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.     

Psychological Model of Military Aggressive Behavior: Findings From Population-Based Surveys

The U.S. military has expressed concern about the influence of deployment and combat exposure on the criminal behavior of personnel returning from Iraq and Afghanistan. This study examines the role of behavioral health risk and protective factors associated with combat exposure and criminal and aggressive behavior in active duty Army and Naval personnel. Data from this cross-sectional study are based on two large anonymous, population-based health-related behavior surveys. Findings show that the proportion of all active duty Army and Naval service personnel who reported encounters with law enforcement or committed one or more aggressive acts in the past year increased from 19.41% in 2005 to 22.58% in 2008. Substance use, especially illicit drug use, and mental health problems were significant correlates of criminal and aggressive behavior, as were younger age, male sex, high impulsivity, and work/family stress. Path modeling suggested that several variables, notably combat exposure and history of childhood abuse, appeared to manifest their influence on criminal or aggressive behavior through increases in substance use and mental health problems. The potential mediating influence of substance use and mental health on combat and other trauma experiences has significant implications for preventing criminal and aggressive behavior among U.S. active duty military personnel.     

Intensive Outpatient Program Using Prolonged Exposure for Combat-Related PTSD: A Case Study

Although prolonged exposure (PE) has been identified as a first-line treatment for posttraumatic stress disorder (PTSD), research has found that military service members and veterans have smaller reductions in symptom severity compared to civilians. The nature of trauma in a deployed combat setting and the unique complexities of military culture have been proposed as explanations for greater rates of PTSD and poorer treatment response to first-line psychotherapies in military and veteran populations. This paper presents a case study to highlight how a novel, intensive outpatient program utilizing prolonged exposure therapy (IOP-PE) may benefit military personnel with combat-related PTSD. The patient is a Caucasian man in his early 40s seeking treatment for PTSD after more than 10 years of enlisted, active duty military service across two branches and three combat deployments. The IOP-PE includes the standard PE components and eight, nonstandard treatment augmentations tailored for military personnel. In contrast to standard PE, which typically is delivered weekly over several months, IOP-PE consists of 15 daily, 90-minute PE sessions conducted over 3 weeks. The patient demonstrated large reductions on the Clinician-Administered PTSD Scale (28 points) and PTSD Checklist (48 points) by the 6-month posttreatment follow-up point. Findings provide support for conducting further research that determines whether IOP-PE is effective and tolerable in military and veteran populations.     

The relationship between self-efficacy,readiness to change,and AUDIT risk levels in a sample of active duty emergency department patients

The purpose of this study was to test the relationship between self-efficacy, readiness to change, and Alcohol Use Disorders Identification Test (AUDIT) risk levels in a sample of active duty drinkers who were seeking care in a military emergency department. Civilian health educators screened participants for alcohol use with the AUDIT and collected sociodemographic, service, and drinking-related cognitions data from active duty patients admitted to an emergency department. A total of 787 active duty military personnel participated in the study. Almost half (48%) drank at least once a week and 32% reported consuming five or more alcoholic drinks during a typical drinking episode. One in five participants reported heavy episodic drinking weekly to almost daily. Results of a multinomial logistic regression model showed that active duty service members with a self-reported diagnosis of posttraumatic stress disorder since joining the military were more likely to be an at-risk or high/severe risk drinker relative to a low risk drinker. Higher controlled drinking self-efficacy was associated with a decrease in the odds of being either an at-risk or high/severe risk drinker. Increased readiness to reduce drinking was associated with an increase in the odds of being either an at risk or high/severe risk drinker. The results of this research suggest self-efficacy to control one’s heavy drinking as well as readiness to change may be important factors to consider when designing alcohol education programs within the military.     

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.     

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.     

The right to refuse treatment in Oregon: A two-year statewide experience

The right to refuse treatment seems well established for psychiatric patients. Individual states, however, have very different procedures for managing this right and for overriding the refusal. Oregon's administrative procedure for override depends on an evaluation by an independent examining psychiatrist. This article empirically examines the 432 refusals leading to override requests in three Oregon psychiatric institutions in 1983 and 1984. Treatment refusal was found to be a common occurrence in all age groups. Those who refused treatment were seriously ill, unemployed, single individuals with previous psychiatric hospitalizations. Most refused treatment because of denial of their illness or delusional thinking about medication. Most refusals were overridden following the independent psychiatrist's examination. Because of the significant cost of the override procedure to the patient and the mental health system, the authors propose a new procedure which combines parts of the current procedure with a requirement that, at the time of the civil commitment hearing, the judge makes a separate decision as to the patient's competency to make treatment decisions.     

