Preferences for gender-targeted health information- A study of male veterans who have experienced military sexual trauma.
Turchik JA, Rafie S, Rosen CS, & Kimerling R.
Am J Mens Health. 2013 Nov 14; PMID: 24232582 [PubMed - as supplied by publisher]

No prior research has examined men's opinions or preferences regarding receiving health education materials related to sexual violence. The objective of the current study was to investigate whether male veteran patients who have experienced military sexual trauma (MST) prefer gender-targeted versus gender-neutral printed health information and whether receipt of this information increased utilization of outpatient mental health services in the following 6-month period.

In-person 45-minute interviews were conducted with 20 male veterans receiving health care services at a large Veterans Health Administration facility to evaluate opinions on a gender-targeted and a gender-neutral brochure about MST. An additional 153 veterans received psychoeducational materials through the mail and participated in the completion of a survey as part of a psychoeducational intervention.

Our results demonstrate that male veterans prefer gender-targeted information about sexual trauma compared to gender-neutral information. Whereas veterans in the study had clear preferences for gender-targeted materials, receipt of information about MST (whether gender-targeted or gender-neutral) did not increase utilization of mental health care in the 6 months following receipt of these materials. These results demonstrated that materials about sexual trauma are acceptable to men and should be gender-targeted. Further research is needed to examine strategies to increase access to mental health care among male Veterans who have experienced MST.
The role of military social support in understanding the relationship between PTSD, physical health, and healthcare utilization in women veterans.
Lehavot K, Der-Martirosian C, Simpson TL, Shipherd JC, & Washington DL.
J Trauma Stress. 2013 Nov 6; PMID: 24203114 [PubMed - as supplied by publisher]

Posttraumatic stress disorder (PTSD) is a significant predictor of both poorer physical health and increased health care utilization, whereas adequate social support is associated with better physical health and less health care utilization. However, research has not previously examined the simultaneous effects of PTSD and social support on health and health care utilization.

This study examined both the independent and interactive effects of PTSD and a particular type of social support (postactive-duty social support from military friends) on self-reported physical health and number of Veterans Health Administration (VHA) visits in the last year. These relationships were examined in a representative, national sample of 3,524 women veterans who completed telephone interviews as part of the National Survey of Women Veterans in 2008-2009. Regression analyses were conducted using these cross-sectional data to examine main effects of PTSD and military social support on physical health and VHA utilization and their interaction.

Screening positive for PTSD was associated with poorer health (B = -3.19, SE = 1.47) and increased VHA utilization (B = 0.98, SE = 0.16), whereas greater military social support was associated with better health (B = 0.97, SE = 0.44) and less frequent VHA utilization (B = -0.15, SE = 0.05). Neither moderation model was significant, such that military social support behaved in a similar way regardless of PTSD status.
Comparing response to cognitive processing therapy in military veterans with subthreshold and threshold posttraumatic stress disorder.
Dickstein BD, Walter KH, Schumm JA, & Chard KM.
J Trauma Stress. 2013 Nov 15; PMID: 24243661 [PubMed - as supplied by publisher]

Research suggests that subthreshold posttraumatic stress disorder (PTSD) symptomatology is associated with increased risk for psychological and functional impairment, including increased risk for suicidal ideation. However, it does not appear that any studies to date have investigated whether subthreshold PTSD can effectively be treated with evidence-based, trauma-focused treatment. Accordingly, we tested response to cognitive processing therapy (CPT) in 2 groups of military veterans receiving care at a VA outpatient specialty clinic, 1 with subthreshold PTSD at pretreatment (n = 51) and the other with full, diagnostic PTSD (n = 483).

Multilevel analysis revealed that both groups experienced a significant decrease in PTSD symptoms over the course of therapy (the full and subthreshold PTSD groups experienced an average decrease of 1.79 and 1.52 points, respectively, on the PTSD Checklist with each increment of time, which was coded from 0 at pretreatment to 13 at posttreatment). After controlling for pretreatment symptom severity, a between-groups difference was not found.

These results suggest that CPT is an effective form of treatment among military veterans, and that its effectiveness does not differ between subthreshold and threshold groups.
Easing reintegration- Telephone support groups for spouses of returning Iraq and Afghanistan service members.
Nichols LO, Martindale-Adams J, Graney MJ, Zuber J, & Burns R.
Health Commun. 2013 Oct 17; PMID: 24134192 [PubMed - as supplied by publisher]

Spouses of returning Iraq (Operation Iraqi Freedom, OIF) and Afghanistan (Operation Enduring Freedom, OEF) military service members report increased depression and anxiety post deployment as they work to reintegrate the family and service member. Reconnecting the family, renegotiating roles that have shifted, reestablishing communication patterns, and dealing with mental health concerns are all tasks that spouses must undertake as part of reintegration.

We tested telephone support groups focusing on helping spouses with these basic reintegration tasks. Year-long telephone support groups focused on education, skills building (communication skills, problem solving training, cognitive behavioral techniques, stress management), and support.

Spouse depression and anxiety were decreased and perceived social support was increased during the course of the study. In subgroup analyses, spouses with husbands whose injuries caused care difficulties had a positive response to the intervention. However, they were more likely to be depressed, be anxious, and have less social support compared to participants who had husbands who had no injury or whose injury did not cause care difficulty.

Study findings suggest that this well-established, high-access intervention can help improve quality of life for military spouses who are struggling with reintegration of the service member and family.
Depressive symptoms, relational turbulence, and the reintegration difficulty of military couples following wartime deployment.
Knobloch LK, Ebata AT, McGlaughlin PC, & Ogolsky B.
Health Commun. 2013 Oct 17; PMID: 24134220 [PubMed - as supplied by publisher]

During reunion following wartime deployment, military couples are at risk for both depression and relationship distress ( Bowling & Sherman, 2008 ). This article applies the relational turbulence model ( Knobloch & Theiss, 2011a ; Solomon & Theiss, 2011 ) to understand the difficulty military couples may experience upon homecoming. One hundred and eighteen military couples completed an online questionnaire once per month for the first 3 months upon reunion following wartime deployment.

Multilevel modeling results indicated that people's depressive symptoms (H1), relational uncertainty (H2), and interference from partners (H3) predicted their difficulty with reintegration. A few partner effects were apparent as well. These findings illuminate the dynamics of the reunion period, extend the relational turbulence model, and suggest guidelines for helping military couples preserve well-being during reintegration following wartime deployment.
Mental health needs of returning veterans.
Keane TM, Docherty JP, Jesse RL, Lee J, McNurlen J, & Zeller E.
J Clin Psychiatry. 2013 Oct;74(10):e20 PMID: 24229760 [PubMed - in process]

As more service members return from war zones around the world, clinicians must be prepared to treat them. Veterans with PTSD and other mental disorders must overcome the stigma associated with seeking treatment, and clinicians must equip these patients and their family members to deal with challenging symptoms. Clinicians should learn about military culture and jargon to better understand these patients and should become familiar with veteran resources to direct veterans and their families to the appropriate services. Clinicians may also need to communicate with their patients' employers to help both parties deal with illnesses such as PTSD. A coordinated effort is needed to meet the needs of veterans and their families, and clinicians play an integral role in recognizing and meeting those needs.
A gendered perspective on military deployment.
Kelly PJ, Nilsson J, & Berkel L.
Women Health. 2013 Nov 26; PMID: 24279913 [PubMed - as supplied by publisher]

ABSTRACT Background: Military deployment, especially in combat or dangerous areas, can have a strong influence on subsequent mental health. This effect may be intensified as a result of the potential stigma that admission of mental health problems indicates weakness. Additional mental health issues exist for female soldiers from the National Guard who are pulled from non-military environments to work under dangerous conditions far from home and traditional social support. Minimal documentation is available about the day-to-day, gendered experiences of deployment for this group of female soldiers. To provide background for appropriate training and support, the aim of this study was to understand better the experiences of military deployment for women in the National Guard.

Methods: We used content analysis to analyze individual, semi-structured interviews with a sample of 42 women from seven U.S. National Guard units who were deployed in combat areas.

Results: Four general themes emerged about deployment experience: the general environment of stress, heterogeneous job responsibilities, home comes with you, and gendered stress.

Discussion: Military efforts are needed to address gender-specific issues associated with deployment and to develop resilience training that will optimize the mental health of female soldiers.
Predictors of completion of exposure therapy in oef-oif veterans with posttraumatic stress disorder.
Gros DF, Price M, Yuen EK, & Acierno R.
Depress Anxiety. 2013 Nov;30(11):1107-13

BACKGROUND: Despite large-scale dissemination and implementation efforts of evidence-based psychotherapy to veterans from Operation Enduring/Iraqi Freedom (OEF/OIF), little is known regarding the factors that contribute to the successful completion of these treatments in this high-risk population. The present study investigated predictors of treatment completion during a standardized exposure-based psychotherapy for PTSD. Read more . . .
Protective factors for mental disorders and psychological distress in female, compared with male, service members in a representative sample.
Mota NP, Medved M, Whitney D, Hiebert-Murphy D, & Sareen J.
Can J Psychiatry. 2013 Oct;58(10):570-8 PMID: 24165104 [PubMed - in process]

Objective: Although military interest in promoting psychological resilience is growing, resources protective against psychopathology have been understudied in female service members. Using a representative sample of Canadian Forces personnel, we investigated whether religious attendance, spirituality, coping, and social support were related to mental disorders and psychological distress in female service members, and whether sex differences occurred in these associations. Read more . . .
Anxiety disorders, active component, U.S. Armed Forces, 2000-2012.
Armed Forces Health Surveillance Center (AFHSC).
MSMR. 2013 Oct;20(10):2-6 PMID: 24191766 [PubMed - in process]

Anxiety is a normal reaction to stress; however, in individuals with anxiety disorder, the anxiety becomes chronic and exaggerated, and affects the physical and psychological health of the individual. The main types of anxiety disorders are generalized anxiety disorder, panic disorder, post-traumatic stress disorder (PTSD), phobias, and obsessive-compulsive disorder (OCD).

Incident diagnoses of anxiety disorders among active component service members steadily increased from 2000 to 2012. A majority of incident anxiety disorder diagnoses were "non-specific" anxiety disorders (ICD-9-CM codes: 300.0, 300.00, or 300.09) and over 75 percent of service members diagnosed with "non-specific" anxiety disorders did not have a more specific anxiety disorder diagnosis during subsequent medical encounters. Incidence rates of anxiety disorders were highest among females, white, non-Hispanics, in the youngest age groups, and among recruits and junior enlisted service members. About one-third of anxiety disorder cases also had a co-occurring diagnosis of either adjustment or depressive disorder within one year before or after the incident anxiety disorder encounter.
Military risk factors for cognitive decline, dementia and Alzheimer's Disease.
Veitch DP, Friedl EK, & Weiner WM.
Curr Alzheimer Res. 2013 Aug 2; PMID: 23906002 [PubMed - as supplied by publisher]

Delayed neurological health consequences of environmental exposures during military service have been generally underappreciated. The rapidly expanding understanding of Alzheimer's disease (AD) pathogenesis now makes it possible to quantitate some of the likely longterm health risks associated with military service. Military risk factors for AD include both factors elevated in military personnel such as tobacco use, traumatic brain injury (TBI), depression, and post-traumatic stress disorder (PTSD) and other nonspecific risk factors for AD including, vascular risk factors such as obesity and obesity-related diseases (e.g., metabolic syndrome), education and physical fitness. The degree of combat exposure, Vietnam era Agent Orange exposure and Gulf War Illness may also influence risk for AD.

