Factors associated with antisocial behavior in combat veterans

The objective of this study was to identify factors associated with antisocial behavior in 1,543 Marines who deployed to combat zones in support of conflicts in Iraq and Afghanistan during 2002–2007. Five factors were associated with antisocial behavior in multivariate analyses: post‐traumatic stress disorder (PTSD) symptoms, deployment‐related stressors, combat exposure, younger age, and being divorced. PTSD symptoms had a stronger association with antisocial behavior than any other variable. A unique and important finding of this study was the association between deployment‐related stressors and a higher incidence of antisocial behavior. Because deployment‐related stressors are potentially modifiable, the military may be able to address them in concrete ways such as by shortening deployments and improving communication with home. Aggr. Behav. 36:330–337, 2010. Published 2010 by Wiley‐Liss, Inc.     

Interactive effects of cumulative lifetime traumatic brain injuries and combat exposure on posttraumatic stress among deployed military personnel

Growing research links Traumatic Brain Injury (TBI) with greater posttraumatic stress disorder (PTSD) symptoms. Much of this research has focused on the influence of the presence or severity of a single TBI while neglecting the potential cumulative effects of multiple TBIs incurred across an individual’s lifetime on combat-related PTSD. The present study addressed this gap using a sample of 157 military service members and 4 civilian contractors who underwent structured TBI interviews at a military hospital in Iraq and completed the Combat Experiences Scale (CES) and Posttraumatic Checklist – Military (PCL-M). Results indicated that a greater number of lifetime TBIs were associated with greater PTSD symptoms when accounting for the presence and severity of a recent, deployment-related TBI. Additionally, a significant interaction of number of lifetime TBIs and combat exposure emerged, indicating that exposure to combat yielded greater PTSD symptoms among those with multiple lifetime TBIs compared to those with one or zero lifetime TBIs. These data suggest that incurring multiple TBIs may amplify the link between combat exposure and PTSD and underscore the need to screen for lifetime TBI history.     

Treatment Adherence Among War Veterans with Posttraumatic Stress Disorder: A Concept Analysis

Aim: This study was made to analyze the concept of treatment adherence among war veterans who suffer posttraumatic stress disorder.

Methods: This concept analysis was done using Walker and Avant’s concept analysis model. Online English and Persian databases were searched using keywords such as “posttraumatic stress disorder,” “mental disorder,” “compliance,” and “adherence.” Finally, 11 eligible documents were included in the analysis. The retrieved articles were perused word-by-word, line-by-line, and paragraph-by-paragraph in order to arrive at an in-depth understanding about their contents. Then, the obtained excerpts from the articles, which were relevant to the study subject matter, were coded. The codes were then grouped into the antecedents, consequences, and attributes of the concept.

Findings: In total, 122 primary codes, 19 subcategories, 8 main categories, and 4 main themes were extracted. The main antecedents of the treatment adherence concept are patients’ personal health background and the attributes of posttraumatic stress disorder and its treatments while its main outcome is the changes in the quality of life. Moreover, the main attribute of adherent veterans is that they take responsibility for their own health and subsequently attempt to plan for health promotion.

Conclusion: The concept of treatment adherence among war veterans who suffer from PTSD is a complex and relative concept which depends on patients’ personal health background as well as the attributes of the afflicting disorder and its treatments. The concept is manifested by patient’s attempts to plan for receiving or parting with treatments and can result in changes in health-related quality of life.     

A Review of Research on Moral Injury in Combat Veterans

The moral injury construct has been proposed to describe the suffering some veterans experience when they engage in acts during combat that violate their beliefs about their own goodness or the goodness of the world. These experiences are labeled transgressive acts to identify them as potentially traumatic experiences distinct from the fear-based traumas associated with posttraumatic stress disorder. The goal of this article was to review empirical and clinical data relevant to transgressive acts and moral injury, to identify gaps in the literature, and to encourage future research and interventions. We reviewed literature on 3 broad arms of the moral injury model proposed by Litz and colleagues (2009) Litz, B. T., Stein, N., Delaney, E., Lebowitz, L., Nash, W. P., Silva, C., &; Maguen, S. (2009). Moral injury and moral repair in war veterans: A preliminary model and intervention strategy. Clinical Psychology Review, 29, 695–706. 10.1016/j.cpr.2009.07.003[Crossref], [PubMed], [Web of Science ®] , [Google Scholar]: (a) the definition, prevalence, and potential correlates of transgressive acts (e.g., military training and leadership, combat exposure, and personality), (b) the relations between transgressive acts and the moral injury syndrome (e.g., self-handicapping, self-injury, demoralization), and (c) some of the proposed mechanisms of moral injury genesis (e.g., shame, guilt, social withdrawal, and self-condemnation). We conclude with recommendations for future research for veterans suffering with moral injury.     

Military occupation as a moderator between combat exposure and posttraumatic stress disorder symptoms in US Army personnel

ABSTRACT

Military occupational designations are standardized classifications that help define and convey a service member’s expected duties and responsibilities. The present study examined how occupational designation was related to adverse combat-reactions, specifically posttraumatic stress disorder (PTSD). It was hypothesized that at comparable levels of combat, non-combat units would display greater symptomology than combat units. The study sample consisted of 785 combat-deployed, active-duty enlisted US Army personnel. Participants were administered self-report questionnaires, including the Combat Experiences Scale and PTSD Checklist for DSM-5. Occupation was coded using the three-branch system (i.e., Operations, Support, & Force Sustainment). Hierarchical multiple linear regression (MLR) was run to examine the effect of occupation, combat, and unit cohesion on PTSD symptoms. Operations units reported the highest frequency of combat exposure; however, Force Sustainment units displayed the highest PTSD symptoms. In MLR analysis, there was a significant interaction between Force Sustainment units and combat exposure (β = 0.10, p = .019), that was not observed in Operations or Support units. These findings demonstrate that PTSD symptom intensity is not solely a function of combat exposure, and that non-combat units may react differently when exposed to elevated levels of combat.