The biopsychosocial-spiritual health of active duty women

ABSTRACT

Women have been an active part of the military since the beginning of American history, holding various roles in the military for centuries. The purpose of this review is to explore the literature pertaining to the biopsychosocial and spiritual health of active duty women. These comparisons help to highlight factors that are most unique to women who are serving in our active duty armed forces. The current review revealed that while active duty women and men report similar levels of resiliency, and women may be no more susceptible to the negative effects of combat than men, there is evidence that active duty women experience higher levels of posttraumatic stress due to physical and sexual trauma in the military aside from combat exposure. Findings suggest that further research is needed to better understand the unique challenges of women in the military in order to create service delivery models that support the BPSS health of women in order to maintain mission readiness and retain women in the military.     

Development and Validation of the Navy Climate Index

Because military work environments have unique contexts, characteristics, and challenges, military policymakers need to understand how personnel perceive the work environment and how this affects individual and organizational outcomes. This study describes the development and testing of the Navy Climate Index (NCI), a new measure comprising items from the Navy-wide Personnel Survey (NPS) that captures eight aspects of psychological climate: advancement/promotion, autonomy/challenge, leadership, communication, fairness, job security, Tempo, and work group. Using NPS data for 3,610 active duty personnel, confirmatory factor analyses support the validity of the NCI. NCI scores were positively associated with job satisfaction, morale, organizational commitment, and retention intentions.     

Psychiatric malpractice in the military

Available data indicates that the incidence of malpractice in military psychiatry, involving both civilian and active duty beneficiaries, is the lowest of all specialties and may be lower than in the civilian sector. Recovery for malpractice damages by means of claim versus suit is restricted to civilian patients; active duty service members recover through a special disability system. The federal government provides military psychiatrists with considerable protection from personal financial loss when involved in malpractice, but there may be limits to that protection. There have been recent efforts to criminally prosecute military physicians in some instances. A registry review of military psychiatry malpractice cases from 1978 to 1987provides a profile of the malpractice situation and suggests areas of practice that need vigilance. The Department of Defense has established a broad-based, comprehensive program of quality assurance and risk management in the interest of maximizing the benefit of medical care and minimizing substandard practice.     

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.     

Affective and effective: Military job performance as a function of work‐related emotional intelligence

The military is a highly stressful career that requires one to work closely with others. These features of the military render it plausible that skills related to emotional perception and management—or emotional intelligence—would tend to benefit performance within this setting. Hypotheses of this type were examined in a panel study that presented 152 active duty military personnel with a new scenario‐based measure that specifically focused on emotional occurrences within the workplace. As hypothesized, work‐related emotional intelligence (W‐EI) positively predicted task performance, discipline, organizational citizenship, and employees with higher W‐EI levels received a greater number of performance commendations. Additionally, these relationships tended to remain significant in discriminant multiple regressions. Altogether, the results provide important evidence for the benefits of W‐EI within an occupational context that requires a high degree of coordination as well as stress management.     

Gender and Military Contextual Risk Factors for Intimate Partner Aggression

This study explored individual and military risk factors for intimate partner aggression (IPA) perpetration among Navy personnel in their second year of service. We found some evidence that job stress was related to higher perpetration among men. Contrary to expectations, ship duty was related to lower perpetration rates, even though it involves more military operational stress and more frequent deployments than does shore duty. Premilitary alcohol problems were a stronger risk factor for men than for women, whereas premilitary patterns of aggressive behavior were a stronger risk factor for women. Recommendations for future research and public health interventions are discussed.     

Posttraumatic Stress,Depression, and Insomnia Among U.S. Air Force Pararescuemen

Few studies have examined rates of mental health problems among special duty military personnel, who often have frequent deployments and high exposure to operational stressors and trauma. The current study examined the severity and rates of positive screening for posttraumatic stress, depression, and insomnia among 194 U.S. Air Force pararescuemen (PJs) in the active duty (AD) and National Guard/Reserve (NG/R) components. Overall estimated rates were 11.6% for probable posttraumatic stress disorder (PTSD), 1.6% for probable depression, and 16.1% for clinical insomnia. PJs in the NG/R reported significantly more severe posttraumatic stress symptoms (F(1, 162) = 10.031, p = .002, partial η² = .058) and were approximately twice as likely to screen positive for probable PTSD (8.5% vs. 19.1%; χ²[1] = 3.679, p = .055). No differences in the rate or severity of depression or insomnia symptoms were found. Rates of positive screens are comparable to or lower than previously published rates among military personnel.     

