Predictors of Suicidal Ideation in a Gender‐Stratified Sample of OEF/OIF Veterans

There is a growing concern about suicide among Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF) veterans. We examined the role of postdeployment mental health in associations between deployment stressors and postdeployment suicidal ideation (SI) in a national sample of 2,321 female and male OEF/OIF veterans. Data were obtained via survey, and path analysis was used. For women and men, mental health symptoms largely accounted for associations between deployment stressors and SI; however, they only partly accounted for the sexual harassment and SI association among women. These findings enhance the understanding of the mental health profile of OEF/OIF veterans.     

An examination of the roles of trauma exposure and posttraumatic stress disorder on emotion regulation strategies of Operation Iraqi Freedom,Operation Enduring Freedom,and Operation New Dawn veterans

Theories of posttraumatic stress disorder (PTSD) implicate emotional processes, including difficulties utilizing adaptive emotion regulation strategies, as critical to the etiology and maintenance of PTSD. Operation Iraqi Freedom, Operation Enduring Freedom, and Operation New Dawn (OIF/OEF/OND) veterans report high levels of combat exposure and PTSD. We aimed to extend findings suggesting that emotion regulation difficulties are a function of PTSD, rather than combat trauma exposure or common comorbidities, to OIF/OEF/OND veterans, in order to inform models of PTSD risk and recovery that can be applied to returning veterans. We tested differences in emotion regulation, measured with the Difficulties in Emotion Regulation Scale and Emotion Regulation Questionnaire, among trauma-exposed veterans with (n = 24) or without PTSD (n = 22) and healthy civilian comparison participants (n = 27) using multivariate analyses of covariance, adjusting for major depressive disorder, anxiety disorders, and demographic variables (age, sex, and ethnicity). Veterans with PTSD reported more use of expressive suppression and more difficulties with emotion regulation than veterans without PTSD and healthy comparison participants. Groups did not differ on cognitive reappraisal. Findings suggest the key role of PTSD above and beyond trauma exposure, depression, and anxiety in specific aspects of emotion dysregulation among OIF/OEF/OND veterans. Interventions that help veterans expand and diversify their emotion regulation skills may serve as helpful adjunctive treatments for PTSD among OIF/OEF/OND veterans.     

Military Veterans' Experiences with Suicidal Ideation: Implications for Intervention and Prevention

We sought to understand Operation Enduring Freedom and Operation Iraqi Freedom (OEF/OIF) veterans' experiences with suicidal ideation. Semi‐structured interviews with 34 OEF/OIF veterans addressed circumstances leading up to disclosure of suicidal ideation during brief clinical assessments. We used an iterative, inductive and deductive thematic analysis approach. Results revealed three pervasive, persistent domains that reinforce the uniqueness of veteran suicidal thoughts: military culture, difficult deployment experiences, and postdeployment adjustment challenges. Within postdeployment, we identified four themes that serve as intervention targets: adjusting to civilian culture, changes to sense of self, feeling overwhelmed by stressors, and lacking life purpose or meaning.     

Web-Based Intervention for Returning Veterans with Symptoms of Posttraumatic Stress Disorder and Risky Alcohol Use

A substantial number of military personnel who have served in Iraq (Operation Iraqi Freedom; OIF) and Afghanistan (Operating Enduring Freedom; OEF) develop symptoms of posttraumatic stress disorder (PTSD) in response to their military experiences and many of these same individuals will drink in a risky or problematic manner following deployment. If left untreated, PTSD symptoms and alcohol problems can become chronic and have a significant, negative impact on the lives of veterans, their families and communities. Further, OIF and OEF service members are often reluctant to seek treatment for mental health symptoms or alcohol problems secondary to stigma. In order to reach this population it is essential that new strategies and venues for delivering evidence-based care are explored. Web-based interventions are uniquely suited to this cohort of veterans in that they have the potential to reach a significant number of veterans who commonly use the Web and who might not otherwise receive care. This article will review the prevalence of PTSD and alcohol problems among OIF and OEF veterans, common barriers they experience with accessing care in traditional mental health settings, and what is known about the effectiveness of Web-based approaches for PTSD and alcohol problems. It also describes the components of a new Web-based intervention, developed by the authors, that uses motivational enhancement and cognitive-behavioral strategies to intervene with returning veterans who report PTSD symptoms and problem drinking. Recommendations for future directions in working with returning veterans with PTSD and alcohol problems will be offered.     

