Psychological Functioning of Partners of Australian Combat Veterans: Contribution of Veterans' PTSD Symptoms and Partners' Caregiving Distress

Previous research has found posttraumatic stress disorder (PTSD) symptoms in combat veterans to be associated with impaired psychological functioning in their partners. However, little is known about possible mediators of this association. The present study investigated the mediational properties of six dimensions of the revised Partners of Veterans' Distress Scale (MacDonell, Marsh, Hine, & Bhullar, 2010). Participants were 181 female partners of Australian combat veterans, age ranging from 43 and 83 years (M = 60.47, SD = 4.96), who completed measures assessing their caregiving distress levels, dyadic adjustment, mental health, and satisfaction with life. The combat veterans also completed a scale measuring their PTSD symptoms. Our results indicated that higher scores of veterans' PTSD were associated with lower levels of dyadic adjustment, mental health, and satisfaction with life in their partners. Partners reported that distress related to exhaustion and intimacy problems significantly mediated the relationship between veterans' PTSD symptoms and their partners' satisfaction with life, whereas partners' distress associated with intimacy problems was the sole significant mediator for their dyadic adjustment, and exhaustion was the only significant mediator for partners' mental health. Implications for programmes designed to address the significant needs of the partners of combat veterans are discussed.     

Combat Stressors Predicting Perceived Stress Among Previously Deployed Soldiers

While combat exposures are considered principle stressors in developing mental health problems, research suggests social support can reduce this risk. Using data from 1,592 previously deployed soldiers, we found five classes of soldiers based on their patterns of responses to items measuring perceived stress. In subsequent analyses, we found increased combat exposure predicted membership in classes with greater combat-related stress, while greater unit cohesion predicted membership in classes with lower perceived stress. Also, greater willingness to report misconduct predicted greater unit cohesion. Results suggest that unit cohesion plays a vital role in the reduction of perceived stress among soldiers.     

Unit Social Cohesion in the Israeli Military as a Case Study of “Don't Ask,Don't Tell”

U.S. military policy “Don't Ask Don't Tell” (DADT) restricted integration of gays in the U.S. military based on the premise that knowledge of gay peers would decrease interpersonal bonds among unit members. Despite the heated debate over DADT, this social cohesion thesis, reflecting the tensions of homosocial desire, has not been tested empirically. The Israeli military provides an operative case‐study for this thesis, given its nonexclusionary policy and intensive combat experience. Measures of perceived social cohesion and knowledge of gay peers were obtained from a sample of 417 combat and noncombat male soldiers using an inventory of interpersonal emotions towards unit members. A MANOVA of social cohesion by knowledge of gay peers and combat/noncombat unit yielded the hypothesized increase in cohesion in combat versus noncombat units. Yet contrary to the DADT premise, knowledge of gay peers did not yield decreased social cohesion. Comparisons with the U.S. military are presented, suggesting in both cases a loose coupling between stated policies and soldiers' experience on the ground. Implications of these findings for the reassessment of DADT and its repeal are discussed.     

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).     

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.     

Neuropsychological Performance in Gulf War Era Veterans: Traumatic Stress Symptomatology and Exposure to Chemical–Biological Warfare Agents

Because complaints of diminished concentration and memory are among the most common health symptoms reported by Gulf War (GW) veterans with unexplained illnesses, this study investigated neuropsychological functions among GW veterans and controls. Relationships between neuropsychological performance, severity of posttraumatic stress disorder (PTSD) symptomatology, and exposure to chemical–biological warfare agents (CBW) were assessed. Participants were 225 veterans recruited from three cohorts: GW-deployed veterans from Ft. Devens, MA ( n = 141) and New Orleans, LA (n = 37), and Germany-deployed veterans from a Maine National Guard unit (n = 47). A comprehensive evaluation was completed. Severity of subclinical PTSD symptomatology was significantly related to scores on specific neuropsychological tests. PTSD symptom severity in GW-deployed veterans was found to be greater and associated with a broader range of neuropsychological deficits than in Germany-deployed veterans. PTSD severity was associated with lower performance on a range of neuropsychological tasks, whereas CBW exposure contributed to performance deficits on specific cognitive tasks.     

