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.     

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。     

The Future of Education and Training in Academic Health Centers

National reports have recommended additions to the core competencies that should be required of all health disciplines, including psychology. The recommendations will affect the education and training of health professionals at academic health centers (AHCs). There will be more focus on training for competence in patient-centered care, evidence-based care, interdisciplinary teamwork, informatics, and continuous quality improvement. Other trends that will affect training of psychologists and other health disciplines in AHC settings include emphasis on better ways to assess the quality of clinical skills, support for improvement of teaching and training, and an increase in educators' status.     

Occupational Therapy Shared Decision Making in Adolescent Mental Health

Shared decision making (SDM) shares values of client-centered practice; however, a few studies exist that explore experiences of occupational therapists (OTs) working in adolescent mental health. This study aims to better understand SDM in adolescent mental health using the Canadian Model of Client-Centered Enablement. A qualitative study included interviews (n = 6) and analysis using an inductive approach. The role of the OT, client factors, therapeutic relationship, and nature of the decision were identified as influencing the process and outcome of SDM. The study helps better understand SDM in practice, the need for specialized education for OTs and has identified future research areas.     

Socioeconomic Status,Emotional/Behavioral Difficulties,and Social Competence among Preschool Children in Japan

Socioeconomic status (SES) is an important contextual factor influencing children’s development. However, there have been limited attempts to examine either the impact of relative poverty on child development or the relationships between specific SES indicators and mental health domains. This study elucidates these relationships in Japanese preschool children who experience high levels of relative poverty. Participants were 3218 Japanese children aged 5–6 years. Their mothers completed self-report questionnaires on SES indicators and the Strengths and Difficulties Questionnaire to measure emotional/behavioral problems. Children’s teachers evaluated children’s social competence using the Social Skills Questionnaire for Preschoolers. Each SES indicator had an inverse relationship with all emotional/behavioral problem domains in the univariate analysis. In the multivariate analysis, lower family income consistently predicted higher scores on all emotional/behavioral problem domains, whereas lower maternal and paternal education levels independently predicted higher scores in specific domains. Each SES indicator had positive relationships with all social competence dimensions in the univariate analysis. Higher family income consistently predicted higher social competence in the multivariate analysis. However, paternal education level only predicted self-control, and maternal education did not predict social competence. Family income and parental education levels were significant independent predictors of emotional/behavioral problems and social competence. Thus, this study suggests that SES does affect child outcomes in a country where there is a high level of relative poverty and underscores the importance of assessing income and education status separately in order to identify their potentially unique associations with development among preschool children.     

Factors that Influence Chaplains’ Suicide Intervention Behavior in the Army

We surveyed 868 Army chaplains and 410 chaplain assistants (CAs) about their role in identifying, caring for, and referring soldiers at risk of suicide to behavioral health care. We applied structural equation modeling to identify how behaviors and attitudes related to intervention behavior. In both samples, reluctance and stigma were related to intervention behaviors; efficacy was correlated with intervention behaviors only among chaplains. Training was associated with increased efficacy and lower levels of stigma among chaplains. Improved training may be warranted, but research needs to identify why chaplains and CAs are reluctant to refer soldiers in distress to behavioral health care.     

Soldiers at risk for individual readiness or morale problems during a six-month peacekeeping deployment to the Sinai

Longitudinal data were examined to predict soldiers' morale, satisfaction with Army life, and the effects of family issues on performance of duties during an overseas deployment (Sinai peacekeeping force during the spring of 1995). Few variables were significant predictors of the outcome measures; however, rank, leaders' support for families, prior satisfaction with Army life and with information released about the deployment appeared to predict better outcomes during the deployment. Rank and leaders' support for families appeared to be more important for married soldiers while satisfaction with predeployment information seemed to be more important for single soldiers. Those who were worried about the effects of the deployment on their families also tended to report interference with their duty performance because of family concerns, but that effect was offset by perceived leaders' concern for families. In conclusion, it appears to the authors that the pre-existing factors studied had much less to do with deployment outcomes than did leadership success before and during the deployment. That's good news for Army leaders about their power to have a positive effect on soldiers' morale during overseas deployments but may be bad news for anyone hoping to find a "magic bullet" for pre-identification of soldiers most likely to retain high morale, regardless of their leadership's competence during an overseas deployment.     

The Role of the Military Psychologist in the Development of National Manpower Policy

