The Associations of Physical and Sexual Assault with Suicide Risk in Nonclinical Military and Undergraduate Samples

The associations of various forms of sexual and physical assault with a history of suicide attempts and recent suicide ideation were studied in two distinct samples: active duty military and undergraduate students. A total of 273 active duty Air Force personnel and 309 undergraduate students anonymously completed self‐report surveys of assault victimization, emotional distress, belongingness, recent suicide ideation, and previous suicide attempts. Among military personnel, rape, robbery, or violent assault was associated with a nonsignificant trend toward increased risk for suicide attempts, whereas physical abuse or battering as an adult was significantly associated with recent suicide ideation. Among undergraduates, unwanted sexual experiences as an adult and physical or sexual abuse as a child were significantly associated with increased risk for suicide attempt, but only unwanted experiences as an adult was significantly associated with increased risk for suicide ideation. Experiencing multiple forms of assault increased risk for suicide attempts and ideation in both groups. Results suggest that different types of assault contribute differentially to suicide risk in military versus undergraduate populations, but experiencing multiple types of assault is associated with increased risk in both groups.     

Are UN Peacekeepers at Risk for Suicide?

Media reports connecting UN peacekeeping duties by Canadian soldiers to their subsequent suicide prompted this study of peacekeeping as suicide risk. In a case-control design we retrospectively compared 66 suicides in the Canadian military between 1990 and 1995 with two control groups: (a) 2,601 controls randomly selected from the electronic military database and (b) 66 matched controls with complete personnel and medical data. We found no increased risk of suicide in peacekeepers except among a subgroup of air force personnel. Here confounding individual factors, isolation from supports, and possibly inadequate preparation for deployment elucidated their suicides. Theater of deployment (e.g., Bosnia) did not affect the suicide rate. Military suicides experienced psychosocial stresses and psychiatric illness more often than their matched controls. We conclude that although peacekeeping per se does not increase overall suicide risk, military life-styles may strain interpersonal relationships, encourage alcohol abuse, and contribute to psychiatric illness and suicide in a minority of vulnerable individuals irrespective of peacekeeping assignment. Careful selection, and preparatory military training that encourages intragroup bonding and mutual support, may protect against suicide risk.     

Discriminators of suicide thoughts and attempts among homeless veterans who abuse substances

Six hundred homeless military veterans who abused substances were examined to determine what factors discriminate between nonsuicidal veterans, those who had suicidal thoughts, and persons who had attempted suicide. Several factors were considered based on attachment theory, including caregiver attachment, sexual abuse, physical abuse, resilience, self-efficacy, and self-esteem. Suicide attempters were discriminated from others by psychiatric comorbidity, early abuse, severity of substance abuse, and longevity of drug use. In contrast, the discriminators between nonsuicidal homeless substance abusers and others were elements of attachment and commitments such as marriage, employment, and religiosity. Some implications of the findings for intervention are discussed.     

Suicide Attempts and Suicide among Marines: A Decade of Follow‐up

Suicidal behavior among military personnel is of paramount public health importance because of the increased risk of death from suicide in this population. Pre‐ and post‐Marine recruit training risk factors for suicide attempts among current and former Marines were examined in 10 years following recruit training. The characteristics of the subsample of current and former Marines who died by suicide during this time are also described. Stressful and traumatic life events (e.g., childhood physical, sexual, and emotional abuse, sexual harassment during recruit training) and pre‐recruit training suicide attempts emerged as having strong associations with post‐recruit training attempts. Half of those who died by suicide in the 10 years following recruit training endorsed at least one significant life stressor prior to joining the Marines. This study highlights the importance of screening for stressful and potentially traumatic experiences occurring both before and during military service as part of a comprehensive suicide risk assessment in military samples.     

