Assessing PTSD in the military: Validation of a scale distributed to Danish soldiers after deployment since 1998

Since 1998, soldiers deployed to war zones with the Danish Defense (≈31,000) have been invited to fill out a questionnaire on post‐mission reactions. This provides a unique data source for studying the psychological toll of war. Here, we validate a measure of PTSD‐symptoms from the questionnaire. Soldiers from two cohorts deployed to Afghanistan with the International Security Assistance Force (ISAF) in 2009 (ISAF7, N = 334) and 2013 (ISAF15, N = 278) filled out a standard questionnaire (Psychological Reactions following International Missions, PRIM) concerning a range of post‐deployment reactions including symptoms of PTSD (PRIM‐PTSD). They also filled out a validated measure of PTSD‐symptoms in DSM‐IV, the PTSD‐checklist (PCL). We tested reliability of PRIM‐PTSD by estimating Cronbach's alpha, and tested validity by correlating items, clusters, and overall scale with corresponding items in the PCL. Furthermore, we conducted two confirmatory factor analytic models to test the factor structure of PRIM‐PTSD, and tested measurement invariance of the selected model. Finally, we established a screening and a clinical cutoff score by application of ROC analysis. We found high internal consistency of the PRIM‐PTSD (Cronbach's alpha = 0.88; both cohorts), strong item‐item (0.48–0.83), item‐cluster (0.43–0.72), cluster‐cluster (0.71–0.82) and full‐scale (0.86–0.88) correlations between PRIM‐PTSD and PCL. The factor analyses showed adequate fit of a one‐factor model, which was also found to display strong measurement invariance across cohorts. ROC curve analysis established cutoff scores for screening (sensitivity = 1, specificity = 0.93) and clinical use (sensitivity = 0.71, specificity = 0.98). In conclusion, we find that PRIM‐PTSD is a valid measure for assessing PTSD‐symptoms in Danish soldiers following deployment.     

Exploring Psychological wellbeing in a Sample of Australian Actors

Objective

The objective of the current study was to explore what factors might impact the psychological wellbeing of adult, Australian professional actors.

Method

Twenty South Australian actors were recruited using purposive and snowball sampling. Ten were male and 10 female, ranging in age from 22 to 66 years old, with self‐reported professional experience ranging from 1 to 50 years. The participants were interviewed in‐depth about their experiences of being an actor, with a particular focus on wellbeing, and the data were analysed using thematic analysis, with numerous checks in place for methodological rigour.

Results

Two broad categories of themes were established; environmental and personal factors. Environmental factors included power, lifestyle, fringe‐dwelling, engagement, the tribe, and taking care of yourself. Personal factors included pursuit, strengths, the calling, precariousness and looking within.

Conclusions

Themes were considered in terms of contemporary wellbeing theory, along with clinical implications relating to the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM5). Findings included: actors experience a range of threats to wellbeing, such as problems with autonomy, lack of environmental mastery, complex interpersonal relationships and high self‐criticism. Factors facilitating wellbeing include ongoing personal growth and a sense of purpose. The findings also suggest that actors are vulnerable to depression, generalised anxiety symptoms, vicarious trauma, and perfectionism.     

Forgiveness and Health: Age Differences in a U.S. Probability Sample

Forgiveness is a variable closely related to religiousness and spirituality that has been hypothesized to be protective of mental and physical health. However, we do not clearly understand which aspects of forgiveness are most clearly associated with health outcomes, and the conditions under which these relationships occur. This study used national probability data to systematically examine age differences in the association between forgiveness, religiousness/ spirituality, and respondent reports of mental and physical health. Results showed age differences in the levels of forgiveness of others and feeling forgiven by God. In both cases, middle and old age adults showed higher levels of these forms of forgiveness than young adults. Furthermore, the relationship between forgiveness of others and respondent reports of mental and physical health varies by age. Forgiveness of others was more strongly related to self-reported mental and physical health for middle and old age adults than for young adults.     

