Suicide Risk among Lesbian,Gay, Bisexual,and Transgender Military Personnel and Veterans: What Does the Literature Tell Us?

Research suggests that both the military and veteran and the lesbian, gay, bisexual, and transgender (LGBT) populations may be at increased risk for suicide. A literature review was conducted to identify research related to suicide risk in the LGBT military and veteran populations. Despite the paucity of research directly addressing this issue, themes are discussed evident in the literature on LGBT identity and suicide risk as well as LGBT military service members and veterans. Factors such as social support and victimization appear to be particularly relevant. Suggestions are made with respect to future research that is needed on this very important and timely topic.     

Contextual Career Counseling for Transitioning Military Veterans

Military culture is a unique subset of the United States, complete with its own language, writing style, norms, membership, rank structure, values, and laws (Harmon, 2007 ). Using contextual theory for career counseling, counselor educators can assist counselors‐in‐training in understanding the effects of the military environment on clients who are military veterans. This article includes a review of the literature and a call for research.     

Assessment for the U.S. Army Comprehensive Soldier Fitness program: the Global Assessment Tool

Psychology and the U.S. military have a long history of collaboration. The U.S. Army Comprehensive Soldier Fitness (CSF) program aims to measure the psychosocial strengths and assets of soldiers as well as their problems, to identify those in need of basic training in a given domain as well as those who would benefit from advanced training, and then to provide that training. The goals of the CSF program include the promotion of well-being as well as the prevention of problems. Assessment is the linchpin of the CSF program, and the Global Assessment Tool (GAT) is a self-report survey that measures psychosocial fitness in emotional, social, family, and spiritual domains. We review the history of psychological assessment in the military and the lessons taught by this history. Then we describe the process by which the GAT was developed and evaluated. We conclude with a discussion of pending next steps in the development and use of the GAT.     

American Military Veteran Entrepreneurs: A Comprehensive Profile of Demographic,Service History,and Psychosocial Characteristics

American military veterans are nearly twice as likely to be self-employed compared with nonveterans and are majority owners in 9% of all businesses nationwide. Despite their contribution to the broader economy and the potential for training programs to cultivate and foster successful self-employment and veteran-lead entrepreneurial ventures, research on veteran entrepreneurs remains limited. To gain a better understanding of the potential strengths and vulnerabilities of veteran entrepreneurs, the current study utilized data from a large, nationally representative sample to profile self-employed veterans (n = 230) and compare them with veterans who work as employees (n = 1,055) with respect to demographic, military service history, and psychosocial characteristics. Results indicated that self-employed veterans were older and more educated and more likely to utilize U.S. Department of Veteran’s Affairs (VA) health care. Self-employed veterans were more likely to serve in Vietnam and to serve in the military for fewer years. No differences were noted in perceived military experience, level of combat exposure, or military branch served as a function of self-employment. Although reporting more lifetime traumas, self-employed veterans did not experience higher rates of current or lifetime psychopathology or lower perceived quality of life. Potential protective resilience-promoting factors may be associated with the higher levels of openness, extraversion, optimism, achievement-orientation (purpose in life), and greater need for autonomy and professional development observed among self-employed veterans. Moreover, self-employed veterans demonstrated higher levels of gratitude, community integration, and altruistic service to others. Findings have potential to inform human resources management strategies and vocational training and reintegration initiatives for veterans.     

Measuring Spiritual Fitness: Atheist Military Personnel,Veterans, and Civilians

This study investigated the impact of transcendent item phrasing (i.e., phrasing which assumes the respondent believes in certain sacred or supernatural concepts) on the validity of the U.S. Army’s Comprehensive Soldier Fitness (CSF) program’s spiritual fitness scale when administered to atheist military personnel, veterans, and civilians. Results indicated that the inclusion of transcendent phrasing led to reduced concurrent validity for the spiritual fitness scale when administered to atheist military personnel and veterans, reduced concurrent and predictive validity when administered to atheists’ but not Christians’ spiritual fitness. Notably, the removal of transcendent phrasing actually led to increased concurrent validity for Christian respondents. Taken together, these findings suggest the Revised scale, which is composed of items that do not rely on transcendent phrasing, produces better psychometric outcomes for both atheist and Christian respondents. Implications for the CSF program and the measurement of spiritual fitness are addressed.     

