Social Support and Postdeployment Coping Self-Efficacy as Predictors of Distress Among Combat Veterans

This study evaluated the indirect effect of received social support on distress severity (i.e., posttraumatic stress and depression symptom severity) among 89 combat veterans. Through integrating the social support deterioration deterrence model and the enabling hypothesis, mediating roles of perceived social support and self-efficacy specific to postdeployment adaptation were investigated. Results showed that (a) received social support and perceived social support were not related, and (b) both received and perceived social support indirectly predicted distress severity (posttraumatic stress and depression symptom severity) through postdeployment coping self-efficacy. Specifically, high received and perceived social support independently predicted high postdeployment coping self-efficacy, and high postdeployment coping self-efficacy predicted lower distress severity levels. Theory enhancement and future research needs are discussed.     

Perceived Ability to Cope With Trauma Among U.S. Combat Veterans

The Perceived Ability to Cope With Trauma (PACT) scale measures perceived forward-focused and trauma-focused coping. This measure may also have significant utility measuring positive adaption to life-threatening trauma, such as combat. Our objective was to examine perceived ability to cope with trauma, as measured by the PACT, and the relationships between this perceived ability and clinically pertinent information (anxiety, depression, posttraumatic stress disorder [PTSD]) among U.S. military veterans. Data were provided from 71 combat veterans, consisting of 47 veterans with PTSD and 24 veterans without PTSD who had subthreshold symptoms of the disorder. All veterans completed standardized clinical interviews as well as a battery of well-validated self-report symptom measures. We found that veterans with PTSD had significantly lower PACT scores than veterans without PTSD; those without PTSD self-reported more ability to engage in forward-focused and trauma-focused coping than those with PTSD. Importantly, we also showed relationships between the PACT scores and indices of psychological difficulties as both Forward Focus and Trauma Focus coping scores negatively correlated with PTSD, depression, anxiety, and alexithymia. Finally, the Forward Focus PACT scale improved prediction of PTSD severity over combat exposure alone. The PACT, especially the Forward Focus scale, appears to be a useful measure of perceived positive coping ability with trauma in combat-exposed veterans who report symptoms of traumatic stress, extending the utility of the measure from normative to clinical populations. The importance of adopting forward-focused coping is discussed.     

The Impact of Benefit Finding and Leadership on Combat-Related PTSD Symptoms

Benefit finding and unit leadership have been identified as buffers against the negative effects of combat exposure on posttraumatic stress disorder (PTSD) symptoms. However, little is known about how these different buffers work together to protect military personnel from the negative effects of combat. We examined benefit finding and leadership as buffers of the combat–PTSD symptoms link in a sample of recently returned combat veterans (N?=?583). Results revealed that when higher levels of noncommissioned officer (NCO) leadership and benefit finding (BF) were reported, fewer PTSD symptoms were endorsed. Additionally, BF buffered the relationship between combat stress and PTSD symptoms, but only under conditions of supportive officer leadership. Implications of these findings for military settings are discussed.     

Anticipatory Anxiety in the Treatment of Combat Veterans with Posttraumatic Stress Disorder

Combat veterans have experienced a transformational process during war zone deployment, including emotional, cognitive, and sensory processing changes. They also return entrenched in military expectations of conduct and behavior. These changes result in anticipatory anxiety that makes it difficult to reintegrate into the civilian world, and are related to symptoms of posttraumatic stress disorder (PTSD). The PTSD Recovery Program at the McGuire Veterans Affairs Medical Center (VAMC) is a manualized treatment that focuses on the personal and daily experiences of combat veterans rather than exposure to traumatic memories. Program evaluation data demonstrated significant reduction in PTSD symptoms and improvements in general self-efficacy and adaptive behaviors. Results support the PTSD Recovery Program as an effective treatment that enhances readjustment to civilian life.     