Using available data on the association of AD and specific exposures and risk factors, the authors have conservatively estimated 423,000 new cases of AD in veterans by 2020, including 140,000 excess cases associated with specific military exposures. The cost associated with these excess cases is approximately $5.8 billion to $7.8 billion. Mitigation of the potential impact of military exposures on the cognitive function of veterans and management of modifiable risk factors through specifically designed programs will be instrumental in minimizing the impact of AD in veteransin the future decades.
Depression and Pain- Independent and additive relationships to anger expression.
Taylor MK, Larson GE, & Norman SB.
Mil Med. 2013 Oct;178(10):1065-1070

Anger and anger expression (ANGX) are concerns in the U.S. military population and have been linked to stress dysregulation, heart disease, and poor coping behaviors.

OBJECTIVE: We examined associations between depression, pain, and anger expression among military veterans.

METHOD: Subjects (N = 474) completed a depression scale, a measure of pain across the last 4 weeks, and an ANGX scale. A multiple regression model assessed the independent and additive relationships of depression and pain to ANGX. Read more . . .
Outcomes of prolonged exposure therapy for veterans with posttraumatic stress disorder.
Goodson JT, Lefkowitz CM, Helstrom AW, & Gawrysiak MJ.
J Trauma Stress. 2013 Aug;26(4):419-25 PMID: 23934939 [PubMed - in process]

Prolonged Exposure (PE) is an evidenced-based psychotherapy for posttraumatic stress disorder (PTSD) that is being disseminated nationally within the U.S. Department of Veterans Affairs (VA) with promising initial results. Empirical evidence, however, regarding the effectiveness of PE for treatment of PTSD in military veterans is limited.

Building on previous treatment outcome research, the current study investigated the effectiveness of PE in a diverse veteran sample. One-hundred fifteen veterans were enrolled in PE at an urban VA medical center and its surrounding outpatient clinics. PTSD and depression symptoms as well as quality of life were measured before and after treatment. Several baseline patient characteristics were examined as predictors of treatment response.

Eighty-four participants completed treatment. Participants experienced a 42% reduction in PTSD symptoms, a 31% reduction in depression symptoms, and an increase in quality of life following PE. Veterans not prescribed psychotropic medication reported greater PTSD symptom reduction than veterans prescribed such medication. The implications of these results for treatment programs targeting PTSD in veterans are discussed.
Symptoms of posttraumatic stress disorder and depression in relation to alcohol-use and alcohol-related problems among Canadian forces veterans.
Fetzner MG, Abrams MP, & Asmundson GJ.
Can J Psychiatry. 2013 Jul;58(7):417-25 PMID: 23870724 [PubMed - indexed for MEDLINE]

OBJECTIVE: Alcohol misuse is common among military veterans affected by posttraumatic stress disorder (PTSD) and depression; however, research to date has provided mixed evidence concerning differential associations among PTSD and depressive symptoms in relation to alcohol misuse. Further, most available studies have examined primarily male samples or have dichotomously grouped participants as either having or not having an alcohol use disorder. Our study sought to explore relations among 2 aspects of alcohol misuse (that is, alcohol-related problems, and quantity or frequency of alcohol use) and symptoms of PTSD and depression in independent samples of female and male military veterans. Read more . . .
Gender differences of postdeployment post-traumatic stress disorder among service members and veterans of the Iraq and Afghanistan conflicts.
Crum-Cianflone NF. & Jacobson I.
Epidemiol Rev. 2013 Aug 29; PMID: 23988441 [PubMed - as supplied by publisher]

Despite the marked expansion of roles for women in the US military over the last decade, whether differences by gender exist in regard to the development of mental health conditions postdeployment is unclear. This comprehensive review of the literature (2001-2012) examined whether US servicewomen were more likely than men to experience post-traumatic stress disorder (PTSD) after returning from deployments to the Iraq and Afghanistan conflicts.

Findings from 18 studies from 8 unique study populations were reviewed. Seven studies found that women had a higher risk for screening positive for PTSD compared with men, including prospectively designed studies that evaluated new-onset PTSD among members from all service branches. Although results from studies with Veterans Affairs samples found women at decreased risk in 4 analyses, these studies used the same source databases, were conducted in treatment-seeking populations, and were mostly unable to account for combat experience. Seven studies detected no differences by gender.

In summary, women appeared to have a moderately higher risk for postdeployment PTSD, although there was a lack of consensus among the studies, and even those with the most rigorous methods were not designed specifically to evaluate potential gender differences. Given the limitations of the published literature, further research should use longitudinal study designs and comprehensive evaluations of deployment experiences while adjusting for predeployment factors to confirm that gender differences exist with regard to postdeployment PTSD.
Risk factors for post-deployment posttraumatic stress disorder in national guard-reserve service members.
Tracie Shea M, Reddy MK, Tyrka AR, & Sevin E.
Psychiatry Res. 2013 Sep 17; PMID: 24054062 [PubMed - as supplied by publisher]

Identification of factors that increase risk for PTSD in military personnel following deployments is critical to early intervention and prevention. The study tested hypothesized main and moderating risk factors for PTSD in National Guard/Reserve members deployed to Iraq or Afghanistan.

Members of the National Guard/Reserves (n=238) completed diagnostic interviews and measures of risk factors at a post-deployment assessment conducted an average of four and a half months following return from deployment. Hierarchical multivariate logistic regression analyses were used to test hypotheses.

Higher levels of combat exposure, life and family concerns during deployment, and post-deployment social support independently predicted PTSD. Life/family concerns during deployment and perceived adequacy of training and preparation were significant moderators of the association between combat exposure and PTSD. Among those with higher levels of both combat exposure and life and family stress, 27% had PTSD in contrast to 3% of those with high exposure but lower levels of such stress during deployment.

In addition to combat exposure, life and family stress during deployment is a particularly important predictor of PTSD. The findings highlight the importance of identifying and addressing such stress.
Why are Iraq and Afghanistan War veterans seeking PTSD disability compensation at unprecedented rates?
McNally RJ, & Frueh BC.
J Anxiety Disord. 2013 Jun;27(5):520-6 PMID: 23954726 [PubMed - in process]

The wars in Iraq and Afghanistan have produced historically low rates of fatalities, injuries, and posttraumatic stress disorder (PTSD) among U.S. combatants. Yet they have also produced historically unprecedented rates of PTSD disability compensation seeking from the U.S. Department of Veterans Affairs. The purpose of this article is to consider hypotheses that might potentially resolve this paradox, including high rates of PTSD, delayed onset PTSD, malingered PTSD, and economic variables.
Posttraumatic stress disorder and suicide risk among veterans- a literature review.
Pompili M, Sher L, Serafini G, Forte A, Innamorati M, Dominici G, Lester D, Amore M, & Girardi P.
J Nerv Ment Dis. 2013 Sep;201(9):802-12 PMID: 23995037 [PubMed - in process]

Posttraumatic stress disorder (PTSD) is frequently associated with suicidal ideation and suicide attempts. Suicide is an important cause of death in veterans, and the risk for intentional death continues to be high many years after service. The aim of the present study was to investigate whether there is a relationship between PTSD and suicidal behavior among veterans. We also discussed the risk factors of suicide among war veterans with PTSD.

A systematic review was conducted focusing on war-related PTSD and suicidal behavior. A total of 80 articles from peer-reviewed journals were identified, 34 were assessed for eligibility, and 16 were included. Having a history of PTSD is associated with higher rates of morbidity and mortality and increased the risk for suicidal behavior. The association between PTSD and suicidal behavior was confirmed by the presence of other risk factors and high rates of comorbidity. Current suicidal behavior should be adequately assessed in war veterans.
A yoga program for the symptoms of post-traumatic stress disorder in veterans.
Staples JK, Hamilton MF, & Uddo M.
Mil Med. 2013 Aug;178(8):854-60 PMID: 23929045 [PubMed - in process]

The purpose of this pilot study was to evaluate the feasibility and effectiveness of a yoga program as an adjunctive therapy for improving post-traumatic stress disorder (PTSD) symptoms in Veterans with military-related PTSD. Veterans (n = 12) participated in a 6 week yoga intervention held twice a week.

There was significant improvement in PTSD hyperarousal symptoms and overall sleep quality as well as daytime dysfunction related to sleep. There were no significant improvements in the total PTSD, anger, or quality of life outcome scores. These results suggest that this yoga program may be an effective adjunctive therapy for improving hyperarousal symptoms of PTSD including sleep quality.

This study demonstrates that the yoga program is acceptable, feasible, and that there is good adherence in a Veteran population.
Mild traumatic brain injury, meaning made of trauma, and posttraumatic stress- A preliminary test of a novel hypothesis.
Holland, Jason M.; Lisman, Ross; & Currier, Joseph M.
Rehabilitation Psychology, Vol 58(3), Aug 2013, 280-286.

Objective: Research has demonstrated that a substantial number of veterans returning from Iraq and Afghanistan with mild traumatic brain injury (mTBI) also contend with symptoms of posttraumatic stress disorder (PTSD). One possible contributing factor for the development and/or exacerbation of PTSD symptoms among individuals with mTBI could involve challenges processing trauma and integrating their memories into existing global meaning systems. The goal of this study was to provide a preliminary examination of whether meaning made of trauma could account for the association between mTBI and PTSD (i.e., reexperiencing, avoidance, and hyperarousal symptoms). Read more . . .
Latent class differences explain variability in PTSD symptom changes during cognitive processing therapy for veterans.
Schumm, Jeremiah A.; Walter, Kristen H.; & Chard, Kathleen M..
Psychological Trauma: Theory, Research, Practice, and Policy, Jul 29 , 2013, No Pagination Specified.

Despite demonstrated effectiveness of cognitive-behavioral psychotherapies for posttraumatic stress disorder (PTSD), there is limited research on the trajectory of PTSD symptom change during the course of these therapies. In addition, existent findings are mixed, making it difficult to know how individuals’ PTSD symptoms will change from week to week during psychotherapy.

The study presented here uses general growth mixture modeling (GGMM) to test the hypothesis that multiple latent classes will explain individual differences in PTSD symptom change during the course of cognitive processing therapy (CPT). Read more . . .
Psychological health of military children- Longitudinal evaluation of a family-centered prevention program to enhance family resilience.
Lester, Patricia; Stein, Judith A.; Saltzman, William; Woodward, Kirsten, et al..
Military Medicine, Volume 178, Number 8, August 2013 , pp. 838-845(8)

Family-centered preventive interventions have been proposed as relevant to mitigating psychological health risk and promoting resilience in military families facing wartime deployment and reintegration. This study evaluates the impact of a family-centered prevention program, Families OverComing Under Stress Family Resilience Training (FOCUS), on the psychological adjustment of military children. Read more . . .
Alcohol use and trauma exposure among male and female veterans before, during, and after military service.
Michelle L. Kelleya, Jennifer Runnalsb, Matthew R. Pearson, et al.
Drug and Alcohol Dependence, Available online 13 August 2013.