Examining Spouse/Partner Presence as a Moderator in the Relationship Between Mental Health Symptoms and Alcohol Use in OEF/OIF Veterans

Veterans from the conflicts in Afghanistan (Operation Enduring Freedom; OEF) and Iraq (Operation Iraqi Freedom; OIF) have reported elevated rates of alcohol consumption, and greater depression and posttraumatic stress disorder (PTSD) symptoms are associated with increased alcohol use. Presence of a spouse/partner, which has been associated with reduced drinking, may buffer the relationship between mental health symptoms and alcohol consumption. To examine this hypothesis, the current study utilized baseline survey data from OEF/OIF veterans (N = 325) enrolled in a brief alcohol intervention. Spouse/partner presence moderated the relationship between depression symptoms and alcohol consumption such that depression was positively associated with drinking for veterans without a spouse/partner. Exploratory analyses indicated that the relationship between depression and alcohol use may be particularly salient for veterans without a spouse/partner and a lower number of deployments. Spouse/partner presence did not moderate the relationship between PTSD symptoms and alcohol consumption. Implications of the findings are discussed.     

Sexuality among wounded veterans of Operation Enduring Freedom (OEF), Operation Iraqi Freedom (OIF), and Operation New Dawn (OND): Implications for rehabilitation psychologists

OBJECTIVE: The sexual lives of returning Operation Enduring Freedom (OEF), Operation Iraqi Freedom (OIF), and Operation New Dawn (OND) veterans have only been discussed minimally in the psychological literature. Given the nature of military social and cultural contexts, the potential for exposure to combat-related stressors that may lead to posttraumatic stress disorder (PTSD), and the risk of traumatic brain injury secondary to physical injury, the potential for significant psychological and relational ramifications exists. This article focuses on the intimate relationships and sexuality of returning OIF/OEF/OND veterans within the context of their personal cultural variables and the diverse experience of being a part of military life. CONCLUSIONS: Culturally competent assessment and evidenced-based treatment approaches are highlighted to offer clinicians initial strategies to begin treatment of sexuality issues within the returning Veteran population. These clinical tools are discussed within a positive psychology approach that emphasizes healthy sexuality as a part of overall satisfactory quality of life.     

Self-Report Measures to Identify Post Traumatic Stress Disorder and/or Mild Traumatic Brain Injury and Associated Symptoms in Military Veterans of Operation Enduring Freedom (OEF)/Operation Iraqi Freedom (OIF)

Individuals serving in Iraq and Afghanistan sustain injuries associated with physical and psychological trauma. Among such injuries, mild traumatic brain injury (mTBI) and post traumatic stress disorder (PTSD) are common. Self-report measures are frequently used to identify mTBI and/or PTSD and symptoms associated with these conditions. In addition to providing information regarding mTBI and PTSD, the goal of this literature review was to identify and present information on the psychometric properties of measures used to obtain information regarding these common conditions among Veterans who have returned from Operation Enduring Freedom (OEF)/Operation Iraqi Freedom (OIF). A comprehensive review of studies in which self-report measures were used to evaluate mTBI, PTSD, and associated symptoms among OEF/OIF Veterans is presented. Findings suggest that additional work is needed to identify psychometrically sound and clinically useful self-report measures that assess mTBI and PTSD and associated symptoms among OEF/OIF Veterans.     

The Importance of Group Cohesion in Inpatient Treatment of Combat-Related PTSD

Abstract

Post-traumatic stress disorder (PTSD) is the most widespread mental illness resulting from exposure to combat, necessitating an increase in the provision of group therapy. This pilot study examined the efficacy of, and treatment outcome predictors associated with, group inpatient treatment of combat-related PTSD. Participants included 38 active duty military personnel deployed during Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF), diagnosed with PTSD, and consecutive admissions to an inpatient PTSD treatment facility. A paired samples t-test revealed significant change in symptom severity and global functioning between pre- and post-treatment. Multiple regression analyses supported the predictive utility of baseline symptomatology and group cohesion (> 50% of the variance in treatment outcome), highlighting the importance of group cohesion in the efficacy of group treatment for combat-related PTSD.     