Impact of emotional approach coping and hope on PTSD and depression symptoms in a trauma exposed sample of Veterans receiving outpatient VA mental health care services

Abstract

The present investigation evaluates the relationship between coping style, dispositional hope, and posttraumatic stress disorder (PTSD) and depression symptom severity in a trauma-exposed Veteran sample. Specifically, we evaluated the adaptive value of emotional avoidant and approach coping strategies and perceptions of hope in a sample of 209 trauma-exposed Veterans receiving outpatient mental health care at a VA facility. Participants completed a life events questionnaire and inventories assessing coping, dispositional hope, and PTSD and depression symptom severity. Hierarchical regression analyses were conducted controlling for relevant demographic variables. Greater levels of emotional avoidance and lower levels of emotional expression were significantly associated with increased PTSD and depression symptom severity. Dispositional hope was positively associated with depression symptoms only and perceptions of hope moderated the association between emotional avoidance coping and depression symptoms. Findings highlight the value of emotional coping strategies and perceptions of hope in posttraumatic adjustment. Specifically, employing coping techniques that encourage emotional expression may promote improved adjustment among trauma-exposed individuals, while reduced perceptions of hope and the use of avoidant coping strategies may place individuals at greater risk for depression following exposure to traumatic events.     

Impact of emotional approach coping and hope on PTSD and depression symptoms in a trauma exposed sample of Veterans receiving outpatient VA mental health care services

The present investigation evaluates the relationship between coping style, dispositional hope, and posttraumatic stress disorder (PTSD) and depression symptom severity in a trauma-exposed Veteran sample. Specifically, we evaluated the adaptive value of emotional avoidant and approach coping strategies and perceptions of hope in a sample of 209 trauma-exposed Veterans receiving outpatient mental health care at a VA facility. Participants completed a life events questionnaire and inventories assessing coping, dispositional hope, and PTSD and depression symptom severity. Hierarchical regression analyses were conducted controlling for relevant demographic variables. Greater levels of emotional avoidance and lower levels of emotional expression were significantly associated with increased PTSD and depression symptom severity. Dispositional hope was positively associated with depression symptoms only and perceptions of hope moderated the association between emotional avoidance coping and depression symptoms. Findings highlight the value of emotional coping strategies and perceptions of hope in posttraumatic adjustment. Specifically, employing coping techniques that encourage emotional expression may promote improved adjustment among trauma-exposed individuals, while reduced perceptions of hope and the use of avoidant coping strategies may place individuals at greater risk for depression following exposure to traumatic events.     

Suicide and War: The Mediating Effects of Negative Mood, Posttraumatic Stress Disorder Symptoms, and Social Support among Army National Guard Soldiers

The mediating effects of posttraumatic stress disorder (PTSD) symptoms, negative mood, and social support on the relationship of war experiences to suicidality were examined. The research literature suggested a sequence among study scales representing these constructs, which was then tested on survey data obtained from a sample of National Guard soldiers (N = 4,546). Results from structural equation modeling suggested that war experiences may precipitate a sequence of psychological consequences leading to suicidality. However, suicidality may be an enduring behavioral health condition. War experiences showed no direct effects on postdeployment suicidality, rather its effect was indirect through PTSD symptoms and negative mood. War experiences were, however, predictive of PTSD symptoms, as would be expected. PSTD symptoms showed no direct effect on postdeployment suicidality, but showed indirect effects through negative mood. Results also suggested that suicidality is relatively persistent, at least during deployment and postdeployment. The percentage of those at risk for suicide was low both during and after deployment, with little association between suicidality and time since returning from deployment. Additionally, few soldiers were initially nonsuicidal and then reported such symptoms at postdeployment. Implications of relationships of both negative mood and combat trauma to suicidality are discussed, as well as possible mediating effects of both personal dispositions and social support on relationships of war experiences to PTSD, negative mood, and suicidality.     

Long-term improvement in coping skills following multimodal treatment in war veterans with chronic PTSD

Due to the long-lasting and resistant symptoms characteristic of chronic combat posttraumatic stress disorder (PTSD), its treatment is complex and often requires a tailored therapeutic approach incorporating both psychotherapy and pharmacotherapy. A multimodal approach of psychoeducative, sociotherapeutic, and dynamically oriented trauma-focused groups is described. We assessed the short- and long-term effectiveness of this therapeutic program by monitoring its impact on PTSD symptoms, depression, neurotic symptoms, coping skills, and quality of life for three years. The findings revealed short-term reduction in the symptoms of PTSD and depression, while the long-term results were manifested as the increased use of all coping mechanisms and a greater level of obsession.     