Recently, the news media have been critical of military recruitment advertising for its purported emphasis on money for education, civilian job/career development, and personal growth and for its deemphasis of the potential for mobilization and deployment. To examine the implications of these asser- tions, we studied new Army Reserve entrants both before and after Operation Desert Storm (ODs). Specifically, our purposes were (a) to summarize enlistment motivations of new recruits; (b) to identify subpopulations that joined the Army Reserve for specific motivations and variations of those motivations; and (c) to examine the relationships between enlistment motiva- tions, expectations for mobilization, and willingness to report for mobiliza- tion. The study employed two samples of nonprior service, junior-ranking enlistees who had served 1 year or less in the unit. One sample was drawn in 1990 before ODs (n = 1,059) and the other was drawn in 1991 following ODs (n = 757). Both samples were part of a larger probability sample of reservists. Enlistment motivations both before and after ODs were best explained (in order of variance accounted for in factor analyses) by the following factors: Wanting to Experience the Military, Personal Development, Pay/Benefits, and Job/Career Development. Wanting to Experience the Military accounted for more variance after ODs than before, whereas the variance attributable to Personal Development decreased across the two time periods. After ODS, there was a notable absence of college students who joined due to the first three factors. In addition, junior enlistees who joined for Pay/Benefits after ODs were more likely to be married, of a lower educational level, and not attending high school than those who joined before ODs. Both before and after ODs, minorities were more likely than nonminorities to join for each of Requests for reprints should be sent to James Griffith, 24435 Cutsail Drive, Damascus, MD 20872. the enlistment motivations, especially to gain JobKareer Development. Two findings supported the contention that new entrants to the Army Reserve joined and planned to stay through the end of their obligation, mobilization or not. First, career intent (the intention to remain in or leave the Army Reserve) was most strongly related to nearly all enlistment motivations. Second, expectations for mobilization and willingness to report for mobiliza- tion were either significantly and positively or nonsignificantly related to enlistment motivations. Implications of findings for future directions in Army Reserve recruitment incentives are discussed.     

Advancing Psychology as a Bio-behavioral Science

Concerns for the integrity of psychology as an independent discipline have caused some psychologists to object to introducing any knowledge from the biological sciences into the training of psychologists. However, calls for the greater incorporation of the behavioral sciences in medical education, increased attention to research on the mechanisms of bio-behavioral interaction, and initiatives in translational medical research and clinical care, have prompted increased interest in interdisciplinary research, health care, and teaching. These changes, in turn, are resulting in a re-conceptualization of the structure of academic medicine with increasing emphasis upon multidisciplinary knowledge and interdisciplinary collaboration, and less emphasis upon disciplinary insularity and competitiveness. If clinical health psychology is to play a role in this evolving concept of academic health care, it must adequately prepare its trainees to function in interdisciplinary academic health care settings. This will require not only expertise in the role of behavioral factors relevant to medical disorders, but also some basic familiarity with the biological processes to which those behavioral factors relate. With the evolution of its fund of knowledge, clinical health psychology has the potential to utilize its science to discover, describe, interpret, teach and clinically apply knowledge of the mechanisms of interaction between biological functions and behavioral, learning, cognitive, socio-cultural and environmental processes. By failing to seize this initiative, clinical health psychology risks becoming irrelevant to the evolving model of medical research, education and health care. Presented, in part, to the Association of Psychologists in Academic Health Centers, Minneapolis, MN, May 2007.     

国外心理健康服务人员胜任特征

什么样的人具有资格担当心理健康服务人员, 这方面的研究属于心理健康服务人员胜任特征的问题。国外有关心理健康服务人员胜任特征的研究主要涉及: 核心胜任特征与特殊胜任特征、能力与胜任特征评估、胜任特征模型及其开发、心理健康服务不同具体领域的胜任特征研究, 这些研究对于改进心理健康服务人员的教育与培训、录用与管理有着重要指导作用。目前该领域研究的局限在于很少关注如何运用已确认的胜任特征去评价心理健康服务领域的学生以及从业人员。     

Psychology in Medical Settings in Thailand

This article explores the development of psychology as a profession in Thailand, its challenges, and future trends. There are currently very few Thai psychologists who are active in the medical fields in comparison to other health care professions. Being held back by limited education and training, many psychologists see their future career as less than promising. The lack of professional licensing standards and dominance of psychiatry further limit their career advancement. However, tremendous opportunities await those who persevere to expand their roles beyond the traditional assessment, treatment, and research models. A small number of them have ventured out into unexplored territories such as behavioral medicine, AIDS counseling, health promotion, and prevention of mental health problems. There is a strong potential for Thai psychologists to make significant contributions in these areas. It is clear that higher standards of education and more rigorous training are needed if this goal is to be realized in the near future.     

A qualitative analysis of strategies for managing suicide-related events during deployment from the perspective of Army behavioral health providers,chaplains, and leaders

The purpose of this qualitative study was to investigate the use of strategies for managing suicide-related events (SREs; i.e., suicide deaths, suicide attempts, and suicidal ideation with a plan and intent to die) during deployment from the perspective of Army decision makers: behavioral health providers (BHPs), chaplains, and leaders. A total of 76 Army personnel participated in individual interviews or focus groups. Participants identified unit watch, weapon removal, medical evacuations, and debriefings as common strategies used to manage SREs in deployed settings. Many of these strategies were highlighted as short-term solutions only. Participants also underscored the importance of unit cohesion and communication among leaders, BHPs, and chaplains to effectively manage SREs. The need for structured guidelines for successfully managing SREs in deployed settings is discussed.     

Addressing the Mental Health Needs of the Rural Underserved: Findings from a Multiple Case Study of a Behavioral Telehealth Project

Behavioral telehealth is a reasonable solution to the accessibility to mental health care problem that exists in many rural communities. This paper reports the results of a multiple case study of a behavioral telehealth program administered through a marriage and family therapy training program. The results suggest that mental health services can be effectively delivered using existing distance education technology to underserved rural populations. Rural communities have unique barriers to accessing mental health care, some of which can be overcome through the distance delivery of services and some of which cannot. In order to effectively deliver treatment, accommodations to the technology must be made by both therapist and client.     