Trauma‐Related Guilt Mediates the Relationship between Posttraumatic Stress Disorder and Suicidal Ideation in OEF/OIF/OND Veterans

Posttraumatic stress disorder (PTSD) and trauma‐related guilt are risk factors for suicidal ideation (SI) in veterans. Components of trauma‐related guilt were examined as serial mediators of the relationship between PTSD and SI. In a sample of 53 OEF/OIF/OND combat veterans, PTSD had an indirect effect on SI through a serial mediation chain of guilt cognitions, distress, and global guilt, suggesting that trauma‐related guilt via cognitions, distress, and global guilt is a pathway from PTSD to SI. Attention should be given to assessing and addressing trauma‐related guilt in veterans experiencing PTSD to prevent SI.     

Prayer Coping,Disclosure of Trauma,and Mental Health Symptoms Among Recently Deployed United States Veterans of the Iraq and Afghanistan Conflicts

U.S. military veterans of the Iraq and Afghanistan conflicts are at risk for developing adverse mental health symptoms. This study was conducted to examine the associations between prayer coping, attitudes toward trauma disclosure, and mental health symptoms (posttraumatic stress disorder [PTSD] and depression) among 110 U.S. veterans who had returned from deployments in Operation Enduring Freedom and Operation Iraqi Freedom within the previous 6 months. Bivariate analyses revealed that prayer coping was positively correlated with an urge to talk about potentially traumatic experiences. When controlling for combat exposure, social support, and disclosure attitudes, multivariate regression analyses indicated that two of the prayer functions—praying for assistance and for calm and focus—were each uniquely linked with less PTSD and depressive symptomatology. In addition, a reliance on avoidant prayer was uniquely correlated with greater depressive symptomatology. These findings support emerging ideas about prayer as a form of trauma disclosure and highlight the relevance of this approach to coping for veterans as they readjust to civilian life.     

Predeployment, deployment, and postdeployment risk factors for posttraumatic stress symptomatology in female and male OEF/OIF veterans

[Correction Notice: An erratum for this article was reported in Vol 120(4) of Journal of Abnormal Psychology (see record 2011-19996-001). In the article there was an error in the affiliation bylines for Rani Elwy and Susan Eisen. Their affiliations should have been listed as Edith Nourse Rogers Memorial Veterans Hospital and Department of Health Policy and Management, Boston University School of Public Health.] Prior research on risk factors for posttraumatic stress symptomatology (PTSS) in war-exposed Veterans has revealed both direct and indirect mechanisms of risk that span predeployment, deployment, and postdeployment timeframes. The aims of the present study were to identify the mechanisms through which previously documented risk factors contribute to PTSS in a national sample of 579 female and male Veterans deployed to Afghanistan for Operation Enduring Freedom (OEF) or to Iraq for Operation Iraqi Freedom (OIF), as well as to examine the extent to which results mirror associations observed among Vietnam Veterans (King, King, Foy, Keane, & Fairbank, 1999). Consistent with conservation of resources (COR) theory (Hobfoll, 1989, 2001), findings indicated that PTSS is accounted for by multiple chains of risk, many originating in predeployment experiences that place Veterans at risk for additional stress exposure, and foretell difficulty accessing resources in the face of subsequent stressors. Importantly, the majority of previously documented mechanisms were replicated in this study, suggesting key pathways through which risk factors may contribute to PTSS across different Veteran populations. Results also revealed a number of novel risk mechanisms for OEF/OIF female Veterans, particularly with respect to the role of deployment family relationships in risk for PTSS.     

Cognitive Sequelae of Blast-Induced Traumatic Brain Injury: Recovery and Rehabilitation

Blast-related traumatic brain injury (bTBI) poses a significant concern for military personnel engaged in Operation Enduring Freedom and Operation Iraqi Freedom (OEF/OIF). Given the highly stressful context in which such injury occurs, psychiatric comorbidities are common. This paper provides an overview of mild bTBI and discusses the cognitive sequelae and course of recovery typical of mild TBI (mTBI). Complicating factors that arise in the context of co-morbid posttraumatic stress disorder (PTSD) are considered with regard to diagnosis and treatment. Relatively few studies have evaluated the efficacy of cognitive rehabilitation in civilian mTBI, but we discuss cognitive training approaches that hold promise for addressing mild impairments in executive function and memory, akin to those seen in OEF/OIF veterans with bTBI and PTSD. Further research is needed to address the patient and environmental characteristics associated with optimal treatment outcome.     