Less Engagement in Pleasurable Activities Is Associated With Poorer Quality of Life for Veterans With Comorbid Postdeployment Conditions

The presence of multiple comorbid conditions is common after combat deployment and complicates treatment. A potential treatment approach is to target shared mechanisms across conditions that maintain poorer health-related quality of life (HRQOL). One such mechanism may be decrements in pleasurable activities. Impairment in pleasurable activities frequently occurs after deployment and may be associated with poorer HRQOL. In this brief report, we surveyed 126 veterans who had previously sought an assessment at a Veterans Affairs postdeployment health clinic and assessed pleasurable activities, HRQOL, and postdeployment health symptoms. Forty-three percent of veterans met our criteria for all 3 postdeployment conditions (posttraumatic stress disorder, depression, and chronic widespread physical symptoms). Greater engagement in pleasurable activities was associated with better HRQOL for all veterans regardless of type or level of postdeployment health symptoms. Future research should study if interventions that encourage veterans with postdeployment health conditions to engage in pleasurable activities are effective rehabilitation strategies.     

Childhood Sexual Assault,Quality of Life,and Psychiatric Comorbidity in Veterans With Military and Civilian Sexual Trauma

Veterans with military sexual trauma (MST) are at risk for a variety of psychiatric conditions, including posttraumatic stress disorder (PTSD) and depression. Survivors of MST are also likely to experience diminished quality of life (QoL). Individuals with higher lifetime incidence of sexual trauma may also be at increased risk for poorer outcomes in QoL and psychiatric symptomatology. The differences in psychological sequelae among those who have experienced sexual trauma as children, and those whose sexual trauma exposure is limited to adulthood are relatively understudied. The majority of sexual trauma literature has focused primarily on civilian trauma, and comparatively few studies have specifically examined psychosocial sequelae (e.g., QoL) in veterans with MST. This study examined how childhood sexual abuse (CSA) affects overall QoL as well as severity of PTSD and depressive symptoms. Veterans who reported CSA had significantly greater depression symptom severity than veterans who did not. No significant differences in PTSD symptom severity or QoL were found between veterans who did and did not report CSA. Results highlight the need for further examination of the relationship between CSA and depression in veterans with MST-related PTSD who also report CSA.     

Religious coping,general coping strategies,perceived social support,PTSD symptoms,resilience, and posttraumatic growth among survivors of the 2010 earthquake in Haiti

This study examines the relationships between coping strategies, perceived social support, resilience, PTSD symptoms, and posttraumatic growth (PTG) in a sample of 256 survivors of the 2010 Haiti earthquake. The results of the bivariate analysis suggested a significant positive correlation between PTG and resilience, PTSD symptoms, perceived social support, positive religious coping, and active coping. There was a significant positive relationship between perceived social support and resilience and between resilience and active coping. PTSD symptoms were positively correlated with both positive and negative religious coping. Results of the multiple regression analysis indicated that positive religious coping, active coping, perceived social support, resilience, and PTSD symptoms accounted for 34% of the variance in the participants’ PTG. The strongest predictor of PTG was positive religious coping, followed by active coping, perceived social support, resilience, PTSD symptoms, and negative religious coping. Implications and recommendations for future research were discussed.     

Coping with Gulf War combat stress: mediating and moderating effects

The authors examined relationships between method of coping with combat-related stress and psychological symptoms among Gulf War Army personnel (N = 1,058). Participants were surveyed on return from the Gulf region (Time 1) with the Coping Responses Inventory (R. Moos, 1990) and a measure of combat exposure. Outcomes were symptom measures of posttraumatic stress disorder (PTSD) and depression. At Time 2 (18-24 months) participants completed the same symptom measures and an index of postwar stress. Higher proportions of approach-based coping in the war zone were related to lower levels of psychological symptoms. Combat exposure moderated the effects of coping on Time 1 PTSD. Coping predicted changes in symptoms of depression but not PTSD. Combat exposure affected changes in depression through postwar stress but had a direct negative effect on PTSD.     