The present study examined lifespan and combat-related trauma exposure as predictors of alcohol use among male and female veterans. Posttraumatic stress and depressive symptoms were examined as mediators of the effects of trauma exposure on alcohol use.

Methods: Data were examined from 1825 (1450 male, 375 female) veterans and active duty service members who took part in a multi-site research study conducted through the Department of Veterans Affairs Mid-Atlantic Mental Illness Research, Education and Clinical Centers (VISN 6 MIRECC).

Results: For both men and women, depressive symptoms significantly mediated the effects of non-combat trauma exposure experienced before, during and after the military, as well as combat- exposure, on alcohol use. With posttraumatic stress symptoms, the models for men and women differed. For men, the effects of non-combat trauma exposure during and after military service, and combat exposure, on alcohol use were mediated by PTSD symptoms; however, for women, PTSD symptoms did not mediate these relationships.

Conclusion: Findings are discussed in the context of potential gender differences in response to trauma such as use of alcohol to cope with traumatic events.
Transitioning from the battlefield to home- An innovative program for Israeli soldiers.
Naomi L. Baum, Danny Brom, & Ruth Pat-Horenczyk, et al..
Journal of Aggression, Maltreatment & Trauma.

Soldiers moving from the army to civilian life encounter significant challenges during this time of transition, both in Israel and internationally. Identifying this period of time as a critical one, the Peace of Mind program is an innovative intervention designed specifically to address the issues occurring therein. This unique model focuses on mental health and normalization of responses, as well as on the processing of traumatic experiences. It is based on the considerable experience at the Israel Center for the Treatment of Psychotrauma in the fields of resilience building and trauma treatment. After reviewing the literature on returning soldiers, the model is described and several vignettes are presented.
Psychological health of military children- Longitudinal evaluation of a family-centered prevention program to enhance family resilience.
Lester P., Stein JA., Saltzman W., Woodward K., Macdermid SW., Milburn N., Mogil C., & Beardslee W..
Military Medicine, Volume 178, Number 8, August 2013 , pp. 838-845(8)

Family-centered preventive interventions have been proposed as relevant to mitigating psychological health risk and promoting resilience in military families facing wartime deployment and reintegration. This study evaluates the impact of a family-centered prevention program, Families OverComing Under Stress Family Resilience Training (FOCUS), on the psychological adjustment of military children. Two primary goals include (1) understanding the relationships of distress among family members using a longitudinal path model to assess relations at the child and family level and (2) determining pathways of program impact on child adjustment.

Multilevel data analysis using structural equation modeling was conducted with deidentified service delivery data from 280 families (505 children aged 3-17) in two follow-up assessments. Standardized measures included service member and civilian parental distress (Brief Symptom Inventory, PTSD Checklist-Military), child adjustment (Strengths and Difficulties Questionnaire), and family functioning (McMaster Family Assessment Device).

Distress was significantly related among the service member parent, civilian parent, and children. FOCUS improved family functioning, which in turn significantly reduced child distress at follow-up. Salient components of improved family functioning in reducing child distress mirrored resilience processes targeted by FOCUS. These findings underscore the public health potential of family-centered prevention for military families and suggest areas for future research.
Military and veteran family-centered preventive interventions and care- making meaning of experiences over time.
William R. Beardslee.
Clinical Child and Family Psychology Review, July 2013.

This commentary discusses key themes in four conceptually related papers in this special issue on military families. Individually, the papers highlight the importance of the experiences of young children, the vital role of family narratives, the need for effective communication in families with a combat-injured member, and the need to understand the many dimensions of grieving and loss. Taken together, they compellingly make the case for family-centered care approaches and interventions.

They also emphasize the need for families to understand and make meaning together of the experiences they have undergone and that this is a long-term, ongoing, dynamic, and interactive process.
Latent class differences explain variability in PTSD symptom changes during cognitive processing therapy for veterans.
Schumm, Jeremiah A., Walter, Kristen H., & Chard, Kathleen M..
Psychological Trauma: Theory, Research, Practice, and Policy, Jul 29 , 2013, No Pagination Specified.

Despite demonstrated effectiveness of cognitive-behavioral psychotherapies for posttraumatic stress disorder (PTSD), there is limited research on the trajectory of PTSD symptom change during the course of these therapies. In addition, existent findings are mixed, making it difficult to know how individuals’ PTSD symptoms will change from week to week during psychotherapy.

The study presented here uses general growth mixture modeling (GGMM) to test the hypothesis that multiple latent classes will explain individual differences in PTSD symptom change during the course of cognitive processing therapy (CPT). Read more . . .
Alcohol use and trauma exposure among male and female veterans before, during, and after military service.
Kelly, ML & Runnals, J., et al.
Drug and Alcohol Dependence, available online 13 August 2013

Background: The present study examined lifespan and combat-related trauma exposure as predictors of alcohol use among male and female veterans. Posttraumatic stress and depressive symptoms were examined as mediators of the effects of trauma exposure on alcohol use. Read more . . .
Family systems and ecological perspectives on the impact of deployment on military families.
Paley B, Lester P, & Mogil C..
Clin Child Fam Psychol Rev. 2013 Jun 13. [Epub ahead of print] PMID:23760926[PubMed - as supplied by publisher]

The scope of sustained military operations in Iraq and Afghanistan has placed great demands on the Armed Forces of the United States, and accordingly, military families have been faced with deployments in more rapid succession than ever before. When military parents fulfill occupational duties during wartime, military children and families face multiple challenges, including extended separations, disruptions in family routines, and potentially compromised parenting related to traumatic exposure and subsequent mental health problems. Such challenges can begin to exert a significant toll on the well-being of both individuals and relationships (e.g., marital, parent-child) within military families.

In order to respond more effectively to the needs of military families, it is essential that mental health clinicians and researchers have a better understanding of the challenges faced by military families throughout the entire deployment experience and the ways in which these challenges may have a cumulative impact over multiple deployments. Moreover, the mental health field must become better prepared to support service members and families across a rapidly evolving landscape of military operations around the world, including those who are making the transition from active duty to Veteran status and navigating a return to civilian life and those families in which parents will continue to actively serve and deploy in combat zones.

In this article, we utilize family systems and ecological perspectives to advance our understanding of how military families negotiate repeated deployment experiences and how such experiences impact the well-being and adjustment of families at the individual, dyadic, and whole family level.
Co-occurring mental health and alcohol misuse- Dual disorder symptoms in combat injured veterans.
Kevin J. Heltemes, Mary C. Clouser, & Andrew J. MacGregor.
Addictive Behaviors, Available online 18 June 2013.

Objective: Service members face difficulties during military deployment potentially resulting in morbidities such as posttraumatic stress disorder (PTSD), depression, and alcohol misuse. The co-occurrence of alcohol misuse and mental health disorders is termed dual disorder and has been associated with adverse outcomes.

Methods: The study included 812 high-risk (i.e., endorsing combat exposure with documented combat injury) male U.S. veterans of Operation Iraqi Freedom, injured between October 2004 and November 2007, identified from the Expeditionary Medical Encounter Database.

Results: PTSD and depression symptoms were significant correlates of alcohol misuse. Veterans with dual disorder symptoms reported a significantly higher mean number of health complaints on the Post-Deployment Health Reassessment compared with those endorsing only mental health symptoms.

Conclusions: These results highlight how mental health disorders among injured service members increases the odds of problem drinking and those with dual disorder have elevated health complaints.
Combat disclosure in intimate relationships- Mediating the impact of partner support on posttraumatic stress.
Balderrama-Durbin, Christina; Snyder, Douglas K, et al..
Journal of Family Psychology, Jun 17 , 2013.

Although previous research has shown a negative relation between partner support and posttraumatic stress disorder (PTSD) symptom severity among military service members following deployment, the mediating mechanisms of this effect remain poorly understood. This study examined willingness to disclose deployment- and combat-related experiences as a mediating mechanism underlying the linkage between intimate partner support and PTSD symptom severity in a sample of 76 U.S. Air Force service members deployed to Iraq in a year-long, high-risk mission.

Airmen's reports of overall social support, and partner support specifically, significantly predicted concurrent postdeployment PTSD symptom severity. Subsequent mediation analyses demonstrated that level of disclosure of deployment- and combat-related experiences by service members to their intimate partners accounted for a significant portion of the relation between partner support and postdeployment PTSD symptom severity. The level of Airmen's disclosure was also inversely related to levels of relationship distress. Implications of these findings for prevention and intervention strategies and for further research are discussed.
Stigma and demographic correlates of help-seeking intentions in returning service members.
Rebecca K. Blais, & Keith D. Renshaw.
Journal of Traumatic Stress, Vol 26 Issue 1.

Many U.S. Iraq/Afghanistan-era veterans return from deployment with posttraumatic stress (PTS) symptoms, but few veterans seek psychological help. Research on barriers to care is growing, but the link between stigma and help-seeking is understudied.

The present study examined anticipated enacted stigma from military and nonmilitary sources, self-stigma, PTS, perceived likelihood of deploying again, marital status, and history of mental health care engagement as correlates of help-seeking intentions from a mental health professional or medical doctor/advance practice registered nurse (MD/APRN) in a sample of 165 combat veterans. Read more . . .
Combat-related killing- Expanding evidence-based treatments for PTSD.
Shira Maguen, & Kristine Burkman.
Cognitive and Behavioral Practice, Available online 9 June 2013.

Despite its prevalence, killing in war is an experience that may not fit neatly into existing models of posttraumatic stress disorder (PTSD) and its treatment. The context in which killing occurred may be complex. Furthermore, while killing may certainly be fear based, an individual may have also killed in response to losing someone close and experiencing sadness and anger, as opposed to fear.

While evidence-based treatments for PTSD may be a good starting point for killing-related trauma, we argue that existing treatments need to be expanded. Complex killing-related cognitions that may not be anticipated or identified, moral injury, self-forgiveness, and loss are all important issues that arise that may need to be addressed in greater detail.

Consequently, we have developed a 6- to 8-session individual treatment module for those impacted by killing in war, expressly designed for use with existing evidence-based treatments for PTSD, currently being validated for use in clinical practice. We see this module as supplementary, rather than as a replacement, building on the skills that veterans have already learned within these treatments. By expanding the types of treatments we offer those who have killed in war, we can ensure that we are providing veterans with comprehensive treatment that takes the complexities of war and its aftermath into account.
Stigma associated with PTSD- Perceptions of treatment seeking combat veterans.
Mittal, Dinesh; Drummond, Karen L.; Blevins, Dean; Curran, Geoffrey; Corrigan, Patrick; & Sullivan, Greer.
Psychiatric Rehabilitation Journal, Vol 36(2), Jun 2013, 86-92.