Targeting Self-Stigma in Returning Military Personnel and Veterans: A Review of Intervention Strategies

Research suggests that mental health-related stigma significantly decreases the use of mental health services by military personnel and veterans. The goal of this article is to review what is known about mental health stigma as it relates to military personnel and veterans, as well as to offer an interpretive review of self-stigma intervention strategies that have been applied within the field. Target areas for future work and the concerns and challenges faced by interventionists are discussed.     

Quality of Life in Gulf War Veterans: the Influence of Recency and Persistence of Psychiatric Morbidity

Important contributors to quality of life (QOL), such as psychosocial factors, have received limited exploration in veteran populations, in contrast to a significant amount of research focused on health-related quality of life (HRQL). This study investigated QOL and HRQL amongst Gulf War veterans compared with an era-military comparison group 20 years after the 1990/91 Gulf War, and whether psychiatric status over time and psychiatric comorbidities predicted QOL and HRQL. We then investigated which of a range of psychological health, physical health and social factors contribute greatest to QOL. Psychological interviews and postal questionnaires were administered to a cohort of Gulf War veterans and a military-era comparison group in 2000–02 and 2011–12. Gulf War veterans had poorer QOL and HRQL compared with a military comparison group, but the pattern of factors that influenced QOL was the same for both groups. Poorer QOL and HRQL were significantly associated with more recent and persistent psychiatric morbidity over time. Further analyses showed that affective disorders, followed by anxiety disorders had the largest impact on QOL and HRQL, and that QOL and HRQL were negatively affected by each additional psychiatric diagnosis. The importance of these findings was highlighted in a structural equation model that revealed psychological health contributed most to QOL, social support contributed a moderate amount, but physical health contributed only a very small amount. QOL in veterans is an important issue even many years after deployment and psychological health plays a predominant role in QOL.

     

Exposing the glosses in Seligman and Fowler's (2011) straw-man arguments

The author was disappointed to see an entire special issue of the American Psychologist (January 2011) devoted to military psychology, but he was especially concerned about the one-sided moral justifications presented by Seligman and Fowler (2011) in the final article of the issue. The author feels they misrepresented potential objections to their program and dismissed the inherent dangers of cooperation between organized psychology and the military.     

Psychopathological View of Posttraumatic Stress Reactions is in the Eye of the Beholder. A Commentary on Schok et al.

Schok et al. (2011) concluded that military veterans with “suspicious minds” are at risk for posttraumatic stress disorder. The authors recommended that negative appraisals of peacekeeping missions are prevented or changed to positive appraisals. In developing their argument, they misrepresented previous Dutch research as adopting a “psychopathological perspective.” This commentary criticizes the medicalization of posttraumatic stress responses that tends to ignore contextual factors and moral issues at stake. Also, the implicit assumptions of a “positive psychology” of posttraumatic stress in military veterans are discussed. Results on the process of attributing meaning are presented and related to the differences in theoretical perspective. A contextualized psychology that appreciates human diversity without prejudice and that stimulates moral and cultural sensitivity is advocated.     

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.     

Long-Term Trajectories and Service Needs for Military Families

The deployment of US military personnel to recent conflicts has been a significant stressor for their families; yet, we know relatively little about the long-term family effects of these deployments. Using data from prior military service eras, we review our current understanding of the long-term functioning and needs of military families. These data suggest that overseas deployment, exposure to combat, experiencing or participating in violence during war deployment, service member injury or disability, and combat-related post-traumatic stress disorder (PTSD) all have profound impacts on the functioning of military families. We offer several recommendations to address these impacts such as the provision of family-centered, trauma-informed resources to families of veterans with PTSD and veterans who experienced high levels of combat and war violence. Recent efforts to address the needs of caregivers of veterans should be evaluated and expanded, as necessary. We should also help military families plan for predictable life events likely to challenge their resilience and coping capacities. Future research should focus on the following: factors that mediate the relationship between PTSD, war atrocities, caregiver burden, and family dysfunction; effective family-centered interventions that can be scaled-up to meet the needs of a dispersed population; and system-level innovations necessary to ensure adequate access to these interventions.     