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.     

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.     

Integrating new soldiers: The role of leaders and unit members

The benefits of positively integrating newcomers into organizations are well known in civilian contexts. Less known is the role of integration among US soldiers who frequently relocate and integrate into new units. Perceptions of integration were examined both cross-sectionally and longitudinally as predictors of mental health, anger reactions, unit climate and functional impairment for soldiers who recently joined their unit. In addition to rating their perceptions of integration, soldiers also rated their leader and unit member support for integration. Cross-sectional correlations indicated that positive personal integration was significantly associated with fewer mental health problems, fewer anger reactions, better unit climate, and less functional impairment. Positive leader and unit support for integration was significantly associated with better unit climate. Positive leader support was also associated with fewer mental health symptoms. Only the associations of positive personal integration, with anxiety symptoms and unit climate held over time. Mediation analyses showed that personal integration fully mediated the cross-sectional relationship between leader support for integration and depression symptoms and partially mediated the relationship between leader support for integration and anxiety symptoms and unit climate. Personal integration also partially mediated the relationship between unit member support for integration and unit climate. These findings identify the importance of the individual’s personal perception of integration in predicting reduced mental health symptoms and increased unit climate, both in the short and long term. Leaders and unit members facilitate this process and could therefore benefit from training on how best to integrate new members to the unit.     

Military Service and Stability in the Family Course

This study explores the popular thesis that the Vietnam War had severe disruptive influences on the marriages of veterans. Analysis of life-history data from 2,303 White men who graduated from Washington State high schools in 1966 and 1967 -just before the height of the Vietnam War - shows that the Vietnam combat veterans (n = 627) were more likely to marry than were noncombat veterans who served during the Vietnam era (n = 586) or nonveterans. We found no long-term evidence of a destructive impact of Vietnam combat service on life-course sequencing or veterans' first marriages. When marital duration and other covariates were taken into account, military service reduced the probability of marital dissolution for White men. This study corroborates Card's (1983) findings for veterans who served prior to the intense combat period.     

Positive impact of prior military combat exposure on Terrorism Prevention work: Inoculation to stress

Forty-four Israeli security agents employed by the Israeli Government Terrorism Prevention Agency providing security services for the national Israeli airlines and the Israeli Consulate in Los Angeles were administered the Subjective Stress Experience Scale (SSES). This scale measures stress at terrorism-prevention work, past stress during combat exposure, and subjects’ most stressful life events. Results support the hypothesis that terrorism prevention personnel who are also combat veterans appraise their work as less stressful than their noncombat exposed counterparts. Combat veterans also rated their combat experience as significantly more stressful than prevention team member’s other stressful life events. Subjects presented a uniform stress- inoculation effect but, combat veterans of the prevention team were more stress-inoculated than their noncombat exposed counterparts.     

Relationships of deployment and combat experiences to postdeployment negative health conditions among Army National Guard soldiers

An interest of researchers and practitioners has been postdeployment adjustment of returned soldiers, though the primary focus has been investigating the prevalence of psychiatric conditions. Less attention has been paid to nonclinical conditions, which still have posed significant adjustment problems for soldiers, in particular, for reserve soldiers who revert back to civilian life, family, and employment. The present study examined the occurrence of postdeployment problems among returned Army National Guard soldiers (N = 4,567 in 50 company-sized units). Survey items reliably indicated 7 problem areas. Highest prevalence of problems was being angry (35.9%) and being unable to sleep (43.3%), followed by alcohol abuse (25.1% reported 5 or more drinks in 1 day). Longer deployment lengths were associated with troubled relationships and aggression toward the significant other adult and children in the household. More deployments were associated with aggression toward household children. Self-reported general combat trauma and having killed or wounded someone were associated with all problem areas. Findings are discussed relative to how combat exposure likely alters soldiers’ perceptions and behaviors, including feelings of loneliness and isolation, and risk-taking behaviors of alcohol abuse and aggression toward others.     