Although stigma associated with serious mental illness, substance abuse disorders, and depression has been studied very little is known about stigma associated with Posttraumatic Stress Disorder (PTSD). This study explored stigma related to PTSD among treatment-seeking Operation Enduring Freedom and Operation Iraqi Freedom (OEF/OIF) combat veterans. Read more . . .
Delayed-onset PTSD after combat - The role of social resources.
Horesh D; Solomon Z; & Ein-Dor T.
Journal of Community Psychology, Volume 41, Number 5, July 2013, pp. 532-548, Article first published online: 10 JUN 2013.

Delayed-onset posttraumatic stress disorder (DPTSD) has been under medico-legal debate for years. Previous studies examining the prevalence and underlying mechanisms of DPTSD have yielded inconclusive findings. This study examined the role of social resources and warzone exposure in DPTSD. Read more . . .
Veterans administration health care utilization among sexual minority veterans.
Simpson, Tracy L.; Balsam, Kimberly F.; Cochran, Bryan N.; Lehavot, Keren; & Gold, Sari D..
Psychological Services, Vol 10(2), May 2013, 223-232.

According to recent census reports, nearly a million veterans have a same-sex partner, yet little is known about them or their use of Veterans Health Care Administration (VHA) services. Gay, lesbian, and bisexual (GLB) veterans recruited from the community (N = 356) completed an on-line survey to assess their rates of VHA utilization and whether they experience specific barriers to accessing VHA services. Read more . . .
Treatment of comorbid pain and PTSD in returning Veterans- A collaborative approach utilizing Behavioral Activation.
Plagge JM, Lu MW, Lovejoy TI, Karl AI, & Dobscha SK..
Pain Med. 2013 Jun 7. [Epub ahead of print] PMID:23746043[PubMed - as supplied by publisher]

OBJECTIVE: We explore preliminary clinical effectiveness and feasibility of an intervention utilizing collaborative care components and behavioral activation (BA) to treat comorbid chronic pain and posttraumatic stress disorder (PTSD). Read more . . .
Barriers to care for women veterans with posttraumatic stress disorder and depressive symptoms.
Lehavot K, Der-Martirosian C, Simpson TL, Sadler AG, & Washington DL..
Psychol Serv. 2013 May;10(2):203-12. PMID:23730964[PubMed - in process]

As the number of women veterans continues to rise, an issue of concern is whether those with mental health symptoms experience disproportionate barriers to care. The purpose of this study was to examine unmet medical needs and barriers to health care among women veterans who screened positive for lifetime posttraumatic stress disorder (PTSD), current depressive symptoms, both or neither. Read more . . .
Influence of trauma history on panic and posttraumatic stress disorder in returning veterans.
Barrera TL, Graham DP, Dunn NJ, & Teng EJ..
Psychol Serv. 2013 May;10(2):168-76. PMID:23730962[PubMed - in process]

The current study examined the role of predeployment sexual and physical abuse, combat exposure, and postdeployment social support in predicting panic disorder and PTSD diagnoses in a large sample of returning veterans. A chart review was conducted for 1740 OEF/OIF veterans who received mental health screenings at a large VA hospital between May 24, 2004 and March 26, 2008. Assessments included psychosocial evaluations conducted by psychiatrists, psychologists, and social workers in addition to self-report measures.

Results suggested that the prevalence of panic disorder (6.1%) and PTSD (28.7%) are elevated among OEF/OIF veterans. Veterans reporting higher levels of combat experience were likely to be diagnosed with PTSD (odds ration [OR], 1.17; 95% confidence interval [CI], 1.10-1.25; p < .001) or comorbid panic disorder and PTSD (OR, 1.18; 95% CI, 1.04-1.33; p < .001). Veterans endorsing predeployment sexual abuse were likely to be diagnosed with comorbid panic disorder and PTSD (OR, 3.05; 95% CI, 1.15-8.08; p < .05), as were veterans endorsing predeployment physical abuse (OR, 0.47; 95% CI, 0.22-1.00; p < .05). Panic disorder was also found to be associated with greater risk for suicide attempts than PTSD (?2 = 16.38, p = .001).

These findings indicate a high prevalence of panic disorder among returning veterans and highlight the importance for clinicians to assess returning veterans routinely for panic disorder in addition to PTSD.
Approaching family-focused systems of care for military and veteran families.
MacDermid Wadswortha, S; Lesterb P; Marinia,C; Cozzac S; Sornborgerb J; Strouseb T; & Beardsleed W.
Mil Behav Health; Volume 1, Issue 1, 2013

Although current research recognizes robust interdependence among family members, it is not yet evident that such principles have fully integrated into existing systems of care for military and veteran families. Such gaps can create disadvantages in delivering effective support, prevention, and treatment, while including families may yield significant advantages.

This article highlights theoretical frameworks and empirical evidence that illustrate the relevance of systemic approaches to supporting service members, veterans, and their families. We discuss examples of family-centered approaches already in place and identify gaps in existing systems of care.
The roles of combat exposure, personal vulnerability, and involvement in harm to civilians or prisoners in Vietnam war-related posttraumatic stress disorder.
Dohrenwend, Bruce P.; Yager, Thomas J.; Wall, Melanie M.; & Adams, Ben G.
Clinical Psychological Science February 15, 2013.

The diagnosis posttraumatic stress disorder was introduced in 1980 amid debate about the psychiatric toll of the Vietnam War. There is controversy, however, about its central assumption that potentially traumatic stressors are more important than personal vulnerability in causing the disorder.

We tested this assumption with data from a rigorously diagnosed male subsample (n = 260) from the National Vietnam Veterans Readjustment Study. Combat exposure, prewar vulnerability, and involvement in harming civilians or prisoners were examined, with only combat exposure proving necessary for disorder onset.

Although none of the three factors proved sufficient, estimated onset reached 97% for veterans high on all three, with harm to civilians or prisoners showing the largest independent contribution. Severity of combat exposure proved more important than prewar vulnerability in onset; prewar vulnerability was at least as important in long-term persistence. Implications for the primacy of the stressor assumption, further research, and policy are discussed.
Posttraumatic stress symptomatology as a mediator of the relationship between warzone exposure and physical health symptoms in men and women.
Schuster-Wachen Jennifer, Shipherd Jillian C., & Suvak Michael.
Journal of Traumatic Stress, Early View.

The mediating role of posttraumatic stress symptomatology (PSS) on the association between warzone exposure and physical health symptoms in 7 bodily systems (cardiovascular, dermatological, gastrointestinal, genitourinary, musculoskeletal, neurological, and pulmonary) was examined. We also examined if mediation effects varied as a function of sex.

A sample of 317 U.S. Gulf war veterans was assessed for warzone exposure, PSS, and physical health symptoms 10 years after deployment.

PSS was significantly associated with postdeployment physical health in all symptom categories when accounting for predeployment health (with effect sizes ranging from a 1.27-1.64 increase in the likelihood of postdeployment physical health symptoms with a 1 standard deviation increase in the PSS symptoms). PSS severity mediated the relationship between warzone exposure and postdeployment symptoms in all physical health domains (with percent mediation ranging 44%-75%). A significant Warzone Exposure × PSS interaction emerged for 5 outcomes such that the effect of PSS on physical health was stronger for veterans reporting lower warzone exposure. No significant interactions with sex emerged.

These findings suggest the important influence of PSS on physical health symptoms for both men and women.
Neural response to errors in combat-exposed returning veterans with and without post-traumatic stress disorder- A preliminary event-related potential study.
Rabinaka, Christine A. ; Holmanb, Alexis; Angstad, Mike; et al.
Psychiatry Research: Neuroimaging, Available online 17 May 2013.

Post-traumatic stress disorder (PTSD) is characterized by sustained anxiety, hypervigilance for potential threat, and hyperarousal. These symptoms may enhance self-perception of one’s actions, particularly the detection of errors, which may threaten safety.

The error-related negativity (ERN) is an electrocortical response to the commission of errors, and previous studies have shown that other anxiety disorders associated with exaggerated anxiety and enhanced action monitoring exhibit an enhanced ERN. However, little is known about how traumatic experience and PTSD would affect the ERN.

To address this gap, we measured the ERN in returning Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF) veterans with combat-related PTSD (PTSD group), combat-exposed OEF/OIF veterans without PTSD [combat-exposed control (CEC) group], and non-traumatized healthy participants [healthy control (HC) group]. Event-related potential and behavioral measures were recorded while 16 PTSD patients, 18 CEC, and 16 HC participants completed an arrow version of the flanker task.

No difference in the magnitude of the ERN was observed between the PTSD and HC groups; however, in comparison with the PTSD and HC groups, the CEC group displayed a blunted ERN response. These findings suggest that (1) combat trauma itself does not affect the ERN response; (2) PTSD is not associated with an abnormal ERN response; and (3) an attenuated ERN in those previously exposed to combat trauma but who have not developed PTSD may reflect resilience to the disorder, less motivation to do the task, or a decrease in the significance or meaningfulness of 'errors,' which could be related to combat experience.
Mild traumatic brain injury and treatment response in Prolonged Exposure for PTSD.
Sripada Rebecca K., Rauch Sheila A.M., Peter W. Tuerk, et al.
Journal of Traumatic Stress, Early View.

A proportion of U.S. veterans returning from Iraq and Afghanistan have experienced mild traumatic brain injury (mTBI), which is associated with increased risk for developing posttraumatic stress disorder (PTSD). Prolonged Exposure (PE) has proven effectiveness in the treatment of PTSD; however, some clinicians have reservations about using PE with individuals with a history of mTBI.

We examined the impact of PE for veterans with PTSD and with or without a history of mTBI in a naturalistic sample of 51 veterans who received PE at a Veterans Health Administration PTSD clinic. We also analyzed previously collected data from a controlled trial of 22 veterans randomly assigned to PE or present centered therapy.

For both sets of data, we found that PE reduced symptom levels and we also did not detect an effect for mTBI, suggesting that PE may be helpful for individuals with PTSD and a history of mTBI.
Posttraumatic stress disorder in OEF-OIF veterans with and without traumatic brain injury.
Ragsdalea,Katie A.; Neera, Sandra M; Beidel, Deborah C.; et al.
Journal of Anxiety Disorders, Available online 25 April 2013.

Veterans of Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF) are presenting with high rates of co-occurring posttraumatic stress disorder (PTSD) and traumatic brain injury (TBI). The purpose of this study was to compare the clinical presentations of combat-veterans with PTSD and TBI (N = 40) to those with PTSD only (N = 56).

Results suggest that the groups present two distinct clinical profiles, with the PTSD + TBI group endorsing significantly higher PTSD scores, higher overall anxiety, and more functional limitations. The higher PTSD scores found for the PTSD + TBI group appeared to be due to higher symptom intensity, but not higher frequency, across PTSD clusters and symptoms. Groups did not differ on additional psychopathology or self-report of PTSD symptoms or executive functioning.