Functional Impairment as a Variable in Adjustment Post-Combat

This study examined how functional impairment relates to postcombat adjustment over time, controlling for the influence of combat exposure. Analyses used sequential random coefficient models to examine 2 hypotheses: a) combat exposure and functional impairment predict the change in posttraumatic stress, depression, and anger/aggression symptoms during the first year postcombat; and b) combat exposure and functional impairment at reintegration predict symptom scores at 1 year postdeployment. A Brigade Combat Team completed surveys at reintegration, 4 months, and 12 months after a 1-year deployment to Iraq. Soldiers reporting high functional impairment at reintegration had higher symptoms at both follow-up periods, and functional impairment was a significant predictor of symptoms at the last time point, even after accounting for the influence of combat exposure. There was also an interaction effect, such that functional impairment exacerbated the impact of combat exposure on posttraumatic stress and anger/aggression symptoms at 12 months postdeployment.     

Prayer Coping,Disclosure of Trauma,and Mental Health Symptoms Among Recently Deployed United States Veterans of the Iraq and Afghanistan Conflicts

U.S. military veterans of the Iraq and Afghanistan conflicts are at risk for developing adverse mental health symptoms. This study was conducted to examine the associations between prayer coping, attitudes toward trauma disclosure, and mental health symptoms (posttraumatic stress disorder [PTSD] and depression) among 110 U.S. veterans who had returned from deployments in Operation Enduring Freedom and Operation Iraqi Freedom within the previous 6 months. Bivariate analyses revealed that prayer coping was positively correlated with an urge to talk about potentially traumatic experiences. When controlling for combat exposure, social support, and disclosure attitudes, multivariate regression analyses indicated that two of the prayer functions—praying for assistance and for calm and focus—were each uniquely linked with less PTSD and depressive symptomatology. In addition, a reliance on avoidant prayer was uniquely correlated with greater depressive symptomatology. These findings support emerging ideas about prayer as a form of trauma disclosure and highlight the relevance of this approach to coping for veterans as they readjust to civilian life.     

Modeling the Indirect Association of Combat Exposure With Anger and Aggression During Combat Deployment: The Moderating Role of Perceived Unit Morale

Anger and aggression are common combat-related behavioral health problems. The impact of combat on anger and aggression appears to be largely attributable to symptoms of posttraumatic stress disorder (PTSD). Factors that moderate the purported pathway from combat to anger and aggression are poorly understood. We examined the conditional direct and indirect associations of combat exposure with self-reported anger and aggression using survey data collected from 592 U.S. Soldiers during a combat deployment in Afghanistan. Unit morale was examined as a moderator between combat exposure and PSTD symptoms, as well as the indirect association of combat exposure with anger and aggression via PTSD symptoms, controlling for depression symptoms. Results indicated that unit morale was negatively correlated with PTSD symptoms and self-reported anger and aggressive behaviors. Perceptions of unit morale moderated the direct association of combat exposure with PTSD symptoms. Unit morale also moderated the indirect association of combat exposure with anger and aggression through PTSD symptoms. Unit morale moderated the association of combat exposure with anger and aggression during combat operations by putatively mitigating the deleterious effect of combat on stress-related symptoms. The impact of policy and leadership on soldier and unit morale should be carefully considered given its protective role during combat operations.     

The Relationship Between Postdeployment Factors and PTSD Severity in Recent Combat Veterans

Combat traumas precipitate posttraumatic stress disorder (PTSD); however, nontraumatic deployment and postdeployment factors may also contribute to PTSD severity. The Deployment Risk and Resilience Inventory (DRRI) was used to investigate pre-, peri-, and postdeployment factors associated with current PTSD severity in 150 recent combat veterans with PTSD and hazardous alcohol use. Hierarchal linear regression analyzed what factors independently predicted PTSD severity when controlling for sociodemographic characteristics and combat specific variables. Four postdeployment factors independently predicted PTSD severity: unemployment, alcohol use, social support, and stressful (nontraumatic) life events. The centrality of trauma in the maintenance of PTSD and clinical implications for treatment providers are discussed.     