Blockchain,The Greater Good,and Human and Civil Rights

The central theme of this paper is that the development of a technology that is predicted to have a major impact on the way we transact with each other should be a matter where the needs of society at large are taken into account. Where the technology is one that emerges from the domain of the Internet, inclusivity becomes even more acute in order to avoid widening the already existing gap in reaping the “digital dividend.” With blockchain, the obligation could even be seen as a moral one, as blockchain is said to have the potential to negate the scope for the abuse of trust by states and institutions. This could be a game changer in areas such as public procurement and the conduct of elections where abuse can lead to the denial of essential resources and a concomitant loss of life, or to conflict and mass killings. Blockchain presents an opportunity for the Internet development community to claim a degree of recognition in the human rights realm by aiding civil intervention in areas where military intervention has been deemed inappropriate.     

Suicidal or self-harming ideation in military personnel transitioning to civilian life

Suicides have markedly increased among military personnel in recent years. We used path analysis to examine factors associated with suicidal/self-harming ideation among male Navy and Marine Corps personnel transitioning to civilian life. Roughly 7% of men (Sailors = 5.3%, Marines = 9.0%) reported ideation during the previous 30 days. Results suggest that combat exposure, substance abuse, and resilience are associated with suicidal ideation/self-harming thoughts through the mediation of posttraumatic stress disorder symptoms and/or depression symptoms. Substance abuse plays a moderating role. Resilience had a direct effect only among the Marines. Implications for improving the transition to civilian life are discussed.     

In Her Own Words: Semi-structured Interviews of Women Veterans Who Experienced Military Sexual Assault

Twenty-one female veterans volunteered to talk about 29 events of military sexual assault (MSA) via semi-structured interviews covering pre-military abuse, during and immediately after the assault and reactions post-assault. The 14 who reported on-going abuse in childhood, also experienced multiple events of MSA. Common themes revealed that most events happened at night (52% specifically referenced night, while 69% most likely occurred at night), 24% in a car, and 24% while the victim was on duty. MSA was associated with a low use of weapons (17% with knives or guns) but a high use (52%) of physical violence (e.g., hitting, choking) and intimidation (59%). 69% knew their perpetrator prior to the assault and 12 of them (60%) were superiors. 34.5% of the perpetrators and 24% of the victims were drinking alcohol prior to the assault. 27.5% reported the MSA; however, 52% had to continue to interact with the perpetrator as part of her job. 67% reported being pregnant or seriously injured as a result of the MSA; however, only 28% received help. 71% disclosed that they had suicidal ideation 14% made suicide attempts while on active duty, and 38% made a suicide attempt some time in their lifetime post-MSA. 52% said the MSA lead to an early discharge from the military. 76% stated MSA interfered with their ability to have an intimate relationship. All participants graduated Warrior Renew sexual trauma treatment and reported positive responses. Although this is a small sample, findings may help generate hypotheses for larger scale studies.     

Substance use treatment programs in the active duty US military: A narrative review

Substance use disorders (SUDs) are a growing problem for the U.S. military. Each branch of the military has its own dedicated substance abuse treatment program. However, there has been limited attention to the research conducted on these programs. The purpose of this narrative review is to describe SUD treatment programs in the U.S. military and to review the extant research published between 2001–2015. Fourteen peer-reviewed articles, 2 official reports, 1 book chapter, 1 thesis, and 1 dissertation were identified. Most SUD treatment programs are nonconfidential, although a confidential program is being piloted by the Army. Recently, the programs have increased their focus on assessment and treatment of comorbid psychological disorders. Further research is required to examine the efficacy, effectiveness, and cost-effectiveness of the treatment programs.     

The Coping Self-Efficacy Scale: Psychometric properties in an outpatient sample of active duty military personnel

ABSTRACT

Active duty military service members endure a unique constellation of stressors while deployed or at home. Yet, assessment of protective factors against these stressors among active duty service members represents an under studied area. The present study advances the assessment of protective factors through the psychometric evaluation of the Coping Self-Efficacy Scale (CSES) in a clinical sample of military service members in mental health or substance abuse treatment (n = 200). Cross-sectional data were drawn from military medical records and a supplemental self-report questionnaire. Data extracted included demographic (e.g., sex, age), military characteristics (e.g., rank, years in service), physical health and mental health (e.g., anxiety, depression), and coping self-efficacy. Findings suggest a 3-factor (i.e., problem-focused coping, thought-stopping, and getting social support) CSES structure with acceptable internal consistency. Further, there were small-to-moderate associations with physical and mental health outcomes, providing evidence of construct validity. There were few significant associations with military-related characteristics. Finally, controlling for covariates, thought-stopping beliefs explained unique variance in suicide-related behaviors. Together, findings support the use of the CSES to measure coping-related beliefs in military service members. Recommendations are offered for future research and practice with active duty service members.     

