Combat exposure, psychological symptoms, and marital satisfaction in National Guard soldiers who served in Operation Iraqi Freedom from 2005 to 2006

In current military operations in Iraq and Afghanistan, US National Guard (NG) troops are serving longer deployments than ever before. Little is known, however, about how such deployments affect this population of individuals, relative to active component (AC) troops. This study investigated the extent of combat exposure, severity of post-deployment psychological symptoms, and general interpersonal functioning, as well as the interrelationships of these variables, in 50 NG soldiers who served a 12-month deployment in Iraq from 2005 to 2006. The results indicate that combat exposure and post-deployment post-traumatic stress symptoms in this sample are greater than those in NG veterans of past military operations, and similar to those of full-time soldiers in current operations. Furthermore, the patterns of interrelationships between combat exposure, psychological symptoms, and interpersonal variables were similar to those detected in prior research on AC troops. These results suggest that NG veterans of current military operations may require similar services as active duty veterans. Given that NG troops are less integrated into the military structure, specific outreach efforts may be needed to help NG veterans to receive such services.     

Psychological symptoms and marital satisfaction in spouses of Operation Iraqi Freedom veterans: relationships with spouses' perceptions of veterans' experiences and symptoms

Much research has shown that spouses of combat veterans with posttraumatic stress disorder (PTSD) have higher rates of psychological and marital distress than do spouses of veterans without PTSD; however, very few studies have examined potential mechanisms of this increased vulnerability. The current study examined spouses of National Guard soldiers recently returned from deployments in Iraq. In addition to documenting elevated levels of psychological symptoms in these spouses, the authors found that spouses experienced greater symptom severity when they perceived high levels of symptoms in soldiers but the soldiers endorsed low levels of symptoms. Furthermore, spouses' marital satisfaction was negatively linked to soldiers' self-reported symptom severity only when spouses perceived that soldiers had experienced low levels of combat activity while deployed. When spouses perceived high levels of such activity, soldiers' self-reported symptoms had no relationship with spouses' marital satisfaction. These findings highlight the importance of interpersonal perceptions in intimate relationships and are consistent with the notion that uncontrollable attributions for a relative's mental health problems may provide a buffer against relationship distress. (PsycINFO Database Record (c) 2008 APA, all rights reserved).     

Killing Versus Witnessing Trauma: Implications for the Development of PTSD in Combat Medics

Killing in combat uniquely predicts elevated PTSD symptomatology among military veterans. This study investigated the effects of combat killing in a sample of 345 U.S. Army combat medics who had recently returned from operational deployments to Iraq or Afghanistan. Combat medics provide frontline medical care before, during, and after battles but also fight alongside other soldiers when under attack. Attempting to kill in combat was a significant predictor of PTSD symptomatology even after accounting for passively witnessing trauma in fellow soldiers. Medics may be well prepared to cope with the passive experiencing and witnessing of war-zone trauma, but may benefit from training to cope with the negative consequences of taking actions to kill.     

Effect of the 5-HTTLPR polymorphism on posttraumatic stress disorder,depression, anxiety,and quality of life among Iraq and Afghanistan veterans

Background and Objectives: Posttraumatic stress disorder (PTSD), depression, anxiety, and stress are significant problems among returning veterans and are associated with reduced quality of life. Design: A correlational design was used to examine the impact of a polymorphism (5-HTTLPR) in the serotonin transporter promoter gene on post-deployment adjustment among returning veterans. Methods: A total of 186 returning Iraq and Afghanistan veterans were genotyped for the 5-HTTLPR polymorphism. Symptoms of PTSD, depression, general stress, and anxiety were assessed along with quality of life. Results: After controlling for combat exposure, age, sex of the participant, and race, 5-HTTLPR had a significant multivariate effect on post-deployment adjustment, such that S′ carriers reported more post-deployment adjustment problems and worse quality of life than veterans homozygous for the L′ allele. This effect was larger when the analyses were restricted to veterans of European ancestry. Conclusions: Our findings suggest that veterans who carry the S′ allele of the 5-HTTLPR polymorphism may be at increased risk for adjustment problems and reduced quality of life following deployments to war zones.     