Designing training programs for perceptual-motor skills: Practical implications from the serial reaction time task

Within various contexts, such as sports and the military, training programs are being designed to effectively and efficiently guide perceptual-motor skill acquisition. Even though this notion is often underestimated, the design of such training programs may greatly benefit from findings and theories from basic cognitive psychology. One particular basic paradigm that addresses this issue is the serial reaction time task. In the current article, we take on the challenge to review this paradigm from an applied point of view. We highlight a range of themes that have been explored with this paradigm that could have a direct relevance for the process of optimizing training procedures for perceptual-motor skill acquisition.     

A Systematic Review of Suicide Prevention Programs for Military or Veterans

Military personnel and veterans have important suicide risk factors. After a systematic review of the literature on suicide prevention, seven (five in the U.S.) studies of military personnel were identified containing interventions that may reduce the risk of suicide. The effectiveness of the individual components was not assessed, and problems in methodology or reporting of data were common. Overall, multifaceted interventions for active duty military personnel are supported by consistent evidence, although of very mixed quality, and in some cases during intervals of declines in suicide rates in the general population. There were insufficient studies of U.S. Veterans to reach conclusions.     

Does EMDR reduce post‐traumatic stress disorder symptomatology in combat veterans?

Prior meta‐analyses have suggested that eye‐movement desensitization and reprocessing (EMDR) may be effective in alleviating the symptoms of post‐traumatic stress disorder (PTSD). EMDR is now being recommended as a treatment for military combat veterans who suffer from PTSD. We provide a review of published outcome studies that appeared in print from 1987 – April, 2008 which examined the specific effects of EMDR on PTSD among military combat veterans. Studies were identified through electronic bibliographic databases, web sites, and manual searches of article reference lists. A total of six randomized controlled trials (RCTs) and three quasi‐experimental studies met our inclusionary criteria and are reviewed. The evidence supporting the use of EMDR to treat combat veterans suffering from PTSD is sparse and equivocal, and does not rise to the threshold of labeling the therapy as an empirically supported treatment. It is premature to incorporate EMDR into routine care for veterans to alleviate combat‐related PTSD. EMDR needs a considerably stronger evidentiary foundation which includes large‐scale RCTs involving credible placebo controlled treatment conditions. Copyright © 2009 John Wiley & Sons, Ltd.     

Intimate partner violence in the military: Treatment considerations

While considerable research has examined the prevalence of IPV in civilian couples, much less information is available on married or cohabitating couples in which one or both parents are active duty soldiers or veterans of foreign wars. In this review, we explore various aspects of the partner violence phenomena among military personnel (i.e., active duty and veterans) and their implications for intervention. We highlight (a) the scope of the problem, (b) discuss domestic violence as defined by the Department of Defense (DoD), (c) list prevalence rates of IPV among military families, (d) identify correlates of IPV, and (e) discuss treatment options for providers working with these couples. We also discuss the barriers to intervention and their implications for victims, perpetrators, and providers. Conclusions and recommendations for future research directions are also briefly discussed.     

Well-being and Coping of Student Veterans Readjusting into Academia: A Pilot Survey

This study explored student veterans coping with transitions to postsecondary education. An instrument using a Tailored Survey Design and an Adult Transitioning Framework was developed to collect coping responses of 13 veterans with deployment experience transitioning to postsecondary education. Results indicated 38% reported difficulty managing finances, 93% utilized military training to manage stressors, and 38% sought environmental supports provided by the university. Findings suggest previous military experiences can be incorporated into occupations supporting individual coping skill development for the transition to postsecondary education. Further research is needed to understand barriers and facilitators of student veteran engagement in university resources.     