Improving Mental Health Treatment Utilization in Military Veterans: Examining the Effects of Perceived Need for Care and Social Support

Many veterans with mental health problems do not adequately utilize needed care. Research has focused on identifying barriers to mental health care in veterans. The current study adds to existing literature by examining whether perceived need for treatment and social support affect treatment utilization in a national longitudinal survey of Iraq and Afghanistan veterans (n = 1,090). The Health Beliefs Model (HBM) postulates that a key reason why patients fail to obtain needed care is their belief “it’s up to me to handle my own problems.” This view was endorsed by 42% in the current national sample of veterans and was found in multivariate analysis to predict less treatment seeking in the next year. Mediation analysis revealed that veterans with higher ratings of social support were less likely to believe they needed to solve mental health problems on their own, indirectly equating to higher odds of treatment use. Simultaneously, findings indicated that posttraumatic stress disorder (PTSD) had a direct effect on more mental health visits but was also associated with higher endorsement that one needed to handle one’s own problems and thus had an indirect effect of reducing mental health visits. Both social support and PTSD affected veterans’ perceptions of needing to solve one’s own problems, significantly predicted follow-up with mental health care. As a result, the findings indicate that clinicians’ should explore veterans’ belief systems about perceived treatment need as well as investigate the role of social support to improve mental health treatment utilization.     

Clarifying Heterogeneity of Daytime and Nighttime Symptoms of Posttraumatic Stress in Combat Veterans With Insomnia

Daytime and nighttime symptoms of posttraumatic stress disorder (PTSD) are common among combat veterans and military service members. However, there is a great deal of heterogeneity in how symptoms are expressed. Clarifying the heterogeneity of daytime and nighttime PTSD symptoms through exploratory clustering may generate hypotheses regarding ways to optimally match evidence-based treatments to PTSD symptom profiles. We used mixture modeling to reveal clusters based on 6 daytime and nighttime symptoms of 154 combat veterans with insomnia and varying levels of PTSD symptoms. Three clusters with increasing symptom severity were identified (n1 = 50, n2 = 70, n3 = 34). These results suggest that, among veterans with insomnia, PTSD symptoms tend to exist on a continuum of severity, rather than as a categorical PTSD diagnosis. Hypotheses regarding possible targeted treatment strategies for veterans within each identified cluster, as well as ways to generalize these methods to other groups within the military, are discussed.     

MMPI configural interpretation as applied to posttraumatic stress disorder in Vietnam veterans

This study investigated the systems of Minnesota Multiphasic Personality Inventory (MMPI) configural interpretation of Skinner and Jackson (1978) and Kunce (1979) with Vietnam veterans with posttraumatic stress disorder (PTSD). MMPI profiles of four groups differing in combat exposure were compared on four MMPI configural variables from Kunce (1979) and Skinner and Jackson (1978). The four groups were (a) PTSD sufferers, (b) Vietnam combat veterans without PTSD, (c) Vietnam noncombat veterans, and (d) Vietnam era veterans. All groups were further divided into hospitalized versus nonhospitalized subgroups. Dependent variables were Skinner and Jackson's (a) sociopathic modal profile, (b) neurotic profile, (c) psychotic profile, and (d) Kunce's emotional expression (enthusiastic-reserved) dimension. Results indicated that hospitalized PTSD subjects had significantly higher scores on Skinner and Jackson's neurotic profile; both hospitalized and nonhospitalized PTSD subjects had higher scores on the psychotic profile and were more "reserved" on Kunce's emotional expression dimension. Results were interpreted in terms of configural MMPI interpretation systems and the adjustment of Vietnam veterans with PTSD. PTSD was viewed as exhibiting cognitive, somatic, and affective features.     

