Dimensionality of the Beck Anxiety Inventory in a Polytrauma Sample of OEF/OIF/OND Veterans: Findings From Exploratory and Confirmatory Factor Analysis

The Beck Anxiety Inventory (BAI) is commonly used as a screening instrument for symptoms of anxiety in clinical settings. The factor structure has been researched in a variety of different clinical settings with results ranging from a 2- to 5-factor structure. The purpose of this study was to explore the factor structure of this instrument in a polytrauma veteran sample. A sample of 304 veterans was used for this study. All subjects were administered the BAI screening measure as part of an evaluation in an outpatient polytrauma clinic. Exploratory factor analysis was conducted for half of the sample, followed by confirmatory factor analysis for the remaining sample to determine the best model. Factor analyses revealed that a 5-factor model provided a best fit. It is interesting to note that previously identified models of the BAI with other types of samples did not provide the best fit for this polytrauma sample. The BAI may provide additional information for clinicians when examining the 5-factor model with veterans in polytrauma settings. The factor structure of the BAI includes 1 factor (i.e., personal safety) that may be unique for veterans who have served in combat zones.     

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.     

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.     

Depressive Symptomatology Mediates Associations With Community Reintegration in Veterans With TBI

Community reintegration (CR) is a challenge for military veterans with traumatic brain injury (TBI). Posttraumatic stress disorder (PTSD), depression, bodily pain, and limitations in physical functioning—common comorbidities with TBI in veterans—have all been associated with problems in CR, but their interrelationships are unclear. The role of depression as a possible mediator of effects on CR has not been examined. We tested depressive symptoms as a possible mediator of CR’s associations with physical limitations, PTSD, and bodily pain. This cross-sectional study used baseline data from a larger randomized controlled trial that evaluated the impact of an in-home intervention for veterans with TBI and their families. Eighty-three military veterans with TBI recruited from a medical rehabilitation service at an urban U.S. Department of Veterans Affairs medical center participated in the study. Interview instruments measured CR, depressive symptoms, physical limitations (limitations in physical functioning), bodily pain, quality of the relationship with key family members, and sociodemographic characteristics. PTSD was determined through review of the electronic medical record. Interview data were collected in veterans’ homes. Depressive symptoms totally mediated the association between physical limitations and CR and the association between PTSD and CR. The bodily pain–CR association was not significant after quality of relationship had been entered into the regression models. Findings suggest that interventions to increase CR of veterans with TBI should address depression, a treatable condition. Replication of our mediation findings in larger veteran and civilian samples with TBI is needed.     

Predictors of PTSD Improvement with Cognitive/Exposure Group Interventions in Operation Enduring Freedom/Operation Iraqi Freedom Female Veterans

Predictors of successful PTSD outcome have been examined through individually delivered treatments. We examined predictors using a group protocol with cognitive, exposure, and skills modules. Assessments included self-report and interview (CAPS, SCID-I/II) measures at baseline, post, and six months; treatment was a 16-week, three-member group for 32 OEF/OIF women Veterans. A regression analysis showed major depressive disorder and no baseline psychiatric medication predicted PTSD improvement. PTSD improvement predicted fewer outpatient medical visits at follow-up. The results supported past research and challenged other findings (e.g., sexual assault predicts less improvement). An additional unique contribution was examining predictors in a group treatment format.     

Exposure,Agency, Perceived Threat,and Guilt as Predictors of Posttraumatic Stress Disorder in Veterans

Using a sample of 289 Iraq/Afghanistan veterans, this study examined the contributions of combat exposure, agency, perceived threat, and guilt to posttraumatic stress disorder (PTSD) symptoms. Regression analyses indicated the four variables (together with demographic variables) accounted for 79% of the variance in PTSD symptoms. Guilt was the most important predictor. In addition, guilt mediated between exposure and PTSD symptoms, perceived threat and PTSD symptoms, and agency and PTSD symptoms. Implications of these findings are discussed.     

Traditional Machismo and Caballerismo as Correlates of Posttraumatic Stress Disorder,Psychological Distress,and Relationship Satisfaction in Hispanic Veterans

An online survey was used to examine 45 Hispanic male veterans’ traditional machismo and caballerismo as correlates of posttraumatic stress disorder (PTSD), psychological distress, and relationship satisfaction. Higher traditional machismo was associated with higher PTSD severity and distress and lower relationship satisfaction. Psychometric properties of the Traditional Machismo and Caballerismo Scale were explored. Se utilizó una encuesta en línea para examinar el machismo y el caballerismo tradicionales de 45 veteranos hispanos varones, y su correlación con el trastorno de estrés post‐traumático (PTSD, por sus siglas en inglés), la angustia psicológica y la satisfacción en sus relaciones. Un mayor nivel de machismo tradicional se asoció con una mayor severidad del PTSD, así como con angustia y una menor satisfacción en las relaciones. Se exploraron las propiedades psicométricas de la Escala de Machismo y Caballerismo Tradicionales.     