The role of postdeployment social factors in linking deployment experiences and current posttraumatic stress disorder symptomatology among male and female veterans

Background and Objectives: The postdeployment social context is likely highly salient in explaining mental health symptoms following deployment. The aim of this study was to examine the role of postdeployment social factors (social support and social reintegration difficulty) in linking deployment-related experiences (warfare exposure, sexual harassment, concerns about relationship disruptions, and deployment social support) and posttraumatic stress disorder (PTSD) symptomatology in male and female veterans.

Design: A survey was administered to 998 potential participants (after accounting for undeliverable mail) who had returned from deployment to Afghanistan or Iraq. Completed surveys were received from 469 veterans, yielding a response rate of 47%.

Methods: Hypotheses were examined using structural equation modeling.

Results: For male and female veterans, deployment factors predicted later PTSD symptoms through postdeployment social support and social reintegration, with lower support and higher social reintegration difficulty both associated with higher PTSD symptomatology. While the final models for women and men indicated similar risk mechanisms, some differences in pathways were observed. Sexual harassment presented more of a risk for women, whereas lower social support was a greater risk factor for men.

Conclusions: Postdeployment social factors appear to represent potentially important targets for interventions aiming to reduce the potential impact of stressful deployment experiences.     

Examining Relationships Among Ethnicity,PTSD, Life Functioning,and Comorbidity in Female OEF/OIF Veterans

There is much literature on posttraumatic stress disorder (PTSD) and male combat veterans, but little on PTSD by gender and ethnicity among women combat veterans. We examine ethnic differences in PTSD and comorbid disorders among 37 Hispanic, 27 White, and 15 Native female Operaton Enduring Freedom/Operation Iraqi Freedom (OEF/OIF) combat veterans. Participants completed the Clinician-Administered PTSD Scale (CAPS), the Structured Clinical Interview for DSM-IV, Axis I (SCID-Axis I and II), Life Events Checklist (LEC), Military Stress Exposure Questionnaire (MSEQ), and the Medical Outcomes Study Short Form-36 (SF-36). Hispanics differed from Whites in having less education, more trauma exposure, higher levels of PTSD, mood disorder comorbidity, and poorer physical and emotional functioning. Natives differed from Whites with more trauma exposure, higher levels of PTSD, poorer emotional functioning, and higher rates of Cluster B PDs.     

A Closer Examination of Sexual Trauma During Deployment: Not all Sexual Traumas are Associated with Suicidal Ideation

Military personnel can be exposed to a wide range of sexual trauma while deployed, including sexual harassment and sexual assault. We examined whether different types of sexual trauma during deployment associated with recent suicidal ideation among previously deployed OEF/OIF/OND veterans admitted to trauma‐focused treatment (n = 199). More severe forms of sexual trauma (e.g., sexual assault) were significantly and positively associated with suicidal ideation. In contrast, sexual trauma involving verbal remarks (e.g., sexual harassment) was not associated with suicidal ideation. Our findings suggest that sexual harassment and sexual assault during deployment may be differentially associated with suicidal ideation.     

Validation of scales from the Deployment Risk and Resilience Inventory in a sample of Operation Iraqi Freedom veterans

The Deployment Risk and Resilience Inventory (DRRI) is a suite of scales that can be used to assess deployment-related factors implicated in the health and well-being of military veterans. Although initial evidence for the reliability and validity of DRRI scales based on Gulf War veteran samples is encouraging, evidence with respect to a more contemporary cohort of Operation Iraqi Freedom (OIF) veterans is not available. Therefore, the primary goal of the present study was to validate scales from the DRRI in a large sample of OIF army personnel diversified in occupational and demographic characteristics. In general, results supported the use of these DRRI scales in this population. Internal consistency reliability estimates were quite strong. Additionally, support was obtained for criterion-related validity, as demonstrated by associations with mental and physical health measures, and discriminative validity, as demonstrated by differences between key military subgroups.     

Interplay Between Service Era,PTSD Symptom Expression,and Treatment Completion Among Veterans

The current veteran population has grown significantly as a result of 3 recent major conflicts: Vietnam, Persian Gulf War, and Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF). Despite a strong presence in VA PTSD specialty clinics nationwide, little is known about how these veteran cohort groups differ in PTSD symptom presentation. Additionally, it is unclear how variations in PTSD symptom presentation may in turn affect treatment adherence and completion. Understanding factors associated with treatment dropout from exposure-based therapy for PTSD is an important area of study, as individuals who drop out of treatment are likely to remain symptomatic and experience significant impairment across a number of psychosocial domains. The present study examined the relationship between service theater affiliation and pretreatment symptom expression as predictors of treatment completion in a sample of 164 veterans. Although treatment completion did not differ by service era, study data revealed statistically significant differences in initial PTSD symptom expression. Implications of the results and future directions are discussed.     