Exposure,Agency, Perceived Threat,and Guilt as Predictors of Posttraumatic Stress Disorder in Veterans

Using a sample of 289 Iraq/Afghanistan veterans, this study examined the contributions of combat exposure, agency, perceived threat, and guilt to posttraumatic stress disorder (PTSD) symptoms. Regression analyses indicated the four variables (together with demographic variables) accounted for 79% of the variance in PTSD symptoms. Guilt was the most important predictor. In addition, guilt mediated between exposure and PTSD symptoms, perceived threat and PTSD symptoms, and agency and PTSD symptoms. Implications of these findings are discussed.     

Moral Injury: A Mechanism for War-Related Psychological Trauma in Military Family Members

Recent research has provided compelling evidence of mental health problems in military spouses and children, including post-traumatic stress disorder (PTSD), related to the war-zone deployments, combat exposures, and post-deployment mental health symptoms experienced by military service members in the family. One obstacle to further research and federal programs targeting the psychological health of military family members has been the lack of a clear, compelling, and testable model to explain how war-zone events can result in psychological trauma in military spouses and children. In this article, we propose a possible mechanism for deployment-related psychological trauma in military spouses and children based on the concept of moral injury, a model that has been developed to better understand how service members and veterans may develop PTSD and other serious mental and behavioral problems in the wake of war-zone events that inflict damage to moral belief systems rather by threatening personal life and safety. After describing means of adapting the moral injury model to family systems, we discuss the clinical implications of moral injury, and describe a model for its psychological treatment.     

Behavioral Health Adjustment in Reserve Component Soldiers During a Noncombat Deployment to Africa

This study benchmarked rates of mental health problems, adjustment difficulties, and perceptions of unit climate among 505 U.S. soldiers (primarily National Guard) deployed to the Horn of Africa in 2012. In addition, the study examined whether differences across these outcomes exist between combat veterans (n = 239) and noncombat veterans (n = 242). Rates of mental health problems among soldiers on this noncombat deployment were lower than rates typically found among soldiers on combat deployments. Furthermore, soldiers without previous combat experience had lower rates of mental health problems and aggression than combat veterans. Similar differences were evident when adjustment difficulties and unit climate variables were compared. Although combat veterans could be valuable in training new soldiers, the results of this study indicate that combat veterans may need more targeted resources to facilitate their adjustment if they are to be optimally utilized.     

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.     

Rumination,Resilience, and Posttraumatic Stress Disorder Symptom Severity Among Veterans of Iraq and Afghanistan

This study investigated the relationships among combat exposure, intrusive, and deliberate rumination, resilience, and posttraumatic stress disorder (PTSD) among service members who deployed to Iraq or Afghanistan (N = 191). Participants completed an online survey and hierarchical linear regression results indicated that enlisted rank, higher combat exposure, lower resilience, and higher intrusive rumination predicted higher levels of PTSD symptom severity. Resilience moderated the relationship between combat exposure and PTSD symptom severity, such that participants who had higher levels of resilience had lower levels of PTSD symptom severity at all levels of combat exposure. These findings suggest the importance of increasing resilience in combat veterans, specifically those of enlisted rank and veterans exposed to higher levels of combat. Findings also suggest that teaching veterans how to control or minimize intrusive rumination might help lower PTSD severity.     

Postdeployment Psychological Health and Interpersonal Problems Among Air Force Mental Health Personnel

This study is one of the first to use validated screening measures to examine the rates of self-reported mental health and interpersonal problems following deployment of military mental health personnel (MMHP). Research has examined the impact of deployment on military personnel finding 10.2% to 29.0% screen positive for at least one mental health problem. However, little is known about impacts of deployment among MMHP. Utilizing health data collected three to twelve months post-deployment from a sample of 759 Air Force MMHP, this study examined rates of positive screens for psychological health or interpersonal problems, subsequent confirmation of positive screens by a medical provider upon examination, and the demographic characteristics associated with psychological health or interpersonal problems. The study found 13.9% screened positive for “possible or probable PTSD,” 4.6% for depressive symptoms, 3.9% for alcohol problems, and 12.6% for interpersonal problems. In total, nearly 26% screened positive for one or more psychological or interpersonal problem. Of those who screened positive, 48.5% of depressive problems, 36.0% of PTSD, 20.0% of alcohol problems and 29.7% of interpersonal problems were confirmed upon subsequent examination by a medical provider. Those who screened positive were more likely to be (a) female, (b) separated, widowed, or divorced, (c) a mental health nurse or psychiatric nurse practitioner, and (d) deployed to Iraq or Afghanistan. The significance, limitations, and implications of the results, along with recommendations for future research are discussed.     