The Welch Emotional Connection Screen: Adapting observational methods to pediatric primary care via resident training

The Welch Emotional Connection Screen (WECS) is a novel instrument that is a brief, practicable, evidenced-based observational screening tool for assessing relationship health between parent and child. The WECS requires observing 2−3 min of face-to-face interactions between parent and child, without toys, prompts, paradigms or technology. Here, we describe a translational project from the coding lab to the primary care provider via a residency training program conducted with 50 residents during a 30-day developmental and behavioral pediatrics medical resident education rotation. The aims of this study were to evaluate the efficacy of WECS pediatric resident training: 1) to improve residents' accuracy in recognizing the dyadic behaviors of emotional connection (EC) via WECS training; and 2) to improve residents' attitudes, self-efficacy, and perceived professional norms (ASPPN) pertaining to Early Relational Health in Pediatrics. Results indicate that using a rapid prototyping approach to training, residents improved in their identification of dyads showing low to midrange levels of emotional connection. As well, resident attitudes about the importance of relationship health in pediatrics and their self-efficacy in identifying emotional connection improved significantly after this brief resident training.     

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.     

Training Psychologists for a Future in Evolving Health Care Delivery Systems: Building a Better Boulder Model

Recent and dramatic changes in the demand for and reimbursement of psychological services and expertise in health care delivery systems have radical implications for the preparation of psychologists at the predoctoral, internship, and postdoctoral levels. In order to respond to these changes effectively and advance the profession, training programs must realize the expanded and potential role of psychological expertise in evolving health care delivery systems. In this paper, we review several limitations and unfortunate consequences of traditional training programs that have confined the scope of research and practice to the realm of mental health. We propose that future psychologists be recognized and trained from a broader perspective as behavioral scientists, prepared to operate at the highest levels of health care delivery systems. Specific recommendations for training and education are discussed.     

Prior Mental Disorders and Lifetime Suicidal Behaviors Among US Army Soldiers in the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS)

We report on associations of retrospectively reported temporally prior mental disorders and Army career characteristics with subsequent first onset of suicidal behaviors in a large, representative sample of US Army soldiers who participated in the Consolidated All‐Army Survey of the Army Study to Assess Risk and Resilience in Servicemembers (N = 29,982). Results reveal that among men and women, all self‐reported lifetime disorders measured (some assessed with screening scales) are associated with subsequent onset of suicide ideation. Among men, three disorders characterized by agitation and impulsiveness (intermittent explosive disorder, panic disorder, and substance disorders) predict the transition from suicide ideation to attempt. For both men and women, being in the Regular Army (vs. National Guard or Army Reserve) predicts suicide attempts in the total sample. For men, a history of deployment and junior rank are predictors of suicide attempts after adjusting for preenlistment disorders but not accounting for pre‐ and postenlistment disorders, suggesting that postenlistment disorders account for some of the increased suicide risk among these career characteristics. Overall, these results highlight associations between mental disorders and suicidal behaviors, but underscore limitations predicting which people with ideation attempt suicide.     

儿童情绪胜任力的研究进展：概念、功能与干预措施

儿童情绪胜任力是指儿童拥有情绪知识,对自身和他人的情绪进行识别和理解,并调节和表达自身情绪的一种综合能力,它在提高儿童的认知能力、促进其身心健康发展、提高社会交往能力以及减少儿童危险行为等方面都有重要作用。研究者开展了以儿童情绪和行为问题改善、压力应对能力提高及情绪识别和管理能力提升为目标的干预项目。未来可进一步探究学校、老师、同伴及儿童自身的人格特点等对其情绪胜任力发展的影响及作用机制,并可从增加个性化干预及提升干预长期效果等视角进一步完善干预措施。     

Enhancing the Behavioral and Mental Health Services Within School-Based Contexts

ABSTRACT

Recent health care reform provides many new opportunities to expand mental health and behavioral support to students in schools and school–community partnerships. Through newly available funding sources, as well as expanded legislative initiatives, school psychologists can advocate for and become leaders in delivering universal programming, tiered mental health supports, and formalized collaborative efforts with community agencies. The authors highlight the application of tiered levels of services, with current practice samples, designed to address students' mental and behavioral health. Implications for practice are discussed.     

Prevalence of Alcohol Use and Reasons for Drinking Among Occupational Therapists: An Exploratory Investigation

Alcohol use by occupational therapists (OTs) and reasons for consuming alcohol were examined. Five hundred participants, randomly selected from American Occupational Therapy Association membership, were mailed surveys, resulting in 165 completed returns. The majority reported drinking alcohol generally for social-interactive motives, consuming one or two drinks one to four times per month. Two-fifths were found to drink intermittently in a potentially unhealthy manner. The percentage of OTs likely consuming alcohol at harmful levels, though comparatively small, is sufficient to warrant consideration by the profession to address the implications of potential alcohol misuse among a segment of its practitioners.