Health and psychiatric impairment associated with moral injury, military sexual trauma, and their co-occurrence in U.S. combat veterans

BACKGROUND

Military sexual trauma (MST) and moral injury (MI) are associated with adverse psychiatric and health outcomes among military veterans. However, no known population-based studies have examined the incremental burden associated with the co-occurrence of these experiences relative to either alone.

METHOD

Cross-sectional data were analyzed from the National Health and Resilience in Veterans Study, a nationally representative sample of 1330 U.S. combat veterans. Veterans reported on history of exposure to MST and potentially morally injurious events (PMIEs). Analyses estimated the lifetime prevalence of MST only, PMIEs only, and co-occurring MST and PMIEs; and examined associations between MST/PMIEs status and psychiatric and physical health comorbidities, functioning, and suicidality.

RESULTS

The lifetime weighted prevalence of exposure to MST only, PMIEs only, and co-occurring MST and PMIEs were 2.7%, 32.3%, and 4.5%, respectively. Compared with all other groups, the co-occurring MST + PMIEs group reported greater severity of posttraumatic stress, depression, generalized anxiety, and insomnia symptoms. They also scored lower on measures of physical, mental, and psychosocial functioning, and reported a greater number of chronic medical conditions and somatic complaints. Veterans with co-occurring MST + PMIEs were more than twice as likely as those with MST only to report past-year suicidal ideation.

CONCLUSIONS

The co-occurrence of MST and MI is associated with a greater psychiatric and health burden among combat veterans than either experience alone. Results underscore the importance of assessing and treating MST and MI in this population. Findings underscore the importance for future work to parse overlap between morally salient aspects of MST and the concept of moral injury.

Survey of psychiatric impairment among residents exposed to environmental pollution from a petrochemical complex

PURPOSE

This study first assessed the occurrence of major depressive disorder (MDD), post-traumatic stress disorder (PTSD), symptoms of poor sleep quality and high levels of distress among residents, caused by reported long-term stress from environmental pollution emitted from the biggest petroleum chemistry factory (PCF) in the world.

METHODS

A total of 328 long-term residents (Mean age = 57.5, SD = 16.5 years, ranging from 22 to 95) were recruited randomly from a total population of 26,632 in Mailiao township in Taiwan next to the PCF. Trained assistants used the Disaster-Related Psychological Screening test, the Perception of Life Threats Caused by the SCNP questionnaire and the Sleep Quality Scale to interview the participants.

RESULTS

The results support our hypotheses that most of the residents (71%) would report life threats caused by the PCF. The residents displayed higher rates of major depressive episodes (24.1%), PTSD (24.5%) and symptoms of poor sleep quality. The more they felt threat from the PCF, the stronger the connection with MDD and PTSD symptoms.

CONCLUSION

The results indicate an increased prevalence of MDD, PTSD and symptoms of poor sleep quality in those exposed to environmental pollution from the PCF, highlighting the need for prompt prevention, diagnostic and therapeutic attention.

Participation of adults with cognitive, physical, or psychiatric impairments in family of origin and intimate relationships: a grounded theory study

BACKGROUND

How adults with disabilities perceive participation has received little attention. Our purpose was to formulate a grounded theory on participation, based on the subjective experience of adults with cognitive, physical, or psychiatric impairment(s), and to identify barriers, facilitators, and support needs concerning participation in different areas of life. We aimed to explore whether the United Nations' Convention on the Rights of Persons with Disabilities (CRPD), ratified by Switzerland in 2014, and its principles are being met. Here we report on the main category and focus on the participation areas 'family of origin' and 'intimate relationships.'

METHODS

In a qualitative, grounded theory study, we conducted problem-centered interviews with 23 adults with cognitive, physical, or psychiatric impairments (30-53 years; 11 men, 12 women), with different housing (on their own, assisted living, with parents) and work situations (primary vs. secondary labor market) in nine German-speaking Swiss cantons.

RESULTS

Participation can be understood as a continuum that extends on a horizontal level (from participation is restricted to participation takes place) and a vertical level (separative setting vs. inclusive setting). In separative as well as in inclusive settings, diverse levels of participation are possible. Many participants were stuck in an 'in-between' area between separative and inclusion-oriented settings. In the family of origin, there was a thin line between fulfilling relations that enhance participation and conflictual relations and overprotective parenting that limit participation. In intimate relationships, opportunities for participation were limited overall. Many interviewees were single. Social environment and family of origin (e.g., parents) can enable and facilitate intimate relationships and sexual contacts but can also be an important barrier.

CONCLUSIONS

Participation can be understood as a continuum. Participation restrictions exist in separative as well as in inclusive-oriented settings, also in the areas of family of origin and intimate relationships. Participation barriers must be torn down in separative as well as in inclusion-oriented settings. Trajectories to inclusive settings should be facilitated. Families with children with impairment(s) should be supported from early on to create the best possible participation possibilities for the (adult) person with impairment(s) and to support the family of origin itself.