iraq and Afghanistan War Veterans

Aggression among combat veterans is of great concern. Although some studies have found an association between combat exposure and aggressive behavior following deployment, others conclude that aggression is more strongly associated with symptoms of posttraumatic stress disorder (PTSD), and that alcohol misuse may influence this association. Many of these studies have assessed aggression as a single construct, whereas the current study explored both nonphysical aggression only and physical aggression in a sample of Iraq and Afghanistan war veterans (N = 337; 91% male). We found that alcohol problems interacted with PTSD symptom severity to predict nonphysical aggression only. At low levels of PTSD symptoms, veterans with alcohol problems were more likely to perpetrate nonphysical aggression only, as compared with no aggression, than veterans without an alcohol problem. There was no difference in the likelihood of nonphysical aggression only between those with and without alcohol problems at high levels of PTSD symptoms. The likelihood of nonphysical aggression only, as compared with no aggression, was also greater among younger veterans. Greater combat exposure and PTSD symptom severity were associated with an increased likelihood of perpetrating physical aggression, as compared with no aggression. Ethnic minority status and younger age were also associated with physical aggression, as compared with no aggression. Findings suggest that a more detailed assessment of veterans' aggressive behavior, as well as their alcohol problems and PTSD symptoms, by researchers and clinicians is needed in order to determine how best to intervene.

Child involvement in interparental conflict and child adjustment problems: a longitudinal study of violent families

This study examined whether child involvement in interparental conflict predicts child externalizing and internalizing problems in violent families. Participants were 119 families (mothers and children) recruited from domestic violence shelters. One child between the ages of 7 and 10 years in each family (50 female, 69 male) completed measures of involvement in their parents' conflicts, externalizing problems, and internalizing problems. Mothers completed measures of child externalizing and internalizing problems, and physical intimate partner violence. Measures were completed at three assessments, spaced 6 months apart. Results indicated that children's involvement in their parents' conflicts was positively associated with child adjustment problems. These associations emerged in between-subjects and within-subjects analyses, and for child externalizing as well as internalizing problems, even after controlling for the influence of physical intimate partner violence. In addition, child involvement in parental conflicts predicted later child reports of externalizing problems, but child reports of externalizing problems did not predict later involvement in parental conflicts. These findings highlight the importance of considering children's involvement in their parents' conflicts in theory and clinical work pertaining to high-conflict families.

Toward a social theory of sexual risk behavior among men in the Armed Services: understanding the military occupational habitus

Worldwide, military personnel have been recognized as a population at elevated risk for sexually transmitted infections (STIs) and HIV; however, it is not well understood how the military occupation itself is implicated in the production of sexual risk behavior. Using qualitative and quantitative data collected from the Belize Defense Force (BDF), we employed a grounded theoretical framework and the Bourdieusian concept of the field and habitus to clarify how the military occupation is implicated in structuring aspects of sexual risk behaviors among personnel. We focus results on in-depth qualitative interviews conducted with 15 male-identified BDF personnel. We identify and describe how two field elements, namely operational tempo and ongoing exposure to occupational hazards, are occupationally specific field elements implicated in the production of sexual risk behavior through the mediating matrix of the military class habitus. Our findings demonstrate a conceptual clarity regarding the institutional field and habitus through which military personnel make sense of and act on the risk of bodily harm with regard to their own sexual behaviors. We conclude by outlining our theoretical concept so that it can be directly applied in public health efforts in order to leverage military occupational field elements for the purpose of HIV and STI prevention.

Cross-sectional prevalence survey of intimate partner violence perpetration and victimization in Canadian military personnel

BACKGROUND

Intimate partner violence (IPV) is prevalent and is associated with a broad range of adverse consequences. In military organizations, IPV may have special implications, such as the potential of service-related mental disorders to trigger IPV. However, the Canadian Armed Forces (CAF) have limited data to guide their prevention and control efforts.

METHODS

Self-reported IPV perpetration, victimization, and their correlates were assessed on a cross-sectional survey of a stratified random sample of currently-serving Canadian Regular Forces personnel (N = 2157). The four primary outcomes were perpetration or victimization of any physical and/or sexual or emotional and/or financial IPV over the lifespan of the current relationship.

RESULTS

Among the 81% of the population in a current relationship, perpetration of any physical and/or sexual IPV was reported in 9%; victimization was reported in 15%. Any emotional and/or financial abuse was reported by 19% (perpetration) and 22% (victimization). Less physically injurious forms of abuse predominated. Logistic regression modelling showed that relationship dissatisfaction was independently associated with all four outcomes (OR range = 2.3 to 3.7). Probable depression was associated with all outcomes except physical and/or sexual IPV victimization (OR range = 2.5 - 2.7). PTSD symptoms were only associated with physical and/or sexual IPV perpetration (OR = 3.2, CI = 1.4 to 7.9). High-risk drinking was associated with emotional and/or financial abuse. Risk of IPV was lowest in those who had recent deployment experience; remote deployment experience (vs. never having deployed) was an independent risk factor for all IPV outcomes (OR range = 2.0 - 3.4).

CONCLUSIONS

IPV affects an important minority of military families; less severe cases predominate. Mental disorders, high-risk drinking, relationship dissatisfaction, and remote deployment were independently associated with abuse outcomes. The primary limitations of this analysis are its use of self-report data from military personnel (not their intimate partners) and the cross-sectional nature of the survey. Prevention efforts in the CAF need to target the full spectrum of IPV. Mental disorders, high-risk drinking, and relationship dissatisfaction are potential targets for risk reduction. Additional research is needed to understand the association of remote deployment with IPV.

Self-report and longitudinal predictors of violence in Iraq and Afghanistan war era veterans

This study, using a longitudinal design, attempted to identify whether self-reported problems with violence were empirically associated with future violent behavior among Iraq and Afghanistan war veterans and whether and how collateral informant interviews enhanced the risk assessment process. Data were gathered from N = 300 participants (n = 150 dyads of Iraq and Afghanistan war veterans and family/friends). The veterans completed baseline and follow-up interviews 3 years later on average, and family/friends provided collateral data on dependent measures at follow-up. Analyses showed that aggression toward others at follow-up was associated with younger age, posttraumatic stress disorder, combat exposure, and a history of having witnessed parental violence growing up. Self-reported problems controlling violence at baseline had robust statistical power in predicting aggression toward others at follow-up. Collateral report enhanced detection of dependent variables: 20% of cases positive for violence toward others would have been missed relying only on self-report. The results identify a subset of Iraq and Afghanistan war veterans at higher risk for problematic postdeployment adjustment and indicate that the veterans' self-report of violence was useful in predicting future aggression. Underreporting of violence was not evidenced by most veterans but could be improved upon by obtaining collateral information.