Examination of the Relationship Between PTSD and Distress Tolerance in a Sample of Male Veterans With Comorbid Substance Use Disorders

Distress tolerance (DT), the perceived or actual ability to tolerate negative emotional or physical states, is inversely related to posttraumatic stress disorder (PTSD) symptoms in civilian, community samples. No studies to date have examined the relationship between DT and PTSD in clinical samples of veterans with a comorbid diagnosis of PTSD and a substance use disorder (SUD). Thus, the present study examined the relationship between DT and PTSD in a sample of predominately African American, male veterans (n = 75) diagnosed with comorbid PTSD and SUD (according to a structured clinical interview). Results of hierarchical linear regression models indicated that DT was inversely related to total PTSD symptom severity score, above and beyond depressive symptoms and SUD severity. Of the 4 symptom clusters, DT was inversely associated with intrusions and hyperarousal. These findings are discussed in light of previous work with civilian samples. Determining whether treatment incorporating DT skills would be useful for veterans undergoing PTSD treatment should be evaluated.     

Replication of the Self-Concept and Identity Measure (SCIM) Among a Treatment-Seeking Sample

Identity distress occurs within a variety of psychiatric conditions. Reliable tools for assessing identity-related functioning among clinical populations are greatly needed. The Self-Concept and Identity Measure (SCIM) is a brief self-report scale designed to assess healthy and disturbed identity dimensions. This measure has been validated within normative but not treatment-seeking samples. The present study used an a priori confirmatory approach to replicate the SCIM’s factor structure among disadvantaged women enrolled in treatment for chemical dependence (N = 216). The original three-factor structure and item loadings generally replicated within this diagnostically diverse, significantly impaired sample. Higher SCIM scores were also associated with other problems, such as emotion dysregulation and depression. Results support the SCIM’s use and scoring with clinical populations.     

Cognitive Functioning in Treatment-Seeking Gulf War Veterans: Pyridostigmine Bromide Use and PTSD

Gulf War (GW) deployed veterans have reported health symptoms since returning from the war that suggest dysfunction of the central nervous system (CNS). These symptoms include memory and concentration difficulties, fatigue, and headaches. Leading hypotheses for the etiology of these cognitive complaints include psychological factors and/or exposures to chemicals with neurotoxic properties. In this study, cognitive functioning was compared in treatment-seeking GW-deployed veterans and a treatment-seeking non–GW-deployed veteran control group. Results indicated that GW-deployed veterans performed significantly worse than the comparison group on tests of attention, visuospatial skills, visual memory, and mood. GW-deployed veterans who reported taking pyridostigmine bromide (PB) performed worse than GW-deployed veterans without PB use on executive system tasks. Treatment-seeking GW-deployed veterans with diagnoses of posttraumatic stress disorder (PTSD) did not differ on cognitive test measures compared with GW-deployed veterans without PTSD. No interaction effect of PTSD and PB use was found.     

Sleep,resilience, and psychological distress in United States military Veterans

Sleep problems are prevalent among Veterans. Left untreated, such problems may elevate psychological distress and increase risk of subsequent mental health disorders. Psychological resilience may buffer against negative psychological outcomes, yet the relationship between sleep and resilience has not been studied. This study explored poor sleep, resilience, and psychological distress using questionnaires collected as part of the Study of Post-Deployment Mental Health. Participants (N = 1,118) had served in the US military since September 11, 2001, had one or more overseas deployments, and were free from a past-month DSM-defined mental health disorder. Hierarchical linear regression was used to examine the association between poor sleep quality (Pittsburgh Sleep Quality Index total score) and psychological distress (Global Symptom Index; Symptom Checklist-90-R), controlling for demographic and health characteristics. Moderation analyses tested for a potential buffering effect of resilience (Connor-Davidson Resilience Scale). Poor sleeping Veterans had worse physical and psychological health, lower resilience, and endorsed more lifetime traumatic events. Poor sleep was associated with greater psychological distress controlling for health and demographic characteristics. Both resilience factors—adaptability and self-efficacy—had significant buffering effects on the relationship between poor sleep and psychological distress, suggesting that resilience may protect against negative outcomes in poor sleepers. Additional research is warranted to better understand the relationships between sleep, resilience, and psychological distress. Such research may inform pertinent prevention efforts, including interventions that improve sleep, enhance resilience, and protect against incident mental health diagnoses.     