中国军人心理健康状况的横断历史研究：1990~2007

使用1990~2007年18年间的142组数据, 以横断历史研究的元分析方法, 研究了108736位中国军人的心理健康状况随年代的变化趋势。这些数据来自94篇相关研究报告, 这些研究都使用了90项症状自评量表(SCL-90)作为心理健康的测评工具。结果发现：(1)世纪之交的18年间, 中国军人的心理健康越来越好; (2)18年间, 中国军人在“人际敏感”方面变化最大, 而在“躯体化”方面变化最小; (3)18年间, 中国军人在“恐怖”方面最没问题, 而在“强迫症状”和“人际敏感”方面所表现出的问题一直突出; (4)中国独生子女军人(N = 1944)的心理健康状况低于非独生子女军人(N = 2649); (5)中国城市籍军人(N = 7808)的心理健康状况低于农村籍军人(N = 11459); (6)中国高中学历军人(N = 10189)的心理健康状况低于初中(N = 8407)和大学学历(N = 863)的军人。     

Prior Health Care Utilization Patterns and Suicide Among U.S. Army Soldiers

Suicides among U.S. Army soldiers are increasing and, in January 2009, outpaced deaths due to combat. For this study, 1,873 army suicides identified through death, inpatient, and emergency room records were matched with 5,619 controls. In multivariate models, older, male, White, single, and enlisted soldiers with a prior injury (OR = 2.04, 95% CI = 1.64‐2.54), alcohol (OR = 3.41, 95% CI = 2.32‐4.99), or mental health hospitalization (OR = 6.62, 95% CI = 4.77‐9.20) were at increased risk for suicide. Risk was greatest immediately following diagnoses, but remained elevated even after 5 or more years of follow‐up. Most injury hospitalizations were unintentional but, nonetheless, significantly associated with suicide. Interactions indicate soldiers with both mental health and injury history are particularly vulnerable.     

MMPI Configural Interpretation as Applied to Posttraumatic Stress Disorder in Vietnam Veterans

This study investigated the systems of Minnesota Multiphasic Personality Inventory (MMPI) configural interpretation of Skinner and Jackson (1978) and Kunce (1979) with Vietnam veterans with posttraumatic stress disorder (PTSD). MMPI profiles of four groups differing in combat exposure were compared on four MMPI configural variables from Kunce (1979) and Skinner and Jackson (1978). The four groups were (a) PTSD sufferers, (b) Vietnam combat veterans without PTSD, (c) Vietnam noncombat veterans, and (d) Vietnam era veterans. All groups were further divided into hospitalized versus nonhospitalized subgroups. Dependent variables were Skinner and Jackson's (a) sociopathic modal profile, (b) neurotic profile, (c) psychotic profile, and (d) Kunce's emotional expression (enthusiastic-reserved) dimension. Results indicated that hospitalized PTSD subjects had significantly higher scores on Skinner and Jackson's neurotic profile; both hospitalized and nonhospitalized PTSD subjects had higher scores on the psychotic profile and were more "reserved" on Kunce's emotional expression dimension. Results were interpreted in terms of configural MMPI interpretation systems and the adjustment of Vietnam veterans with PTSD. PTSD was viewed as exhibiting cognitive, somatic, and affective features.     

Neuropsychological Performance in Gulf War Era Veterans: Neuropsychological Symptom Reporting

Relationships between broad-based health symptoms and neuropsychological performance have been investigated previously in Gulf War (GW) veterans. However, very little has been done to assess relationships between severity of neuropsychological symptom complaints and performance on objective neuropsychological tests. In this study, relationships between level of self-reported neuropsychological symptom severity and objective neuropsychological performance measures were investigated. Participants included 240 veterans from three GW-era cohorts: GW-deployed veterans recruited from Ft. Devens, MA, (n = 142) and from New Orleans, LA (n = 51), and veterans deployed to Germany from a Maine National Guard unit (n = 47). Findings suggest that level of subjective neuropsychological complaints was associated primarily with mood symptoms in GW-era veterans. Among GW-deployed troops, high neuropsychological symptom reporters endorsed more tension, fatigue, and confusion and less vigor than those reporting fewer cognitive complaints. Current findings emphasize the importance of independent assessment of subjective symptoms and objective neuropsychological performance.