Further analysis indicated PTSD severity, and not TBI, was responsible for group differences, suggesting that treatments implicated for PTSD would likely be effective for this population.
PTSD symptoms and family versus stranger violence in Iraq and Afghanistan veterans.
Sullivan, Connor P. & Elbogen, Eric B.
Law and Human Behavior, May 6 , 2013, No Pagination Specified.

As a diagnosis, posttraumatic stress disorder (PTSD) has been associated with violence committed by veterans in many studies; however, a potential link to specific PTSD symptoms has received relatively less attention. This paper examines the relationship between PTSD symptoms and different types of violent behavior in Iraq and Afghanistan veterans. Read more . . .
Prevalence and features of generalized anxiety disorder in Department of Veteran Affairs primary care settings.
Melissa E. Milanaka, Daniel F. Gros, et al.
Psychiatry Research, Available online 7 May 2013.

Generalized anxiety disorder (GAD) is a highly prevalent distressing condition for individuals in both community and community primary care settings. However, despite the high prevalence of GAD identified in epidemiological studies, little is known about GAD and its related symptoms and impairments in veteran populations.

The present study investigated the prevalence, comorbidity, physical and mental health impairment, and healthcare utilization of veteran participants with GAD, as well as comparing symptoms of GAD and posttraumatic stress disorder (PTSD). Veterans (N=884) participated in a cross-sectional investigation in primary care clinics in four Veteran Affairs Medical Centers (VAMCs) and completed diagnostic interviews and self-report questionnaires; a chart review was conducted to assess their VAMC healthcare utilization.

A large number of participants (12%) met diagnostic criteria for GAD, reporting significantly worse emotional health, pain, and general health, in addition to increased mental healthcare utilization and antidepressant medications. In addition, GAD was found in 40% of participants with PTSD, resulting in more severe symptoms and impairment than in patients with GAD alone. These findings provide evidence of high prevalence and severe impairment associated with GAD in veterans and highlight the need for improved recognition, assessment, and treatments for GAD.
A cluster randomized trial of adding peer specialists to intensive case management teams in the Veterans Health Administration.
Matthew Chinman, Rebecca S. Oberman, Barbara H. Hanusa, Amy N. Cohen, Michelle P. Salyers, Elizabeth W. Twamley, & Alexander S. Young.
Journal of Behavioral Health Services & Research May 2013.

Use of peer specialists (PSs)-individuals with serious mental illness who use their experiences to help others with serious mental illness-is increasing. However, their impact on patient outcomes has not been demonstrated definitively.

This cluster randomized, controlled trial within the Veterans Health Administration compared patients served by three intensive case management teams that each deployed two PSs for 1 year, to the patients of three similar teams without PSs (Usual Care). All patients (PS group = 149, Usual Care = 133) had substantial psychiatric inpatient histories and a primary Axis 1 psychiatric disorder. Before and after the year PSs worked, patients were surveyed on their recovery, quality of life, activation (health self-management efficacy), interpersonal relations, and symptoms.

Patients in the PS group improved significantly more (z = 2.00, df = 1, p = 0.05) than those receiving Usual Care on activation. There were no other significant differences. PSs helped patients become more active in treatment, which can promote recovery.
Neuropsychological functioning of combat veterans with posttraumatic stress disorder and mild traumatic brain injury.
Jason R. Soble, Lisa B. Spanierman & Julie Fitzgerald Smith.
Journal of Clinical and Experimental Neuropsychology, Published online15 May 2013

This study examined the neuropsychological performance of 125 outpatient Operation Enduring Freedom/Operation Iraqi Freedom combat veterans with posttraumatic stress disorder (PTSD) and nonacute mild traumatic brain injury (TBI) (n = 66) and PTSD (n = 59) across multiple cognitive domains to determine whether mild TBI results in greater impairment among those with PTSD.

Profile analyses revealed that veterans with PTSD and mild TBI did not differ significantly from those with just PTSD across domains, suggesting that comorbid mild TBI does not result in an additive effect. A norms-based comparison also revealed that neither group demonstrated impaired performance on any of the objective neuropsychological measures examined. However, both groups endorsed moderately elevated symptoms of depression and anxiety, indicating that comorbid psychopathology may contribute to subjective cognitive complaints.
Improving access to care for women veterans suffering from chronic pain and depression associated with trauma.
Gabriel Tan, Devika Srivastava, Donna Smith , et al..
Pain Medicine, Early View

Access to care has become a priority for the Veterans Administration (VA) health care system as a significant number of veterans enrolled in the VA health care system reside in rural areas. The feasibility and effects of a novel clinical intervention that combined group therapy and biofeedback training was evaluated on women veterans living in rural areas. Read more . . .
Support mechanisms and vulnerabilities in relation to PTSD in veterans of the Gulf War, Iraq War, and Afghanistan deployments- A systematic review.
Breanna K. Wright, Helen L. Kelsall, Malcolm R. Sim, David M. Clarke, & Mark C. Creamer.
Journal of Traumatic Stress, Early View.

Pre-trauma factors of psychiatric history and neuroticism have been important in highlighting vulnerability to posttraumatic stress disorder (PTSD), whereas posttrauma support mechanisms have been associated with positive health and well-being outcomes, particularly in veterans. The relationship between these factors and PTSD has not been the subject of a systematic review in veterans. Read more . . .
Sexual dysfunction in male Iraq and Afghanistan war veterans- Association with posttraumatic stress disorder and other combat-related mental health disorders- A population-based cohort study.
Breyer BN, Cohen BE, Bertenthal D, Rosen RC, Neylan TC, & Seal KH.
The Journal of Sexual Medicine, Early View.

Introduction: Mental health disorders are prevalent in the United States, Iraq, and Afghanistan war veterans. Mental illness, including posttraumatic stress disorder (PTSD) with or without psychiatric medications, can increase the risk for male sexual dysfunction, threatening quality of life. Aims: We sought to determine the prevalence and correlates of sexual dysfunction among male Iraq and Afghanistan veterans. Methods We performed a retrospective cohort study of 405,275 male Iraq and Afghanistan veterans who were new users of U.S. Department of Veterans Affairs healthcare from October 7, 2001 to September 30, 2009 and had 2-year follow-up. Read more . . .
Significant others' responses to pain in veterans with chronic pain and clinical levels of post-traumatic stress disorder symptomatology.
Alschuler KN, & Otis JD.
European Journal of Pain (EUR J PAIN), 2013 Feb; 17 (2): 245-54.

BACKGROUND: Pain and post-traumatic stress disorder (PTSD) are two of the most common health complaints among US veterans. Studies suggest that the co-morbidity of these disorders exacerbates veterans' experiences of chronic pain. Although a limited number of papers have reviewed reasons for this exacerbation, no studies have explored the potential contribution of significant others' responses to veterans' experience of pain in the context of PTSD symptomatology. The purpose of this study was to explore whether significant others' responses to chronic pain differed for veterans with and without clinical levels of PTSD symptoms. It was hypothesized that veterans who presented with higher levels of PTSD symptomatology would report higher levels of 'punishing' responses to their pain from significant others. Read more . . .
Efficacy of a Cognitive-Behavioral Treatment for insomnia and nightmares in Afghanistan and Iraq veterans With PTSD.
Skye Ochsner Margolies, Bruce Rybarczyk, Scott R. Vrana, David J. Leszczyszyn, & John Lynch.
Journal of Clinical Psychology, 29 APR 2013

Sleep disturbances are a core and salient feature of posttraumatic stress disorder (PTSD). Pilot studies have indicated that combined cognitive-behavioral therapy for insomnia (CBT-I) and imagery rehearsal therapy (IRT) for nightmares improves sleep as well as PTSD symptoms. Read more . . .
Overgeneralized autobiographical memory and future thinking in combat veterans with posttraumatic stress disorder.
Brown AD, Root JC, Romano TA, Chang LJ, Bryant RA, & Hirst W.
J Behav Ther Exp Psychiatry. 2013 Mar;44(1):129-34 PMID: 22200095 [PubMed - indexed for MEDLINE]

BACKGROUND: Studies show that individuals with Posttraumatic Stress Disorder (PTSD) tend to recall autobiographical memories with decreased episodic specificity. A growing body of research has demonstrated that the mechanisms involved in recalling autobiographical memories overlap considerably with those involved in imagining the future. Although shared autobiographical deficits in remembering the past and imagining the future have been observed in other clinical populations, this has yet to be examined in PTSD. This study examined whether, compared to combat trauma-exposed individuals without PTSD, those with combat-related PTSD would be more likely to generate overgeneralized autobiographical memories and imagined future events. Read more . . .
Prospective study of posttraumatic stress disorder and disease activity outcomes in US veterans with rheumatoid arthritis.
Mikuls TR, Padala PR, Sayles HR, Yu F, Michaud K, Caplan L, Kerr GS, Reimold A, Cannon GW, Richards JS, Lazaro D, Thiele GM, & Boscarino JA.
Arthritis Care Res (Hoboken). 2013 Feb;65(2):227-34. doi: 10.1002/acr.21778. PMID:22740431[PubMed - indexed for MEDLINE]

OBJECTIVE: To examine the relationship between posttraumatic stress disorder (PTSD) and disease activity in US veterans with rheumatoid arthritis (RA). Read more . . .
Psychological trauma symptom improvement in veterans using emotional freedom technique- a randomized controlled trial.
Church D, Hawk C, Brooks AJ, Toukolehto O, Wren M, Dinter I, & Stein P.
J Nerv Ment Dis. 2013 Feb;201(2):153-60. PMID:23364126[PubMed - indexed for MEDLINE]

This study examined the effect of Emotional Freedom Techniques (EFT), a brief exposure therapy combining cognitive and somatic elements, on posttraumatic stress disorder (PTSD) and psychological distress symptoms in veterans receiving mental health services. Veterans meeting the clinical criteria for PTSD were randomized to EFT (n = 30) or standard of care wait list (SOC/WL; n = 29).

The EFT intervention consisted of 6-hour-long EFT coaching sessions concurrent with standard care. The SOC/WL and EFT groups were compared before and after the intervention (at 1 month for the SOC/WL group and after six sessions for the EFT group). The EFT subjects had significantly reduced psychological distress (p < 0.0012) and PTSD symptom levels (p < 0.0001) after the test. In addition, 90% of the EFT group no longer met PTSD clinical criteria, compared with 4% in the SOC/WL group. After the wait period, the SOC/WL subjects received EFT. In a within-subjects longitudinal analysis, 60% no longer met the PTSD clinical criteria after three sessions. This increased to 86% after six sessions for the 49 subjects who ultimately received EFT and remained at 86% at 3 months and at 80% at 6 months.