Reactions to a survey among those who were and were not sexually assaulted while serving in the military

Surveys are among the most common methods for evaluating military sexual assault experiences among members of the U.S. military; however, little research has examined how receiving surveys about such sexual assaults might affect recipients. In the present sample of 530 active duty and veteran military personnel, just 10% reported unexpected upset, 11% reported regretting participation in the survey, and 22% reported benefitting from that participation overall. A minority of respondents with a history of sexual assault while in the military reported unexpected upset, although the prevalence was three times higher than that of participants without such history (24% vs 8%). There were no statistically significant differences in perceived regret and benefit of participation in the survey between those with and without a history of sexual assault while in the military. Although limited in number, male military sexual assault survivors (n = 8) were significantly more likely than female survivors to report being more upset by the survey than they had anticipated. Implications for future research are discussed.     

The collaborative assessment and management of suicidality (CAMS) versus enhanced care as usual (E-CAU) with suicidal soldiers: Moderator analyses from a randomized controlled trial

Given historically high rates of suicide among military personnel over the past decade the present study analyzed whether key demographic, military, and research-based variables moderated clinical treatment outcomes of 148 suicidal active duty US Army soldiers. This is a secondary analysis of data from a randomized controlled trial comparing the collaborative assessment and management of suicidality (CAMS) to enhanced care as usual (E-CAU; Jobes et al., 2017). Nine potential moderator variables were derived from the suicidology literature, military-specific considerations, and previous CAMS research; these were sex, age, marital status, race, lifetime suicide attempts, combat deployments, time in service, initial distress, and borderline personality disorder diagnosis. The clinical outcomes included six suicide- and mental health-related variables. Six of the eight significant moderator findings in this study showed CAMS outperforming E-CAU in certain subgroups with medium to large effect sizes ranging from 0.48 to 1.50. Collectively, the results suggest that CAMS was associated with the greatest improvement among lower complexity soldier patients, particularly those with lower initial distress and fewer deployments. Those who were married or older generally responded better to CAMS, although the results were not entirely consistent with respect to age. CAMS’s effectiveness for married soldiers and those with lower initial distress was a particularly robust finding that persisted when adjusting more stringently for multiple testing. This study sheds light on several factors associated with the success of CAMS among suicidal soldiers that can assist in matching the treatment to those that may benefit the most.     

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.     

Citizens Coping as Soldiers: A Review of Deployment Stress Symptoms Among Reservists

The present study provides a summary of studies examining the prevalence of posttraumatic stress (PTSD) and related symptoms among reserve personnel deployed during Operations Enduring Freedom and Iraqi Freedom. The few extant studies showed that in-theater and shortly after returning from deployment, reserve and active duty personnel had similar rates of PTSD and related symptoms. Sometime after deployment, reserve personnel reported higher rates of PTSD and related symptoms than active duty personnel. A work stress model is used to develop several possible explanations of findings, having implications for practices to reduce stress symptoms among reservists and for improving research and theory of future studies examining PTSD and related symptoms among reservists.     

Implementation and Dissemination of Military Informed and Evidence-Based Interventions for Community Dwelling Military Families

Community dwelling military families from the National Guard and Reserve contend with deployment-related stressors in relative isolation, living in communities where mental health providers may have little knowledge of military culture. When they are community residents, active duty service members and families tend to live in close proximity to their military installations. This article will focus primarily on the challenges to quality mental health care for reserve component (RC) families. Where studies of RC families are absent, those of active component (AC) families will be highlighted as relevant. Upon completion of a deployment, reintegration for RC families is complicated by high rates of symptomatology, low service utilization, and greater barriers to care relative to AC families. A paucity of providers skilled in evidence-based treatments (EBTs) limits community mental health capacity to serve RC military families. Several emergent programs illustrate the potential for better serving community dwelling military families. Approaches include behavioral health homes, EBTs and treatment components, structured resiliency and parent training, military informed schools, outreach methods, and technology-based coping, and psychoeducation. Methods from implementation science to improve clinical skill acquisition and spread and sustainability of EBTs may advance access to and quality of mental health treatment and are reviewed herein. Recommendations related to research methods, military knowledge and treatment competencies, and transition to a public health model of service delivery are discussed.