Clinical Validation of the Swedish Version of the Quality of Life Inventory in Crime Victims with Posttraumatic Stress Disorder and a Nonclinical Sample

The Swedish version of the Quality of Life Inventory (QOLI) was cross-culturally validated with a crime victim sample (N = 53) with posttraumatic stress disorder (PTSD) and a nonclinical group (N = 100) with no lifetime and current psychiatric disorder from the general population in the Stockholm county of Sweden. The QOLI showed excellent internal consistencies in the clinical and the nonclinical sample. In addition, PTSD participants displayed a significantly lower self-perceived quality of life in 13 out of 16 domains of life than the nonclinical individuals. Furthermore, the QOLI was inversely correlated with interview and self-report measures of PTSD symptoms, depression, and anxiety. Overall, the results support the utility of the Swedish QOLI version as a potentially useful measure of self-perceived quality of life in Swedish clinical and nonclinical samples. The results are discussed in relation to the Swedish cross-cultural validation of the QOLI, methodological limitations and future directions.     

Handling Spirituality/Religion in Professional Training: Experiences of a Sample of Muslim Psychology Students

With increasing research interest in the relationship between spirituality/religion and mental health, the present study uses semi-structured interviews on a select group of Muslim students to explore their understanding and handling of spirituality in a secular training programme. Their understanding of spirituality, its perceived role in therapy and their training experiences are subjected to qualitative analysis using the framework approach (Ritchie & Spencer, 1994. In A. Bryman & R.G. Burgess (Eds), Analysing Qualitative Data. London: Routledge). All five participants perceived spirituality as central to human functioning. Probes into their training experience uncovered issues of bias against religious applicants, apprehension about demonstrating religious commitment, fear of punishment for compromising religious integrity, better rapport with Muslim patients but general uncertainty about handling spiritual issues in therapy, and a strong desire for the integration of spirituality/religion in the program.Cynthia Joan Patel, M.A., is a Lecturer in the School of Psychology at the University of Kwazulu-Natal, Westville Campus, Durban, South Africa. She is a Registered Counselling and Research Psychologist with the Health Professions Council of South Africa). Her research interests include women and religion, attitudes toward abortion, and the meaning of work in women’s lives. Armas E. E. Shikongo, M.A., is a Lecturer in the Department of Psychology at the University of Namibia. His research area is the psychology of spirituality.     

Psychometric Properties of the Parenting Sense of Competence Scale in Treatment-Seeking Post-9/11 Veterans

Although evidence suggests deployment-related stress impacts parenting, few measures of parenting competency have been validated in returning post-9/11 veterans. As part of clinical care in a multidisciplinary clinic serving veterans and military families, 178 treatment-seeking OEF/OIF/OND veterans completed measures including the 16-item Parenting Sense of Competence Scale (PSOC), a widely-used measure of parental efficacy and satisfaction; the Family Assessment Device—general functioning subscale; and the depression, anxiety, and stress scale. Utilizing data from an IRB-approved de-identified data repository, we examined the psychometrics and factor structure of the PSOC. According to a proposed clinical cut-off, 10?% of our clinical sample of veterans exhibited low self-confidence in parenting. A confirmatory factor analysis of the 2-factor structure introducing correlated error terms between items 3 and 9, and between items 10 and 11, revealed to be a satisfactory fit to the data (Χ ² /df?=?1.57, RMSEA?=?0.056 [90?% CI 0.039–0.073]; CFI?=?0.928; TLI?=?0.914; SRMR?=?0.055). In addition, the PSOC exhibited good convergent validity with measures of parental distress (r?=??.22, p?<?0.01 with anxiety symptoms, and r?=??.33, p?<?.001 with depressive symptoms) and family functioning (r?=??.53, p?<?.0001), very good temporal stability (r?=?.81, p?<?.0.0001), and excellent internal consistency (α?=?.85). The PSOC exhibited satisfactory psychometric properties in treatment-seeking veterans and may be used by clinicians and researchers to assess parenting sense of competence, including satisfaction and sense of efficacy, in this population.     