Involving Police Departments in Early Awareness of Concussion Symptoms during Domestic Violence Calls

ABSTRACT

Police officers around the world respond to and investigate calls regarding domestic violence (DV) daily. Police departments operate with standard protocols, particularly when engaging in investigations that involve allegations of strangulation or sexual assault. Operating under advisement of the Maricopa County Attorney’s Office, the Mesa Police Department (Mesa, AZ) has established protocols for detecting, recording, and prosecuting DV cases that involve strangulation and sexual assault. Allegations of strangulation (defined as impeded breathing) or sexual assault prompt officers to offer a forensic nursing exam (FNE) combined with strangulation treatment by forensic nurses at the Mesa Family Advocacy Center. Recognizing the potential for head injury to the assault victim in all DV situations, including intimate partner violence (IPV), the police department has added concussion-awareness training, as well as a point-of-incident investigative tool for its officers to record neurological function of the victim. Officers were instructed to use the ConQVerge device to measure and record the Near Point of Convergence (NPC) as a test of neurological impairment in suspected head injuries. In this article, we discuss the challenges and opportunities for assisting victims of DV strangulation and sexual assault (including non-DV sexual assault) with on-site assessment and consent for further medical assessment and treatment. Additionally, rates of domestic assault victims that report a crime, but decline to follow through with forensic medical tests, are reported for the first time. Lessons learned from the project that inform strategic operations in this space are offered to other agencies prior to the implementation of similar procedures.     

Psychological impact of remote combat/graphic media exposure among US Air Force intelligence personnel

Since 2001 there has been a significant increase in the use of intelligence, surveillance, and reconnaissance (ISR) analysis for tactical, operational, and strategic decision makers engaged in global operations. To meet this demand, US Air Force intelligence personnel participate in remote combat and graphic media exploitation operations (e.g., review of still imagery, video, and audio), the long-term psychological effects of which are not well understood. Research to date has focused primarily on outcomes related to how intelligence personnel work, versus the specifics of what they do. Military psychologists embedded in ISR units conducted studies to address this gap. Intelligence analysts participated in focus groups and surveys assessing the frequency of exposure, previous exposures to other potentially traumatic events, symptoms of PTSD, moral injury, and other psychosocial experiences. Results showed that exposure levels, albeit virtual, rivaled or exceeded those reported by a sample of special operations forces. Results also showed that specific types of exposures (e.g., witnessing US military casualties, civilian casualties, atrocities committed by the enemy) are related to increased posttraumatic stress and other sequelae that may not adequately be captured by standard posttraumatic stress disorder screening measures. The results contribute to the existing literature on posttraumatic stress, shed new light on the emerging construct of moral injury, and highlight challenges presented by remote combat and graphic media exploitation operations to force health sustainment and performance optimization. The authors provide directions for future research and recommendations for ongoing assessment, monitoring, and selection and training of ISR personnel.     

An Analogue Study of the Psychological and Psychosocial Processes Associated With Post‐concussion Symptoms

This study used an analogue design to investigate post‐concussion syndrome and the psychological and psychosocial processes associated with post‐concussion symptom (PCSx) reporting. The study examined the role of expectation in reporting of PCSx, the nature of associated psychological and psychosocial difficulties, and the “good‐old‐days” phenomenon. Forty‐five healthy participants were randomly assigned to one of two groups: (1) a control group or (2) an expectation group who were asked to perform as if they had experienced a mild traumatic brain injury. Fourteen psychiatric patients comprised the clinical group. Self‐report questionnaires assessing PCSx and psychological and psychosocial variables were administered. It was hypothesised that PCSx would be non‐specific, that the expectation group would report greater dysfunction than controls, and that the “good‐old‐days” phenomenon would cause the expectation and clinical groups to underestimate pre‐morbid PCSx. All participants reported some degree of dysfunction, and the expectation and clinical groups underestimated past PCSx. The expectation group reported more PCSx and psychological and psychosocial dysfunction than controls, resembling the clinical group. The results demonstrate that expectation can cause otherwise healthy individuals to resemble a clinical group in terms of their level of endorsement of psychological and psychosocial dysfunction.     

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.     