The Influence of Survey Confidentiality and Construct Measurement in Estimating Rates of Childhood Victimization Among Navy Recruits

Surveys that directly ask participants whether they have been abused are likely to derive different results than studies that ask about specific childhood sexual experiences or about experiences with specific types of parental aggression that participants may or may not personally define as abusive. Rates are also likely to be affected by the level of confidentiality of the survey. We compared results from the nonconfidential military Sailor's Health Inventory Program (SHIP; Mittelman, Plunkett, & Bayer, 1998) with the results of the Survey of Recruits' Behaviors (SRB; Merrill, Newell, Hervig, Booth-Kewley, Patriarca, & Gilman, 1998). The SRB included both confidential and anonymous survey conditions. Rates of self-reported childhood abuse varied markedly. SHIP rates were lowest, with 5% of the participants identified as victims of abuse. Using SRB behavioral definitions under anonymous survey conditions resulted in the highest rate of 63%. Data derived using self-definitions and behavioral definitions independently accounted for variability in participants' symptoms of depression, anxiety, and sexual difficulties.     

Military Family Advocacy in the U.S. Army: Program Service Outcomes and Family Participation

Violence in military families remains a vexing problem. Since the advent of the Global War on Terror, there is inconsistent evidence that the prevalence of family violence is increasing, particularly during and after military deployments. However, child neglect appears to increase significantly during military deployments. The military has developed family advocacy programs designed to keep families safe and intervene to reduce the deleterious effects of exposure to family violence. This is one of the first studies to examine the quality with which a family advocacy program is implemented and the degree to which families engage with the program. To conduct this study, the case files of 226 families who came in contact with the Army Family Advocacy Program (FAP) and whose cases were closed in 2013 were reviewed and coded across several implementation and service outcomes. These included involvement of qualified staff, whether or not appropriate victim and offender assessments were completed, degree of inter-agency communication, and appropriateness of referrals, among others. Soldier and family member participation in FAP and other Army-sponsored programs designed to reduce violence was also assessed. Generally speaking, the Army Family Advocacy Program was implemented with high quality, established processes and procedures for handling cases were largely followed, and FAP staff responded rapidly and thoroughly to reported abuse. However, family engagement with Army services and supports was low. Developing robust approaches to engaging families in family programming must be a high priority going forward.     

Efficacy of Treating Sexual Trauma in a Substance Abuse Residential Program for Women

This is a program evaluation of treating sexual trauma in a residential substance abuse treatment program for women. Residents who were seeking treatment for their substance abuse disorder (SUD), also had a history of both childhood and adult sexual trauma. Given the literature supporting concurrent trauma-SUD treatment, the Warrior Renew (WR) protocol (Katz, Warrior Renew: Healing from military sexual trauma, Springer, New York, 2014) was added to the curriculum of Alcoholics Anonymous 12-step groups, relapse prevention, and substance abuse education classes. The WR manual consists of coping skills to address sleep and anxiety, and cognitive/experiential restructuring to address anger/resentments due to injustice, betrayal, and self-blame. It also addresses interpersonal factors such as relationship patterns and healthy interpersonal skills. This evaluation was conducted as part of routine clinical care in a naturalistic setting. Nineteen residents graduated the program and opted to complete pre-and post-treatment assessments. Findings revealed significant decreases in symptoms of anxiety, depression, posttraumatic negative thinking, and PTSD, and significant increases in positive factors of optimism and self-esteem-- all with large effect sizes. In addition, 95% of the sample had a reliable change at the 95% confidence interval. Resident’s feedback to staff reflected strong positive endorsement of the WR program. Results suggest WR is a promising effective treatment for women who have had sexual trauma in a substance abuse residential treatment program.     