The results are consistent with that of other published reports showing EFT's efficacy in treating PTSD and comorbid symptoms and its long-term effects.
Group exposure therapy treatment for post-traumatic stress disorder in female veterans.
Castillo DT, C' de Baca J, Qualls C, & Bornovalova MA..
Mil Med. 2012 Dec;177(12):1486-91. PMID:23397693[PubMed - indexed for MEDLINE]

OBJECTIVES: The purpose of this study was to examine the application of a group exposure therapy model, the content of which consisted solely of repeated imaginal exposure during sessions, in a clinical sample of female veterans with post-traumatic stress disorder (PTSD). Establishing group delivery of exposure therapy will expand options, increase efficiency, and introduce group curative factors. Read more . . .
The effects of alcohol problems, PTSD, and combat exposure on nonphysical and physical aggression among Iraq and Afghanistan war veterans.
Stappenbeck, Cynthia A.; Hellmuth, Julianne C.; Simpson, Tracy; & Jakupcak, Matthew.
Psychological Trauma: Theory, Research, Practice, and Policy, Apr 1 , 2013, No Pagination Specified.

Aggression among combat veterans is of great concern. Although some studies have found an association between combat exposure and aggressive behavior following deployment, others conclude that aggression is more strongly associated with symptoms of posttraumatic stress disorder (PTSD), and that alcohol misuse may influence this association. Many of these studies have assessed aggression as a single construct, whereas the current study explored both nonphysical aggression only and physical aggression in a sample of Iraq and Afghanistan war veterans (N = 337; 91% male).

We found that alcohol problems interacted with PTSD symptom severity to predict nonphysical aggression only. At low levels of PTSD symptoms, veterans with alcohol problems were more likely to perpetrate nonphysical aggression only, as compared with no aggression, than veterans without an alcohol problem. There was no difference in the likelihood of nonphysical aggression only between those with and without alcohol problems at high levels of PTSD symptoms. The likelihood of nonphysical aggression only, as compared with no aggression, was also greater among younger veterans. Greater combat exposure and PTSD symptom severity were associated with an increased likelihood of perpetrating physical aggression, as compared with no aggression. Ethnic minority status and younger age were also associated with physical aggression, as compared with no aggression.

Findings suggest that a more detailed assessment of veterans' aggressive behavior, as well as their alcohol problems and PTSD symptoms, by researchers and clinicians is needed in order to determine how best to intervene.
Outcomes of participation in the REACH Multifamily Group Program for veterans with PTSD and their families.
Fischer, Ellen P.; Sherman, Michelle D.; Han, Xiaotong; & Owen Jr., Richard R..
Professional Psychology: Research and Practice, Mar 18 , 2013, No Pagination Specified.

Posttraumatic stress disorder (PTSD) is prevalent among users of the Veterans Affairs (VA) health care system. Effective approaches to involving family in care for PTSD are critical because family functioning both affects and is affected by treatment outcomes. Although multifamily group treatment is an evidence-based practice for schizophrenia and other serious mental illnesses, no data have been published on its effectiveness for those living with PTSD and their family members.

This study examined the impact of participation in REACH (Reaching out to Educate and Assist Caring, Healthy Families), an adaptation of the multifamily group psychoeducation program tailored for delivery to veterans with PTSD and their family members. Read more . . .
Attentional interference by threat and post-traumatic stress disorder- The role of thought control strategies.
Wisco BE, Pineles SL, Shipherd JC, & Marx BP.
Cogn Emot. 2013 Mar 21; PMID: 23517445 [PubMed - as supplied by publisher]

Attentional interference by threat is associated with PTSD, but the mechanisms of this relationship remain unclear. Attentional interference might be related to increased use of maladaptive thought control strategies, such as suppressing unwanted thoughts (thought suppression) or replacing threatening thoughts with everyday concerns (worry), which increase PTSD risk. Conversely, attentional interference might be associated with reduced use of adaptive strategies, such as talking about threatening thoughts (social control), which decrease PTSD risk.

This study tested if thought control strategies mediate the relationship between attentional interference and PTSD. Sixty-one male Vietnam-era veterans completed measures of PTSD symptoms and thought control strategies. Participants also completed a Visual Search Task measuring attentional interference, which required participants to identify a target letter string among a group of threat or neutral words.

Attentional interference by threat was related to PTSD symptoms, and mediation analyses revealed significant indirect effects of attentional interference through thought suppression and worry. Attentional interference was related to re-experiencing and avoidance, but not hyperarousal, symptom clusters. Thought suppression was a unique mediator for re-experiencing, whereas thought suppression and worry both mediated the relationship with avoidance.

These results offer evidence for maladaptive thought control strategies as a mechanism linking attentional biases for threat to PTSD.
“Toughness” in association with mental health symptoms among Iraq and Afghanistan war veterans seeking veterans affairs health care.
Jakupcak, Matthew; Blais, Rebecca K.; Grossbard, Joel; Garcia, Hector; & Okiishi, John.
Psychology of Men & Masculinity, Feb 18 , 2013

The association between endorsement of emotional “toughness” (i.e., extreme self-reliance and the suppression of outward displays of emotional distress) and likelihood for screening positive for mental health conditions was examined in a male sample of 198 Iraq and Afghanistan veterans presenting for postdeployment Veteran Affairs health care.

After accounting for relevant covariates, veterans endorsing higher levels of emotional toughness were more likely to screen positive for posttraumatic stress disorder and depression. There was also a nonsignificant trend (p = .08) associated with a positive relationship between toughness and likelihood of self-reported alcohol abuse.

Results are discussed in terms of identifying and addressing toughness norms among returning veterans to promote effective use of mental health services.
Evaluation of a removable intraoral soft stabilization splint for the reduction of headaches and nightmares in military PTSD patients- A large case series.
Moeller DR.
J Spec Oper Med. 2013;13(1):49-54 PMID: 23526322 [PubMed - as supplied by publisher]

This large case series reports the results of using a removable soft intraoral stabilization splint in the treatment of chronic headaches and chronic nightmares in 60 military post-traumatic stress disorder (PTSD) patients of the Vietnam, Desert Storm, Operation Iraqi Freedom, and Operation Enduring Freedom conflicts.

Patient treatment criteria included meeting all of the following requirements: minimum of three headaches per week; minimum of three nightmares per week; minimum of three sleep interruptions per week; minimum of three intraoral or extraoral (craniofacial) trigger points; and previous PTSD diagnosis by the U.S. Army or Veterans Administration with duration of this disorder for a minimum of three years.

Significant reduction (60%?90%) in headache and nightmare severity, intensity, and duration was obtained in 75% of the 44 patients who completed the three-month follow-up.
PTSD and conflict behavior between veterans and their intimate partners.
Heyman RE.
J Anxiety Disord. 2013 Mar 4;27(2):240-251 PMID: 23523947 [PubMed - as supplied by publisher]

This study examined the influence of trauma history and PTSD symptoms on the behavior of veterans and their intimate partners (287 couples; N=574) observed during conflict discussions and coded using the Rapid Marital Interaction Coding System (Heyman, 2004).

Dyadic structural equation modeling analyses showed that PTSD was associated with more frequent displays of hostility and psychological abuse and fewer expressions of acceptance and humor in both veterans and their partners.

Findings provide new insight into the social and emotional deficits associated with PTSD and emphasize the importance of addressing the trauma histories and PTSD of both partners when treating veteran couples with relationship disturbance.
Evaluating the feasibility of Goal Attainment Scaling as a rehabilitation outcome measure for veterans.
Lewis VJ, Dell L, & Matthews LR.
Rehabil Med. 2013 Mar 28;45(4):403-9 PMID: 23546308 [PubMed - in process]

Objective: The increasing number of veterans with complex health conditions accessing rehabilitation leads to the need for an outcome measure that identifies success in areas beyond return to work. The current study was designed to assess the feasibility of Goal Attainment Scaling as a routine measure of outcomes of rehabilitation. Read more . . .
Gender differences in posttraumatic stress symptoms among OEF-OIF veterans- An item response theory analysis.
King MW, Street AE, Gradus JL, Vogt DS, & Resick PA.
J Trauma Stress. 2013 Mar 22; PMID: 23526678 [PubMed - as supplied by publisher

Establishing whether men and women tend to express different symptoms of posttraumatic stress in reaction to trauma is important for both etiological research and the design of assessment instruments. Use of item response theory (IRT) can reveal how symptom reporting varies by gender and help determine if estimates of symptom severity for men and women are equally reliable.

We analyzed responses to the PTSD Checklist (PCL) from 2,341 U.S. military veterans (51% female) who completed deployments in support of operations in Afghanistan and Iraq (Operation Enduring Freedom/Operation Iraqi Freedom [OEF/OIF]), and tested for differential item functioning by gender with an IRT-based approach.

Among men and women with the same overall posttraumatic stress severity, women tended to report more frequent concentration difficulties and distress from reminders whereas men tended to report more frequent nightmares, emotional numbing, and hypervigilance. These item-level gender differences were small (on average d = 0.05), however, and had little impact on PCL measurement precision or expected total scores. For practical purposes, men's and women's severity estimates had similar reliability.

This provides evidence that men and women veterans demonstrate largely similar profiles of posttraumatic stress symptoms following exposure to military-related stressors, and some theoretical perspectives suggest this may hold in other traumatized populations.
A pilot evaluation of the afterdeployment.org online posttraumatic stress workshop for military service members and veterans.
Bush, Nigel E.; Prins, Annabel; Laraway, Sean; O'Brien, Karen; Ruzek, Joséf; & Ciulla, Robert P.
Psychological Trauma: Theory, Research, Practice, and Policy, Mar 25 , 2013, No Pagination Specified.

This pilot study employed a nonconcurrent, multiple-baseline single-case design to examine the impact of an online self-management posttraumatic stress (PTS) workshop on self-reported symptoms of PTS, depression, and functional impairment.

Eleven student veterans with PTS first completed between three and five weekly baseline measures. Second, they took part in eight weekly online workshop sessions, each accompanied by symptom assessments. Third, they completed postintervention outcome measures. Read more . . .
Participation in outdoor recreation program predicts improved psychosocial well-being among veterans with post-traumatic stress disorder- A pilot study.
Vella, Elizabeth Jane; Milligan, Briana; Bennett, & Jessie Lynn.
Military Medicine, Volume 178, Number 3, March 2013 , pp. 254-260(7)

Purpose: Evaluate the effectiveness of a 2-day, 3-night outdoor recreation intervention involving fly-fishing in reducing the psychological concomitants of stress among 74 veterans (M = 47.27, SD = 14.55 years) with post-traumatic stress disorder (PTSD).

Methods: Participants completed repeated assessments of attentiveness, mood, depression, anxiety, and somatic stress across 3 time periods, corresponding to 2 weeks before the trip (baseline), the last day of the trip, and a 6-week follow-up. Assessments of perceptual stress, PTSD symptoms, and sleep quality were also administered during the baseline and follow-up periods.

Results: Acute effects were observed for improvements in attentiveness and positive mood states, coupled with significant and sustained reductions in negative mood states, anxiety, depression, and somatic symptoms of stress. Comparisons between the baseline and follow-up periods revealed significant improvements in sleep quality and reductions in perceptual stress and PTSD symptoms.