Temporal Associations Between Posttraumatic Stress Symptoms and Depression in Response to Online Expressive Writing Interventions in a Hispanic Sample

Some expressive writing (EW) interventions targeting posttraumatic stress symptoms (PTSS) may reduce both PTSS and comorbid depression symptoms. The temporal associations between PTSS and depression symptom levels in response to EW interventions are unknown. This study examined the directionality of PTSS and depression symptom levels from baseline to 1-week, 1-month, and 3-month follow-ups of two online EW interventions in a Hispanic sample with diverse trauma experiences. Participants (n = 70) completed either emotion-focused or fact-focused writing for 3 consecutive days online. A manifest autoregressive model with cross-lagged effects and treatment condition was analyzed. All but one first-order autoregressive path were statistically significant, with later PTSS and depression scores significantly predicted by those scores at preceding time points. The cross-lagged effects findings suggest that earlier PTSS levels influenced later depression levels, but earlier depression did not influence later PTSS, demonstrating a unidirectional temporal association. Severe PTSS may hinder EW treatment gains in depression. Superior outcomes for emotion-focused writing relative to fact-focused writing were also found.     

Depression Following Traumatic Brain Injury: The Validity of the CES-D as a Brief Screening Device

The validity, reliability, and factor structure of the Center for Epidemiological Studies-Depression Scale (CES-D) was examined with 253 patients seen for neuropsychological evaluation following traumatic brain injury (TBI). All patients completed the CES-D; 31 also completed the Beck Depression Inventory (BDI) and 17 completed the Minnesota Multiphasic Personality Inventory-II (MMPI-II). The CES-D demonstrated good concurrent, construct validity, significantly correlating with the BDI (r = .673, p < .0001) and the MMPI-II (Depression Scale T score r = .536, p = .027). The CES-D also demonstrated good internal consistency (coefficient alpha = .8195) and split-half reliability (Spearman–Brown r = .8284). Principal components factor analysis with varimax rotation resulted in a four-factor solution that accounted for 56.01% of the variance. The factor structure differed from the originally reported factor structure, and indicated that somatic difficulties were strongly associated with dysphoric affect in TBI patients. The CES-D is a valid and reliable screening instrument for use with TBI patients.     

The organisation and content of trauma memories in survivors of road traffic accidents

We investigated the trauma narratives of 131 road traffic accident survivors prospectively, at 1 week, 6 weeks, and 3 months post-trauma. At 1 and 6 weeks, narratives of survivors with acute stress disorder (ASD) or post-traumatic stress disorder (PTSD) were less coherent and included more dissociation content. By 3 months, their narratives also contained more repetition, more non-consecutive chunks, and more sensory words. Traumatic brain injury was associated with a separate characteristic, confusion, at all three time points. Three aspects of narrative organisation at 1 week--repetition, non-consecutive chunks, and coherence--predicted PTSD severity at 3 months after controlling for initial symptoms. The results suggest both a strong concurrent and predictive relationship between narrative disorganisation and ASD/PTSD but that as people recover from ASD, their narratives do not necessarily become less disorganised.     

Body-Region-Specific Injuries as Predictors of Psychosocial Outcomes Among Those Injured in Combat: Results From the Wounded Warrior Recovery Project

Associations between body region injured and psychosocial outcomes may have implications for injury prevention and mitigation strategies. The present study investigated the association of body-region—specific injuries and their association with 3 psychosocial outcomes (i.e., quality of life, QOL; posttraumatic stress disorder, PTSD; and depression) among a large sample of U.S. military service members injured in combat. A total of 1,011 individuals wounded in combat enrolled in the Wounded Warrior Recovery Project and provided QOL, depression, and PTSD measures on a Web-based survey. These psychosocial variables were linked with the presence/absence of combat injuries in 9 different body regions (head, face, neck, thorax, spine, abdomen, upper extremity, lower extremity, and external skin/other), as well as overall injury severity and demographic factors. Two-step hierarchical linear regressions revealed that after adjusting for overall injury severity and time since injury, those with combat-related head and spine injuries were particularly at risk for relatively worse psychosocial outcomes. Head and spinal injuries were associated with lower QOL and higher PTSD and depression. Overall, even those with relatively minor injuries may be at risk of lower QOL and adverse psychosocial outcomes. These findings may highlight the need for early interventions to minimize the psychological effects of combat injuries to the head and spine.     

A Preliminary Study for Exploring Different Sources of Guilt in a Sample of Veterans Who Sought Chaplaincy Services

Limited research has suggested that experiencing guilt may contribute to the risk of suicidal behavior in some veteran populations. Using data collected by chaplains, this study compared the frequency with which 94 veterans with a history of suicide ideation experienced guilt relative to 670 veterans without a history of ideation. We then compared main sources of guilt reported by ideators and nonideators. Ideators reported experiencing guilt significantly more often than nonideators. No differences were noted for the source of guilt among those who reported frequently experiencing this emotion. Ideators with an infrequent experience of guilt significantly more often named life and the military as the main source of this emotion. Clinicians should be mindful of the need to appropriately assess for and address guilt among veterans at increased risk of suicide. A variety of sources, not limited only to military experiences, may contribute to a veteran’s sense of guilt.     