You Can't Be Serious!

Abstract

Jim Cotter frames this paper in the form of a one-sided conversation with Michael Vasey about two particular phrases that Vasey was responsible for in the current Anglican liturgy. The first comes from the baptismal rite and talks of the candidate submitting themselves to Christ as Lord. By reference to marriage and other liturgical contexts, Cotter asks whether this is an appropriate image for the twenty-first century, especially in the light of the debate about sexual abuse. The second phrase is taken from the Easter liturgy and talks of light invading the darkness. Once again Cotter challenges the military implications of this language and the negative associations that such a phrase gives to ‘darkness’ Cotter makes a call for far more careful reflection on the use of language in worship and offers a number of alternative suggestions of his own.     

THE CLASSICAL CONFUCIAN POSITION ON THE LEGITIMATE USE OF MILITARY FORCE

Focusing on the thought of Mencius and Xunzi, this essay reconstructs and examines the classical Confucian position on the legitimate use of military force. It begins by sketching historically important political concepts, such as types of political leaders, politics of the kingly way versus politics of the hegemonic way, and the controversial role of lords‐protector. It then moves on to explore Confucian criteria for justifying resort to the use of force, giving special attention to undertaking punitive expeditions to interdict and punish aggression and tyranny. Following this discussion, the essay then attends to important Confucian moral constraints on how military force is properly employed, including prohibitions on attacking the defenseless, indiscriminate slaughter of enemy forces, destruction of civilian infrastructure, prisoner abuse, and non‐consensual annexation of territory. The essay concludes by first discussing an illustrative case from Mencius and then comparing its reconstruction of the Confucian position to those offered by other scholars.     

A Therapeutic Model of Self‐Forgiveness With Intervention Strategies for Counselors

Self‐forgiveness is associated with psychological and relational well‐being and may be a worthwhile treatment goal for clients who have hurt others. The authors utilized theoretical and empirical literature to describe a 4‐component therapeutic model of self‐forgiveness—responsibility, remorse, restoration, and renewal—and offer suggestions for promoting each component with clients. Finally, the authors explore potential contraindications and the applicability of self‐forgiveness for military veterans, clients in substance abuse treatment, and clients convicted of a crime.     

History of military service and the risk of suicidal ideation: findings from the 2008 national survey on drug use and health

Studies of completed suicide by history of military service have produced inconsistent findings; no representative population‐based study has compared the risk of nonfatal suicidal behavior among veterans with risk among nonveterans. The objective of this study was to examine whether male veterans of the U.S. military are at heightened risk of suicidal ideation, compared with males who never served in the U.S. military. A total of 17,641 adult men completed the 2008 National Survey on Drug Use and Health (NSDUH). Subjects provided information about history of ever having served in the U.S. armed forces, past suicidal ideation, alcohol and drug abuse and dependence, measures of psychological distress, and sociodemographic data. Overall, men who had ever served in the armed forces were no more likely than men who had never served to report having seriously considered suicide over the prior 12 months. Military status was not differentially associated with other known suicide risk factors assessed by NSDUH, including psychiatric disorders. Our findings suggest that evidence‐based suicide prevention strategies applicable to the general population should be employed to reduce suicide risk among the veteran population as well.     

Air Force Commanders' Disciplinary Decisions on Spouse Abuse Cases

ABSTRACT

Inconsistencies exist among Air Force commanders when disciplining spouse abuse offenders, possibly owing to inadequate training, unclear role expectations, conflicting policy statements, or personal biases. This situation may lead to inappropriate decisions, further endangering victims and negatively impacting mission readiness. A sample of 624 Air Force squadron commanders was surveyed to measure how their perceived role and operations tempo affect their disciplinary decisions on two abuse scenarios. The study tested role and decision-theory concepts. Statistical results supported role theory in the predicted direction, and decision theory, but in the opposite direction hypothesized. Implications for theory, practice, and policy development for the military are discussed.