Conclusions: The current findings suggest that combat veterans with PTSD may benefit from participation in group-based outdoor recreation as a means to improve psychosocial well-being.
Risk and protective factors associated with symptoms of post-traumatic stress, depression, and alcohol misuse in OEF-OIF veterans.
James LM, Van Kampen E, Miller RD, & Engdahl BE.
Mil Med. 2013 Feb;178(2):159-65 PMID: 23495461 [PubMed - in process]

Military personnel returning from the conflicts in Iraq and Afghanistan commonly experience mental health problems and efforts are underway to determine risk and protective factors associated with postdeployment mental health concerns.

This study examined the contribution of trait neuroticism, predeployment life events, combat experience, perceptions of threat, and postdeployment social support on mental health symptoms at 6 months, 12 months, and 24 months postdeployment. Two hundred seventy-one veterans completed self-report measures.

Hierarchical regression analyses demonstrated that neuroticism predicted post-traumatic stress and depressive symptoms at all 3 time points; perceived threat predicted post-traumatic stress symptoms at time 1 and time 2 and depressive symptoms at time 2. Social support was a strong negative predictor of post-traumatic stress and depressive symptoms. Alcohol misuse was not significantly predicted by any of the variables.

The present study highlights the role of perceived threat and trait neuroticism on postdeployment mental health symptoms and indicates social support is a robust protective factor. Efforts aimed at increasing sustained postdeployment social support may help defend against significant mental health problems among veterans.
Psychopharmacological treatment for military posttraumatic stress disorder- An integrative review.
Jennifer Tawa & Susan Murphy.
Journal of the American Academy of Nurse Practitioners, Early View.

Purpose Posttraumatic stress disorder (PTSD) is a serious mental health disorder. The current first-line psychopharmacologic treatment for PTSD is selective serotonin reuptake inhibitors (SSRIs). Recently, the efficacy of SSRIs has been challenged in favor of propranolol use.

This article reviews the origins of PTSD, its impact within the veteran population, psychopharmacological treatment of PTSD, and current literature on the use of propranolol for PTSD treatment. Read more . . .
Posttraumatic stress disorder and cannabis use characteristics among military veterans with cannabis dependence.
Boden, M. Babson, K. et al.
The American Journal on Addictions. 6 MAR 2013

The present study is the first to explore links between PTSD and cannabis use characteristics immediately prior to a cannabis quit attempt, including motives, use problems, withdrawal, and craving.

Methods: Measures of PTSD diagnosis, symptom severity, and cannabis use characteristics were administered to a sample of cannabis dependent military veterans (n = 94). Hypotheses were tested with a series of analyses of variance and covariance and hierarchical multiple regressions with Bonferroni corrections. Analyses were conducted with and without adjusting for variance shared with substance use (cannabis, alcohol, tobacco) in the previous 90 days, and co-occurring mood, anxiety, and substance use diagnoses.

Results and Conclusions: Compared to participants without PTSD, participants with PTSD reported significantly increased: (a) use of cannabis to cope, (b) severity of cannabis withdrawal, and (c) experiences of craving related to compulsivity, emotionality, and anticipation, with findings regarding coping and craving remaining significant after adjusting for covariates. Among the total sample, PTSD symptom severity was positively associated with (a) use of cannabis to cope, (b) cannabis use problems, (c) severity of cannabis withdrawal, and (d) experiences of craving related to compulsivity and emotionality, with findings regarding withdrawal and emotion-related craving remaining significant after adjusting for covariates.

Thus, links between PTSD and using cannabis to cope, severity of cannabis withdrawal, and especially craving appear robust across measures of PTSD and analytical method.
Iraq and Afghanistan veteran presentations to Combat Stress since 2003.
van Hoorn LA, Jones N, Busuttil W, Fear NT, Wessely S, Hunt E, & Greenberg N.
Occup Med (Lond). 2013 Mar 11; 23479566 [PubMed - as supplied by publisher]

Background: Recently, proposals have been made to improve mental health care for UK military veterans. Combat Stress (CS), a veteran's charity, has provided mental health services for veterans since 1919. Since 2003, service users have included veterans from the Iraq and Afghanistan conflicts; however, their pattern of help-seeking has not been evaluated.

Aims: To describe the characteristics of the veteran population of the recent Iraq or Afghanistan conflicts who sought help from CS between 2003 and May 2011.

Methods: CS Iraq and Afghanistan veteran clinical and welfare records were evaluated.ResultsNine hundred and eighty-eight records were evaluated. The median time for veterans of recent conflicts to seek help from CS since discharge from military service was ~2 years, considerably shorter than the mean time of 14 years previously estimated by CS. Approximately, three-quarters of the veterans receiving a full clinical assessment (n = 114), received a diagnosis of post traumatic stress disorder (PTSD) (n = 87). Approximately half of the clinically assessed veterans self-referred to CS (51%); their most frequent diagnosis was PTSD.

Conclusions: Veterans who have served in Iraq and Afghanistan are presenting to Combat Stress sooner, and at a younger age, than veterans of previous conflicts and operations.
Are Iraq and Afghanistan veterans using mental health services? New data from a national random-sample survey.
Elbogen EB, Wagner HR, Johnson SC, Kinneer P, Kang H, Vasterling JJ, Timko C, & Beckham JC.
Psychiatr Serv. 2013 Feb 1;64(2):134-41 PMID: 23475498 [PubMed - in process]

OBJECTIVE: This study analyzed data from a national survey of Iraq and Afghanistan veterans to improve understanding of mental health services use and perceived barriers.

METHODS: The National Post-Deployment Adjustment Survey randomly sampled post-9/11 veterans separated from active duty or in the Reserves or National Guard. The corrected response rate was 56% (N=1,388). Read more . . .
Alcohol use, military sexual trauma, expectancies, and coping skills in women veterans presenting to primary care.
Suzannah K. Creecha, & Brian Borsari.
Addictive Behaviors. Available online 26 February 2013.

Background: Little is known regarding alcohol use and its correlates in women Veterans. An understanding of these variables is of utility to providers in primary care at Veterans Affairs (VA) hospitals, who are among the first to identify and intervene for problem drinking.

Objective: The objective of this study was to describe and explore the associations between posttraumatic stress disorder symptoms, experience of military sexual trauma (MST), expectancies for alcohol use, and coping skills in predicting drinking behavior. Read more . . .
Treatment-seeking barriers for veterans of the Iraq and Afghanistan conflicts who screen positive for PTSD.
Stecker T, Shiner B, Watts BV, Jones M, & Conner KR.
Psychiatr Serv. 2013 Mar 1;64(3):280-3 PMID: 23450385 [PubMed - in process]

OBJECTIVES: Barriers associated with the decision not to seek treatment for symptoms of combat-related posttraumatic stress disorder (PTSD) were examined.

METHODS: Participants were 143 military men and women who served in Operation Enduring Freedom or Operation Iraqi Freedom (OEF/OIF) and who screened positive for posttraumatic stress disorder (PTSD), as assessed by the PTSD Checklist-Military Version, and who had not sought treatment for PTSD. During a cognitive-behavioral telephone intervention, participants were asked about their beliefs concerning seeking PTSD treatment.

RESULTS: Four categories of beliefs were associated with the decision to seek treatment, including concerns about treatment (40%), emotional readiness for treatment (35%), stigma (16%), and logistical issues (8%).

CONCLUSIONS: This work suggests areas for intervention efforts to minimize barriers to treatment for PTSD for OEF/OIF veterans.
Military-related posttraumatic stress disorder and intimate relationship behaviors- A developing Dyadic Relationship Model.
April A. Gerlock, Jackie Grimesey, & George Sayre.
Journal of Marital and Family Therapy.

The protracted conflict in Iraq and Afghanistan and an all-volunteer military has resulted in multiple war zone deployments for many service members. While quick redeployment turnaround has left little time for readjustment for either the service member or family, dealing with the long-term sequelae of combat exposure often leaves families and intimate partners ill-prepared for years after deployments.

Using a modified grounded theory approach, digitally recorded couple interviews of 23 couples were purposefully selected from a larger sample of 441 couples to better understand the impact of war zone deployment on the couple. The veteran sample was recruited from a randomly selected cohort of men in treatment for posttraumatic stress disorder (PTSD).

Overall, it was found when veterans experiencing deployment-related PTSD reenter or start new intimate relationships they may bring with them a unique cluster of interrelated issues which include PTSD symptoms, physical impairment, high rates of alcohol and/or drug abuse, and psychological and physical aggression. These factors contributed to a dynamic of exacerbating conflict. How these couples approached relationship qualities of mutuality, balanced locus of control and weakness tolerance across six axes of caregiving, disability, responsibility, trauma, communication, and community impacted the couple's capacity to communicate and resolve conflict. This dyadic relationship model is used to help inform implications for clinical practice.
Increased risk of alcohol and drug use among children from deployed military families.
Acion L, Ramirez MR, Jorge RE, & Arndt S.
Addiction. 2013 Feb 26; PMID: 23441867 [PubMed - as supplied by publisher]

AIMS: To examine the association between military deployment of a parent and use of alcohol and drugs among children of deployed military personnel.

DESIGN: Observational and cross-sectional study. SETTING: Data from the 2010 Iowa [USA] Youth Survey, a statewide survey of 6th, 8th, and 11th graders, were analyzed during 2011. Read more . . .
Health-related quality of life of Canadian Forces veterans after transition to civilian life.
Thompson J, Hopman W, Sweet J, VanTil L, MacLean MB, VanDenKerkhof E, Sudom K, Poirier A, & Pedlar D.
2013;104(1):e15-e21 Not yet in PubMed

OBJECTIVES: Describe health-related quality of life (HRQoL) of former Canadian Forces (CF) men and women in uniform (Veterans) after transition to civilian life, and compare to age- and sex-adjusted Canadian norms. Read more . . .
Can mental health and readjustment be improved in UK military personnel by a brief period of structured postdeployment rest (third location decompression)?
Jones N, Jones M, Fear NT, Fertout M, Wessely S, & Greenberg N.
Occup Environ Med. 2013 Feb 26; PMID: 23444279 [PubMed - as supplied by publisher]

OBJECTIVE: Third Location Decompression (TLD) is an activity undertaken by UK Armed Forces (UK AF) personnel at the end of an operational deployment which aims to smooth the transition between operations and returning home. We assessed whether TLD impacted upon both mental health and postdeployment readjustment. Read more . . .
PTSD risk and mental health care engagement in a multi-war era community sample of women veterans.
Washington DL, Davis TD, Der-Martirosian C, & Yano EM.
J Gen Intern Med. 2013 Feb 23; PMID: 23435765 [PubMed - as supplied by publisher]

BACKGROUND: Post-traumatic stress disorder (PTSD) is common in women veterans (WVs), and associated with significant co-morbidity. Effective treatment is available; however, PTSD is often unrecognized.

OBJECTIVES: Identify PTSD prevalence and mental healthcare (MHC) use in a representative national WV sample. Read more . . .
Health care utilization among veterans with pain and posttraumatic stress symptoms.
Outcalt SD, Yu Z, Hoen HM, Pennington TM, & Krebs EE.
Pain Med. 2013 Feb 22; PMID: 23432958 [PubMed - as supplied by publisher]

OBJECTIVE: To examine health care utilization among veterans with both chronic pain and posttraumatic stress symptoms.