The Army National Guard in OIF/OEF: Relationships among combat exposure,postdeployment stressors,social support,and risk behaviors

With the continued operations in Iraq and Afghanistan, studies of the prevalence of posttraumatic stress disorder and related symptoms are now common. However, lacking is how these symptoms relate to precipitating conditions and the mitigating effects of social support on these symptoms. This is particularly relevant for reserve military personnel, who have been shown to be greater at-risk for postdeployment problems. The present study examined questionnaire data obtained from Army National Guard (ARNG) units immediately after their return from deployment to Iraq and Afghanistan during 2010 (N = 4329 soldiers in 50 units). Findings showed few soldiers displayed risk behaviors (i.e., daily alcohol use, use of illicit drugs, suicide thoughts, and physically threatening others) during and after deployment. Those most likely to have more postdeployment risk behaviors were also those who showed more risk behaviors during deployment. A substantial percentage of soldiers reported combat exposure, postdeployment negative emotions, and postdeployment loss of a personal relationship. These reported outcomes were all related to increased risk behaviors after deployment. The buffering effect of social support on postdeployment risk behaviors was equally evident when data were examined individually and when grouped by unit memberships. Implications of findings for future research, practice, and policies are discussed.     

Intimate partner cohesion and military unit cohesion: Different types of interpersonal relationships each uniquely predict soldier well-being

Although research on military populations has found that measures of personal well-being are correlated with both intimate partner cohesion and military unit cohesion, it is not clear how these correlations should be interpreted. Based on Relationship Regulation Theory, it was expected that each type of interpersonal relationship would have independent effects, that each would uniquely predict outcomes, and that effects would remain significant after controlling for person-level traits and experiences, such as trait resilience and exposure to combat. A sample of 273 active-duty military personnel completed self-report measures of cohesion in two types of interpersonal relationships (intimate relationships and military unit relationships), two control variables (trait resilience and combat exposure), and three outcome variables (well-being, negative emotionality, and trauma-related stress). Results indicated that cohesion in the two types of relationships were minimally related to each other, but both correlated with outcome variables. Effects for each type of interpersonal relationship remained significant after controlling for the other type and controlling for trait resilience and combat exposure. The results suggest that the effects of interpersonal cohesion are best understood as reflecting experiences in specific types of relationships rather than general characteristics of people in those relationships.     

Factors Associated With Physical Aggression Among US Army Soldiers

There are a growing number of studies that have approximated levels of aggression and associated outcomes among combat veterans returning from Iraq and Afghanistan using brief screening assessments. However, further research to evaluate the relative role of combat exposures and overt physical behaviors is required to further elucidate potential associations between military service, combat deployment, and overt physical aggression. The purpose of the current study was to assess the prevalence of self‐reported physical aggression in a sample of US Army soldiers using an adaptation of the Revised Conflict Tactics Scale (CTS2), and examine factors associated with higher levels of aggression. A population‐based cross‐sectional study was conducted at a single US Army Installation within a sample of active duty US Army soldiers (n = 6,128) from two large units. Anonymous surveys were collected 6 months following deployment to measure overt aggressive behaviors, posttraumatic stress disorder, anxiety, depression, traumatic brain injury, and misuse of alcohol. There were a relatively higher number of minor and severe physical overt aggressive actions reported among soldiers who previously deployed, notably highest among deployed soldiers reporting the highest levels of combat intensity. Soldiers screening positive for the misuse of alcohol were also significantly more likely to report relatively higher levels of physical aggression. This study quantified overt aggressive behaviors and associated factors, showing increasing combat exposures may result in increased physical aggression. Clinicians treating service members returning from combat may consider assessing relative levels of combat. Aggr. Behav. 38:357‐367, 2012. Published 2012 Wiley Periodicals, Inc.?     

Personality Assessment Inventory profiles of deployed combat troops: an empirical investigation of normative performance

The present study examined the normative scores and psychometric properties of the Personality Assessment Inventory (PAI; Morey, 1991) within a non-treatment-seeking sample of soldiers deployed to combat zones in Iraq, compared with a sample of community adults matched with respect to age and gender. Results indicate the scores and properties of the PAI scales were generally quite similar in the Iraq and community samples, with modest differences emerging on only 3 subscales addressing antisocial behavior, issues with close relationships, and interpersonal vigilance. These results suggest that standard normative interpretation of PAI scales is appropriate even when the instrument is administered in a combat zone. In comparison with prior research, the results may suggest that documented mental health issues among combat veterans, when present, may be particularly likely to emerge postdeployment.     