Competence, Risk, and Resilience in Military Families: Conceptual Commentary

This commentary highlights conceptual themes in the opening section of this special issue on military families in relation to a new synthesis of developmental systems theory that emerged from developmental, ecological, and family systems theory, as well as developmental psychopathology and risk/resilience frameworks. Articles in this special issue draw on these concepts to characterize and guide the burgeoning research on military families. This perspective emphasizes that multiple dynamic systems interact across levels to shape individual development, as well as the function of families and military units. Developmental timing is important for understanding how challenges of military life may impact individuals and families. Cascade effects are noted, where stress experienced by one family or service member can influence the function of other individuals or larger systems. Capacity for resilience is distributed across systems, including families and cultures, as well as resources or supports provided by military organizations to foster adaptive responses or recovery. These systems include schools and educational programs that play key roles in fostering and supporting resilience for children. Overall, developmental system concepts have considerable utility for guiding research with military families, particularly in regard to promoting resilience. Moreover, lessons learned from military families and programs may have much broader implications for many other nonmilitary children, families, and organizations that share similar goals and challenges.     

Toward Training Transformation

This article briefly discusses common themes concerning training transformation shared by articles in this special issue. Themes include: the continuing combat training center revolution, the interplay between theory and practice in military training programs, training as an engineering discipline, the role of training as a contributor to human performance in military operations, the use of training simulations to assess human performance, and data standards. The article emphasizes the need for researchers to better explain and articulate the value and return on investment of training in general and training transformation in particular. Meeting this need will better inform decisions and decision makers in allocating resources to training across the full range of defense requirements.     

Depressive Symptomatology Mediates Associations With Community Reintegration in Veterans With TBI

Community reintegration (CR) is a challenge for military veterans with traumatic brain injury (TBI). Posttraumatic stress disorder (PTSD), depression, bodily pain, and limitations in physical functioning—common comorbidities with TBI in veterans—have all been associated with problems in CR, but their interrelationships are unclear. The role of depression as a possible mediator of effects on CR has not been examined. We tested depressive symptoms as a possible mediator of CR’s associations with physical limitations, PTSD, and bodily pain. This cross-sectional study used baseline data from a larger randomized controlled trial that evaluated the impact of an in-home intervention for veterans with TBI and their families. Eighty-three military veterans with TBI recruited from a medical rehabilitation service at an urban U.S. Department of Veterans Affairs medical center participated in the study. Interview instruments measured CR, depressive symptoms, physical limitations (limitations in physical functioning), bodily pain, quality of the relationship with key family members, and sociodemographic characteristics. PTSD was determined through review of the electronic medical record. Interview data were collected in veterans’ homes. Depressive symptoms totally mediated the association between physical limitations and CR and the association between PTSD and CR. The bodily pain–CR association was not significant after quality of relationship had been entered into the regression models. Findings suggest that interventions to increase CR of veterans with TBI should address depression, a treatable condition. Replication of our mediation findings in larger veteran and civilian samples with TBI is needed.     

Introduction to Michotte's heritage in perception and cognition research

Several decades after Michotte's work was published, it continues to inspire current research in perception, cognition, and beyond. In this special issue we pay tribute to this heritage with a collection of empirical and theoretical papers on amodal completion and the perception of causality, two areas of research within which Michotte's work and ideas have had a lasting influence. As a background to better understand the remaining papers, we briefly sketch Michotte's life and work and the scope (in breadth and in depth) of his impact. We then review Michotte's seminal contributions to the areas covered in this special issue, some of the major research discoveries and themes in the intervening decades, and the major open questions and challenges we are still facing. We also include a sneak preview of the papers in this special issue, noting how they relate to Michotte's work and to each other. This review shows both how much influence Michotte has had on contemporary perception and cognition research, and how much important work remains to be done. We hope that the papers in this special issue will serve both to celebrate Michotte's heritage in this respect, and to inspire other investigators to continue the projects he began.