Ethical considerations in the management of military related concussion

Since the year 2000 over 300,000 military service members have been diagnosed with mild traumatic brain injury/concussion. Consequently, this injury has become the subject of increased awareness and study within the military healthcare environment. Although single and/or isolated concussions typically heal in a relatively rapid fashion with limited to no long-term sequelae, there is debate in the field about the impact of repeat concussion. To this end, various ethical challenges arise when managing patients with such injuries. Several papers outlining these issues with regard to athletes have been published in the sports medicine literature. However, because providers caring for military service members must make return-to-duty-decisions, practice within the military setting results in a number of unique ethical considerations. More specifically, management of service members with a history of repeat concussion and increasingly complicated recoveries, as well as the potential for premature return-to-duty are topics of concern for military health care providers. Using the American Psychological Association ethical principles and standards, the current article outlines various ethical challenges to concussion management in the military setting. The ethical principles of Beneficence and Nonmaleficence and Respect for People’s Rights and Dignity, as well as the 3 related ethical standards of Competence, Avoiding Harm, and Conflict of Interest are discussed. Policy changes are highlighted as a proximal solution to these ethical challenges.     

Psychological Distress and Symptoms of Posttraumatic Stress Disorder in Jewish Adolescents Following a Brief Exposure to Concentration Camps

We investigated the psychological impact of an organized visit to Polish concentration camps on Jewish-American adolescents. Eighty-seven adolescents who participated in a B'nai B'rith memorial visit to concentration camps in Poland completed measures of general psychological adjustment and posttraumatic stress disorder (PTSD) at four time-points: pretest, posttest, 6-month follow-up and 12-month follow-up. Measures included the SCL-90-R, the Mississippi Scale for PTSD, and the Impact of Events Scale (IES) for PTSD. On the SCL-90-R, changes in somatization, interpersonal sensitivity, obsessive-compulsive tendencies, depression, anxiety, and phobic anxiety were observed over time, with peak symptom scores at posttest and 6-month follow-up. Scores on the Mississippi Scale for PTSD and the IES Intrusion subscale also increased at 6-months. Predictors of PTSD symptoms on the Mississippi Scale included previous psychiatric treatment and SCL-90-R symptoms of paranoia, depression, and psychosis. Elevated psychotic symptoms on the SCL-90-R predicted PTSD symptoms on the IES. Jewish adolescents with preexisting symptoms of generalized distress or psychoticism appeared at increased risk for PTSD symptoms following exposure to Holocaust stimuli. This study contributes a prospective, multi-measure assessment of trauma reactions in adolescents.     

An Initial Investigation of the Factor-Analytic Structure of the Impact of Event Scale-Revised With a Volunteer Firefighter Sample

We provide an initial evaluation of the factor structure of the Impact of Event Scale-Revised (IES-R) when used with a volunteer firefighter and a similar community participant sample. A volunteer firefighter sample (n = 65) and a sample of similar community respondents (n = 103) completed a questionnaire study, including responses to the IES-R. The IES-R data from both groups were entered into a three-factor principal components analysis with direct oblimin rotation. We found further support for the validity of the IES-R when used with a community sample. However, our data suggested that when using the IES-R with a community sample, the choice between a two- and a three-factor model may depend on the composition of the participants. For volunteer firefighters, the factor-analytic structure of the IES-R appeared to be similar to that of the community sample, with more scatter in terms of item loadings. To our knowledge, there is no previous research considering the use of the IES-R with a strictly volunteer firefighter sample. In addition, despite adequate research on the factor-analytic structure of the original IES, little research has considered the factor-analytic structure of the more recent IES-R, even with community samples.     

Psychological Distress in a Sample of Teachers

This article describes a cross-sectional study of the links between job-related stressors and depressive and psychophysiologic symptoms and morale in 67 New York City teachers. The teachers' mean score on the Center for Epidemiologic Studies Depression Scale (CES-D; M = 13.03) was higher than might be expected from average community residents. The teachers also tended to express dissatisfaction with their jobs. The CES-D and the Psychophysiologic Symptom Scale were correlated as highly as their reliabilities would permit, a finding consistent with the view that the CES-D and the Psycho physiologic Symptom Scale measure the same construct, nonspecific psychological distress. The correlational findings suggest that distress is distinct from job-related morale, which was indexed by measures of motivation to continue teaching and job satisfaction. The results of regression analyses, which controlled for sociodemographic factors, indicated that the level of job strain (frequency of ongoing stressors) is more closely related to psychological distress and low morale than episodic stressors, including crimes in which the teacher was victim. The regression analyses also indicated that colleague support was related to lower symptom levels and higher morale.