The Estimated Impact of Performing Arts on Adolescent Mood Within a Community Sample of Mental Health Professionals

ABSTRACT

In a brief survey, the authors solicited professional opinions regarding the probable impact of performing arts on adolescent mood stability using a hypothetical scenario where 20 moderately depressed 15-year-olds agreed to participate in a high school play, musical, or other singing performance. The results of the survey indicated that clinicians generally believed performing arts could be helpful for depressed adolescents. The authors discuss the potentials for implementing school and community based performing arts as an adjunctive approach to help adolescent clients cope with emotional problems.     

Intensive Cognitive Processing Therapy Associated With Reduced PTSD Treatment Dropout in a Case-Controlled Study of Treatment-Seeking Veterans

Cognitive Processing Therapy (CPT) is an empirically supported psychotherapy for posttraumatic stress disorder (PTSD). The complex issue of treatment attrition is a frequently cited concern regarding CPT and other evidence-based psychotherapies for PTSD. The current study investigated the feasibility and effectiveness of “intensive” CPT, a treatment-consistent modification of CPT in which sessions are conducted more frequently than standard protocol. Fifty-four military veterans (20% female; M_age = 46; 80% Caucasian) seeking outpatient treatment for PTSD were included in this study. Patients who elected to receive intensive CPT (n = 27) were matched with archival records of individuals who received standard CPT (n = 27). Patients across treatment conditions were matched based on baseline symptom severity as measured by the PTSD Checklist for DSM-5 (PCL-5; M_PCL-5 = 52.61). Treatment outcomes were compared and longitudinal multilevel modeling was used to compare rate of symptom change over time. Patients who elected to engage in intensive CPT were twice as likely to complete treatment (88.9%) as those who received standard CPT (44.4%), X²(1, N = 54) = 12.00, p = .001. On average, intensive CPT patients completed treatment in about 25% of the time as standard CPT patients (33.8 days vs. 125.7 days). Patients in intensive CPT also demonstrated greater benefit: 81.4% reported a clinically significant improvement in PCL-5 scores compared to 51.8% of those in standard CPT, X²(1, N = 54) = 5.33, p = .020, φ = −0.314. Intensive and standard CPT performed comparably in regard to final PCL-5 score, change over time, and screening cutoff. In addition, there were no differences in treatment outcomes based on licensure status of the provider nor whether treatment was delivered in person or virtually. Intensive CPT represents a novel, treatment-consistent adaptation that was utilized to treat a group of veterans with PTSD with minimal treatment dropout. Patients who elected to engage in more frequent treatment were more likely to complete treatment, did so in one quarter of the time, and reported similar to better treatment outcomes. Providers may consider encouraging their patients to participate in treatment as frequently as they are able. However, preliminary findings are based on a nonrandom sample and design limitations temper conclusions.     

Examining Compulsive Sexual Behavior and Psychopathology Among a Sample of Postdeployment U.S. Male and Female Military Veterans

Compulsive sexual behavior (CSB) is defined as difficulties in controlling inappropriate or excessive sexual fantasies, urges, or behaviors that cause subjective distress or impairment in important areas of daily functioning. Using data from a baseline telephone interview, we examined the prevalence of CSB in a convenience sample of 820 postdeployed U.S. military male and female veterans and investigated correlates of CSB with sociodemographics and other mental health and sexual history characteristics. More men (13.8%) than women (4.3%) endorsed CSB-related symptoms. Given the limited sample size of women reporting CSB, correlational analyses were conducted only with men. After adjusting for significant sociodemographics, results indicated that gambling, suicidality, and sexually transmitted infections were significantly associated with male CSB. Current results suggest that CSB may be prevalent among U.S. military veterans post deployment and associated with significant negative health indices in men. CSB warrants attention regarding screening and intervention.     