Prospective associations between changes in mental health symptoms and health-related quality of life in veterans seeking posttraumatic stress disorder residential treatment

Background and Objectives: This study examined prospective associations between changes in mental health symptoms (posttraumatic stress disorder [PTSD], depression) and health-related quality of life (physical health, psychological well-being) for veterans with PTSD. Design: This study focused on 139 patients who completed a residential treatment program for PTSD in the Veterans Health Administration. Methods: Patients completed the veteran-specific, 12-item Medical Outcomes Study Short Form, PTSD Checklist – Military version, and Beck Depression Inventory at pre-treatment, discharge, and a four-month follow-up. When accounting for demographic factors, combat exposure, and baseline scores on the respective outcome variables (e.g. mental health, physical health, PTSD, and depressive symptoms), a series of multivariate analyses were conducted for treatment-related changes in mental and physical health on the outcome measures. Results: Reductions in PTSD symptomatology during the treatment period were prospectively linked with better health-related outcomes at the four-month follow-up. In addition, improved physical health and psychological well-being during treatment were each similarly associated with better PTSD and depression outcomes in the months following treatment. Conclusions: Addressing concerns in mental and physical health might have synergistic effects across both domains, supporting the need for holistic models and integrated health care strategies for treating veterans with PTSD.     

Moral transgression during the Vietnam War: a path analysis of the psychological impact of veterans’ involvement in wartime atrocities

Background and Objectives: Involvement in wartime combat often conveys a number of deleterious outcomes, including posttraumatic stress disorder (PTSD), depression, hostility, aggression, and suicidal ideation. Less studied is the effect of engagement in wartime atrocities, including witnessing and perpetrating abusive violence.

Design and Methods: This study employed path analysis to examine the direct effects of involvement in wartime atrocities on hostility, aggression, depression, and suicidal ideation independent of combat exposure, as well as the indirect effects via guilt and PTSD symptom severity among 603 help-seeking male Vietnam War veterans.

Results: Involvement in wartime atrocities was predictive of increased guilt, PTSD severity, hostility, aggression, depressive symptoms, and suicidal ideation after controlling for overall combat exposure. Combat-related guilt played a minor role in mediating the effect of atrocity involvement on depression and suicidal ideation. PTSD severity had a larger mediational effect. However, it still accounted for less than half of the total effect of involvement in wartime atrocities on hostility, aggression, and suicidal ideation.

Conclusions: These findings highlight the heightened risk conveyed by involvement in wartime atrocities and suggest that the psychological sequelae experienced following atrocity involvement may extend well beyond guilt and PTSD.     

Does Reintegration Stress Contribute to Suicidal Ideation Among Returning Veterans Seeking PTSD Treatment?

Although posttraumatic stress disorder (PTSD) and other psychiatric symptoms are well‐established risk factors for suicidal ideation among returning veterans, less attention has been paid to whether the stress of reintegrating into civilian society contributes to suicidal ideation. Utilizing a sample of 232 returning veterans (95% male, mean age = 33.63 years) seeking PTSD treatment, this study tested whether reintegration difficulties contribute to suicidal ideation over and above the influence of PTSD symptoms, depression symptoms, and potential substance misuse. Logistic regressions indicated that reintegration stress had a unique effect on suicidal ideation over and above PTSD and depression symptoms. Reintegration stress interacted with substance misuse to predict suicidal ideation, such that the effect of reintegration stress on suicidal ideation was much larger for those with potential substance misuse. Exploratory analyses also examined which types of reintegration difficulties were associated with suicidal ideation, and found that difficulty maintaining military friendships, difficulty getting along with relatives, difficulty feeling like you belong in civilian society, and difficulty finding meaning/purpose in life were all significantly associated with suicidal ideation, beyond the effects of psychiatric symptoms and potential substance misuse. Findings highlight the importance of addressing reintegration stress for the prevention of suicide among returning veterans. Implications for treatment are discussed.