Complicating Factors Associated with Mild Traumatic Brain Injury: Impact on Pain and Posttraumatic Stress Disorder Treatment

The nature of combat in Iraq and Afghanistan has resulted in high rates of comorbidity among chronic pain, posttraumatic stress disorder (PTSD), and mild traumatic brain injury (mTBI) in Veterans of Operations Enduring Freedom and Iraqi Freedom (OEF/OIF). Although separate evidence-based psychological treatments have been developed for chronic pain and PTSD, far less is known about how to approach treatment when these conditions co-occur, and especially when they co-occur with mTBI. To provide the best care possible for OEF/OIF Veterans, clinicians need to have a clearer understanding of how to identify these conditions, ways in which these conditions may interact with one another, and ways in which existing evidence-based treatments can be modified to meet the needs of individuals with mTBI. The purpose of the present paper is to review the comorbidity of pain, PTSD, and mTBI in OEF/OIF Veterans, and provide recommendations to clinicians who provide care to Veterans with these conditions. First, we will begin with an overview of the presentation, symptomatology, and treatment of chronic pain and PTSD. The challenges associated with mTBI in OEF/OIF Veterans will be reported and data will be presented on the comorbidity among all three of these conditions in OEF/OIF Veterans. Second, we will present recommendations for providing psychological treatment for chronic pain and PTSD when comorbid with mTBI. Finally, the paper concludes with a discussion of the need for a multidisciplinary treatment approach, as well as a call for continued research to further refine existing treatments for these conditions.     

The cycle of violence as a function of PTSD and appetitive aggression: A longitudinal study with Burundian soldiers

During deployment, soldiers face situations in which they are not only exposed to violence but also have to perpetrate it themselves. This study investigates the role of soldiers' levels of posttraumatic stress disorder (PTSD) symptoms and appetitive aggression, that is, a lust for violence, for their engaging in violence during deployment. Furthermore, factors during deployment influencing the level of PTSD symptoms and appetitive aggression after deployment were examined for a better comprehension of the maintenance of violence. Semi-structured interviews were conducted with 468 Burundian soldiers before and after a 1-year deployment to Somalia. To predict violent acts during deployment (perideployment) as well as appetitive aggression and PTSD symptom severity after deployment (postdeployment), structural equation modeling was utilized. Results showed that the number of violent acts perideployment was predicted by the level of appetitive aggression and by the severity of PTSD hyperarousal symptoms predeployment. In addition to its association with the predeployment level, appetitive aggression postdeployment was predicted by violent acts and trauma exposure perideployment as well as positively associated with unit support. PTSD symptom severity postdeployment was predicted by the severity of PTSD avoidance symptoms predeployment and trauma exposure perideployment, and negatively associated with unit support. This prospective study reveals the importance of appetitive aggression and PTSD hyperarousal symptoms for the engagement in violent acts during deployment, while simultaneously demonstrating how these phenomena may develop in mutually reinforcing cycles in a war setting.     

Moderating Effect of Marital Status on the Association Between Combat Exposure and Post-Deployment Mental Health in Canadian Military Personnel

For military personnel, there are positive and negative aspects of marriage, which may contribute to mental health during times of high stress. The present study investigated the relationship of marital status with three mental health outcomes (general mental health, posttraumatic stress disorder [PTSD], depression) among 14,624 Canadian military personnel recently deployed in support of the mission in Afghanistan. Greater combat exposure was associated with poorer postdeployment mental health, but marital status was, on its own, only slightly associated with PTSD. Marital status significantly moderated the relationship between combat exposure and mental health: For both single and married participants, mental health declined as combat exposure increased, but this association was stronger for married members. This association could be due to the additional familial demands that married personnel may face upon their return from deployment or to the stresses associated with poor marital satisfaction. Overall, results suggest that the relationship between marital status and mental health after deployment is complex and may vary according to other factors.     

Combat Exposure and Posttraumatic Stress Disorder Among Portuguese Special Operation Forces Deployed in Afghanistan

Several combat- and noncombat-related stressors have been reported in Afghanistan. There is now accumulating evidence that suggests that posttraumatic stress disorder (PTSD) is linked to combat experiences; however, little is known about how these exposures might affect elite combat troops. This research aims to evaluate the prevalence of combat and noncombat related stressors, as well as PTSD in Portuguese Special Forces deployed in Afghanistan. Overall, participants reported high levels of exposure to combat and adverse physical conditions but also high levels of within-unit comradeship. The analysis also exposed that 2.7% of the participants reported symptoms compatible with PTSD and 8.8% with compatible partial PTSD. When the authors conducted a binary logistic regression, only the higher levels of combat exposure explained the symptoms of PTSD.