A Psychological Support for Peacekeeping Soldiers and their Families: A Preliminary Model

Being a military family can be challenging, and the demands placed on soldiers and their families can become very complex. Military deployments are part of a soldier's military career that cannot be avoided and have the potential to influence military families directly. Separation within a military family is an inherent consequence of military deployments. Military deployments consist of various phases. Each phase has unique emotional and psychological challenges attached to it. These challenges can significantly influence every member in the military family. It is therefore imperative that the military, soldier and military families be sensitized around these phases and their unique challenges. A model is proposed to empower military families in the face of deployment.     

Interactive effects of cumulative lifetime traumatic brain injuries and combat exposure on posttraumatic stress among deployed military personnel

Growing research links Traumatic Brain Injury (TBI) with greater posttraumatic stress disorder (PTSD) symptoms. Much of this research has focused on the influence of the presence or severity of a single TBI while neglecting the potential cumulative effects of multiple TBIs incurred across an individual’s lifetime on combat-related PTSD. The present study addressed this gap using a sample of 157 military service members and 4 civilian contractors who underwent structured TBI interviews at a military hospital in Iraq and completed the Combat Experiences Scale (CES) and Posttraumatic Checklist – Military (PCL-M). Results indicated that a greater number of lifetime TBIs were associated with greater PTSD symptoms when accounting for the presence and severity of a recent, deployment-related TBI. Additionally, a significant interaction of number of lifetime TBIs and combat exposure emerged, indicating that exposure to combat yielded greater PTSD symptoms among those with multiple lifetime TBIs compared to those with one or zero lifetime TBIs. These data suggest that incurring multiple TBIs may amplify the link between combat exposure and PTSD and underscore the need to screen for lifetime TBI history.     

A Jungian approach to dreams reported by soldiers in a modern combat zone

Treating combat deployed soldiers is becoming more prevalent and needed in psychiatry. Modern combat produces unique psychological challenges, including those without criteria for post-traumatic stress disorder (PTSD). This article will attempt to share the primary author's experience with psychotherapy in a combat zone, along with understanding the general themes of dreams the author encountered while being deployed. Toward that end, the primary author [RW] discusses his personal experiences in Iraq working with soldiers whom he saw and treated while in theatre, with a particular focus on the dreams they reported. The co-authors [EG and MI] afterward collaborated with the primary author to formulate and provide insight into the dreams from a Jungian perspective.     

The impact of individual trauma symptoms of deployed soldiers on relationship satisfaction.

Research traditionally has focused on the development of individual symptoms in those who experienced trauma directly but has overlooked the interpersonal impact of trauma. The current study reports data from 45 male Army soldiers who recently returned from a military deployment to Iraq (Operation Iraqi Freedom) or Afghanistan (Operation Enduring Freedom) and their female spouses/partners. The results indicated that increased trauma symptoms, particularly sleep problems, dissociation, and severe sexual problems, in the soldiers significantly predicted lower marital/relationship satisfaction for both soldiers and their female partners. The results suggest that individual trauma symptoms negatively impact relationship satisfaction in military couples in which the husband has been exposed to war trauma.     

Family Systems and Ecological Perspectives on the Impact of Deployment on Military Families

The scope of sustained military operations in Iraq and Afghanistan has placed great demands on the Armed Forces of the United States, and accordingly, military families have been faced with deployments in more rapid succession than ever before. When military parents fulfill occupational duties during wartime, military children and families face multiple challenges, including extended separations, disruptions in family routines, and potentially compromised parenting related to traumatic exposure and subsequent mental health problems. Such challenges can begin to exert a significant toll on the well-being of both individuals and relationships (e.g., marital, parent–child) within military families. In order to respond more effectively to the needs of military families, it is essential that mental health clinicians and researchers have a better understanding of the challenges faced by military families throughout the entire deployment experience and the ways in which these challenges may have a cumulative impact over multiple deployments. Moreover, the mental health field must become better prepared to support service members and families across a rapidly evolving landscape of military operations around the world, including those who are making the transition from active duty to Veteran status and navigating a return to civilian life and those families in which parents will continue to actively serve and deploy in combat zones. In this article, we utilize family systems and ecological perspectives to advance our understanding of how military families negotiate repeated deployment experiences and how such experiences impact the well-being and adjustment of families at the individual, dyadic, and whole family level.