A Comparison of Homeless Male Veterans in Metropolitan and Micropolitan Areas in Nebraska: A Methodological Caveat

This study explored differences between homeless male veterans in metropolitan and micropolitan cities in Nebraska on sociodemographic, housing, clinical, and psychosocial characteristics as well as health service use. A convenience sample of 151 homeless male veterans (112 metropolitan, 39 micropolitan) were recruited from Veterans Affairs facilities and area shelters in Omaha, Lincoln, Grand Island, and Hastings in Nebraska. Research staff conducted structured interviews with homeless veterans. Results showed that compared to homeless veterans in metropolitans, those in micropolitans were more likely to be White, unmarried, living in transitional settings, and were far more transient but reported greater social support and housing satisfaction. Veterans in micropolitans also reported more medical problems, diagnoses of anxiety and personality disorders, and unexpectedly, were more likely to report using various health services and less travel time for services. Together, these findings suggest access to homeless and health services for veterans in micropolitan areas may be facilitated through Veterans Affairs facilities and community providers that work in close proximity to one another. Many homeless veterans in these areas are transient, making them a difficult population to study and serve. Innovative ways to provide outreach to homeless veterans in micropolitan and more rural areas are needed.     

Optimism and Mental Health in Adolescence: a Prospective Validation Study of the Dutch Life-Orientation Test-Revised (LOT-R-A) for Adolescents

The study aimed to examine the psychometric properties of the Dutch Life Orientation Test-Revised for Adolescents (LOT-R-A), a self-report questionnaire assessing dispositional optimism, and to evaluate the two-factor structure (optimism, pessimism). The LOT-R-A and the questionnaires measuring well-being (MHC-SF-A) and psychological problems (SDQ) were completed by 459 Dutch adolescents (178 boys and 281 girls) between the ages of 11 and 18 years at baseline and 281 adolescents at a four-week follow-up. The results confirmed the two-factor structure (optimism, pessimism) of the LOT-R-A. The findings provided evidence of internal consistency of scores ranging from low to good, and evidence of good test-retest reliability of scores. Further, scores of optimism were cross-sectionally positively associated with scores of positive emotions and well-being and negatively with scores of psychological problems and negative emotions, providing evidence of convergent and divergent validity of optimism scores with emotions, well-being, and psychological problems. Lastly, scores of optimism were prospectively positively associated with scores of well-being and negatively with scores of psychological problems, providing evidence of criterion validity of optimism scores with well-being and psychological problems. Based on these findings it can be concluded that the LOT-R-A is a valid instrument to examine optimism among adolescents. Future research can help to elucidate the role of optimism in mental health interventions and can gather knowledge on how these interventions can be refined to optimally cultivate optimism during the developmental period of adolescence.     

Using Photography to Explore Recovery Themes With Veterans

This author of this study examined if creating photographs to explore a recovery experience could be therapeutic. Veterans from multiple war periods, who were receiving outpatient mental health treatment, voluntarily enrolled in a six-week photography workshop. During the workshop, 31 veterans learned the basics of photography and discussed recovery challenges with peers. For the final class, participants created a six-image portfolio that visually expressed a personal recovery theme. Pre-and post, 10-item Likert scale questionnaires were completed in order to evaluate the benefits of the photography workshop. There was a statistically significant increase in the post test questionnaire score (+0.47 points, p = 0 .001). The findings support the hypothesis that taking photographs while in recovery can improve personal reflection and organization of thinking, as well as promote recovery discussions, communication, social support, and sense of purpose. Recovery themes included dealing with pain, isolation, growth, transformation, and healing.     

Standardization of a Spirituality Scale with a South African Sample

The study reports on the psychometric properties of a Spirituality Scale developed in the USA in a South African setting. Respondents were 218 women and 84 men with a mean age of 25.54 years and an age range from 17 to 85 years. The majority (70%) were isiZulu speakers. Factor analyses suggested a multidimensional structure, consisting of three factors, labelled perennial spirituality, respect and purpose. The scores from the scale were moderately reliable in their internal consistency. A shortened 12-item Spirituality Scale (SS-12) has potential for research use in South Africa.