METHODS: Retrospective cohort study of 40,716 veterans in a VA regional network from January 1, 2002 to January 1, 2007. Veterans were categorized into pain-only, posttraumatic stress disorder symptoms (PTSD)-only, and pain plus PTSD (pain+PTSD) comparison groups. Negative binomial models were used to compare adjusted rates of primary care, mental health, and specialty pain service use, as well as opioids, benzodiazepines, nonopioid analgesics, and antidepressant prescriptions. Rates of clinic visits were calculated by days per year, and rates of medication use were calculated by prescription months per year. Participants were followed for a mean duration of 47 months. Read more . . .
Treatment adherence in cognitive processing therapy for combat-related PTSD with history of mild TBI.
Davis JJ, Walter KH, Chard KM, Parkinson RB, & Houston WS.
Rehabil Psychol. 2013 Feb;58(1):36-42 PMID: 23437998 [PubMed - in process]

Objective: This retrospective study examined treatment adherence in Cognitive Processing Therapy (CPT) for combat-related posttraumatic stress disorder (PTSD) in Veterans of Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF) with and without history of mild traumatic brain injury (mTBI). Read more . . .
The use of clonidine in the treatment of nightmares among patients with co-morbid PTSD and traumatic brain injury.
Alao A, Selvarajah J, & Razi S.
Int J Psychiatry Med. 2012;44(2):165-9 PMID: 23413663 [PubMed - in process]

OBJECTIVE: To describe the successful treatment of PTSD associated nightmares in two patients with PTSD.

CASE SUMMARIES: The report of the successful use of clonidine to treat PTSD associated nightmares among two Veterans following combat exposure.

DISCUSSION: Clonidine, a centrally acting alpha-agonist agent used to treat hypertension, stimulates alpha-adrenoreceptors in the brain stem. This action results in reduced sympathetic outflow from the central nervous system. We hypothesize that this central mechanism of action is why clonidine may be more effective in treating nightmares among patients with PTSD when compared with other agents.

CONCLUSION: Clonidine should be considered as an alternative in the treatment of nightmares among patients with PTSD.
Impact of impaired sleep on the development of PTSD symptoms in combat veterans: A prospective longitudinal cohort study.
van Liempt S, van Zuiden M, Westenberg H, Super A, & Vermetten E.
Depress Anxiety. 2013 Feb 6; PMID: 23389990 [PubMed - as supplied by publisher]

BACKGROUND: A significant proportion of soldiers return from deployment with symptoms of fatigue, sleep difficulties, and posttraumatic complaints. Disrupted sleep has been proposed as a contributing factor for the development of posttraumatic stress disorder (PTSD). This study investigates the impact of impaired sleep and nightmares before deployment on the development of PTSD symptoms. Read more . . .
The relationship between PTSD and chronic pain- mediating role of coping strategies and depression.
Morasco BJ, Lovejoy TI, Lu M, Turk DC, Lewis L, & Dobscha SK.
Pain. 2013 Jan 11; PMID: 23398939 [PubMed - as supplied by publisher]

People with chronic pain and comorbid posttraumatic stress disorder (PTSD) report more severe pain and poorer quality of life than those with chronic pain alone. This study evaluated the extent to which associations between PTSD and chronic pain interference and severity are mediated by pain-related coping strategies and depressive symptoms. Read more . . .
The impact of posttraumatic stress disorder on blood pressure and heart rate in a veteran population.
Paulus EJ, Argo TR, & Egge JA.
J Trauma Stress. 2013 Jan 31; PMID: 23371434 [PubMed - as supplied by publisher]

Hyperarousal is a hallmark of posttraumatic stress disorder (PTSD). PTSD has been associated with increased blood pressure (BP) and heart rate (HR) in veteran populations. We retrospectively identified male patients consulted to outpatient psychiatry at the Iowa City Veterans Affairs Healthcare System. Patients were divided into PTSD (n = 88) and non-PTSD (n = 98) groups. All PTSD patients and a subset of non-PTSD patients had documented blast exposure during service. The study investigated whether patients with PTSD had higher systolic blood pressure (SBP), diastolic blood pressure (DBP), and heart rate (HR) than patients without PTSD. The effect of trauma exposure on BP was also examined.

Mean SBP (133.8 vs. 122.3 mm Hg; p < .001), DBP (87.6 vs. 78.6 mm Hg; p < .001), and HR (78.9 vs. 73.1 bpm; p < .001) were all significantly higher in the PTSD group. Trauma-exposed patients without PTSD had significantly higher BP than nonexposed patients. The prevalence of hypertension (HTN) was 34.1% (diagnosed and undiagnosed) among PTSD patients. Patients with PTSD had higher BP and HR compared to patients without PTSD.

Trauma exposure may increase BP in this population. These findings will increase awareness about the cardiovascular implications of PTSD.
The impact of exercise on suicide risk- examining pathways through depression, PTSD, and sleep in an inpatient sample of veterans.
Collin L. Davidson, Kimberly A. Babson PhD, & Marcel O.
Suicide and Life-Threatening Behavior.

Suicide has a large public health impact. Although effective interventions exist, the many people at risk for suicide cannot access these interventions. Exercise interventions hold promise in terms of reducing suicide because of their ease of implementation. While exercise reduces depression, and reductions in depressive symptoms are linked to reduced suicidal ideation, no studies have directly linked exercise and suicide risk. The current study examined this association, including potential mediators (i.e., sleep disturbance, posttraumatic stress symptoms, and depression), in a sample of Veterans. SEM analyses revealed that exercise was directly and indirectly associated with suicide risk. Additionally, exercise was associated with fewer depressive symptoms and better sleep patterns, each of which was, in turn, related to lower suicide risk.
Uniformity of evidence-based treatments in practice? Therapist effects in the delivery of cognitive processing therapy for PTSD.
Laska KM, Smith TL, Wislocki AP, Minami T, & Wampold BE.
J Couns Psychol. 2013 Jan;60(1):31-41 PMID: 23356465 [PubMed - in process]

Objective: Various factors contribute to the effective implementation of evidence-based treatments (EBTs). In this study, cognitive processing therapy (CPT) was administered in a Veterans Affairs (VA) posttraumatic stress disorder (PTSD) specialty clinic in which training and supervision were provided following VA implementation guidelines. The aim was to (a) estimate the proportion of variability in outcome attributable to therapists and (b) identify characteristics of those therapists who produced better outcomes. Read more . . .
Prevalence and characteristics of military malingering.
Lande RG, & Williams LB.
Mil Med. 2013 Jan;178(1):50-4 PMID: 23356119 [PubMed - in process]

The authors' principle objective was determining the prevalence and characteristics of medical malingering in the military. The authors accessed an electronic database used by the Department of Defense to monitor and manage military health care activities worldwide. The authors searched the database from 2006 to 2011 in the Northern Regional Medical Command for all instances where a health care provider, consequent to an outpatient medical visit, diagnosed malingering, factitious disorder with psychological symptoms, or factitious disorder with physical symptoms.

During the time period studied, the Northern Regional Medical Command reported 28,065,568 health care visits. During the same time period, clinicians diagnosed 1,074 individuals with malingering, factitious disorder with predominantly psychological signs and symptoms, or factitious disorder with predominantly physical signs and symptoms. The typical subject diagnosed with one of these disorders was young, male, nonmarried, and enlisted. Although most diagnoses came from a mental health clinic, other medical specialties also contributed to the total tally.

These diagnoses are extremely rare based on the findings from this study of outpatient medical care visits.
Psychological trauma symptom improvement in veterans using emotional freedom techniques- a randomized controlled trial.
Church D, Hawk C, Brooks AJ, Toukolehto O, Wren M, Dinter I, & Stein P.
J Nerv Ment Dis. 2013 Feb;201(2):153-60 PMID: 23364126 [PubMed - in process]

This study examined the effect of Emotional Freedom Techniques (EFT), a brief exposure therapy combining cognitive and somatic elements, on posttraumatic stress disorder (PTSD) and psychological distress symptoms in veterans receiving mental health services.

Veterans meeting the clinical criteria for PTSD were randomized to EFT (n = 30) or standard of care wait list (SOC/WL; n = 29). The EFT intervention consisted of 6-hour-long EFT coaching sessions concurrent with standard care. The SOC/WL and EFT groups were compared before and after the intervention (at 1 month for the SOC/WL group and after six sessions for the EFT group). The EFT subjects had significantly reduced psychological distress (p < 0.0012) and PTSD symptom levels (p < 0.0001) after the test. In addition, 90% of the EFT group no longer met PTSD clinical criteria, compared with 4% in the SOC/WL group. After the wait period, the SOC/WL subjects received EFT.

In a within-subjects longitudinal analysis, 60% no longer met the PTSD clinical criteria after three sessions. This increased to 86% after six sessions for the 49 subjects who ultimately received EFT and remained at 86% at 3 months and at 80% at 6 months. The results are consistent with that of other published reports showing EFT's efficacy in treating PTSD and comorbid symptoms and its long-term effects.
Personal characteristics affecting veterans' use of services for posttraumatic stress disorder.
Brooks E, Novins DK, Thomas D, Jiang L, Nagamoto HT, Dailey N, Bair B, & Shore JH.
Psychiatr Serv. 2012 Sep 1;63(9):862-7 PMID: 22707088 [PubMed - indexed for MEDLINE]

OBJECTIVE: Posttraumatic stress disorder (PTSD) is widespread among veterans, but many veterans with PTSD use few health services. This study examined how individual characteristics influenced use of outpatient visits by veterans with PTSD. Read more . .
Patterns of illness explaining the associations between posttraumatic stress disorder and the use of CT.
Abrams TE, Vaughan-Sarrazin M, Richardson K, Cram P, & Rosenthal GE.
Radiology. 2013 Jan 29; PMID: 23360739 [PubMed - as supplied by publisher]

Purpose: To examine the relationship between posttraumatic stress disorder (PTSD) and computed tomography (CT) utilization and to determine whether there were patterns of comorbid illness that could explain the relationship. Read more . . .
A pilot randomized controlled trial with paroxetine for subthreshold PTSD in Operation Enduring Freedom Operation Iraqi Freedom era veterans.
Naylor JC, Dolber TR, Strauss JL, Kilts JD, Strauman TJ, Bradford DW, Szabo ST, Youssef NA, Connor KM, Davidson JR, & Marx CE.
Psychiatry Res. 2012 Dec 28; 23276723 [PubMed - as supplied by publisher]

Subthreshold posttraumatic stress disorder (PTSD) is associated with increased risk for suicidality, depression, and functional impairment. We thus conducted a small (N=12) pilot randomized controlled trial (RCT) with paroxetine for subthreshold PTSD in Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF) era veterans.

Hospital Anxiety and Depression Scale (HADS) scores improved by 30.4% in the paroxetine group. Paroxetine may have promise for subthreshold PTSD.
Anxiety sensitivity and sleep quality- independent and interactive predictors of posttraumatic stress disorder symptoms.
Babson KA, Boden MT, Woodward S, Alvarez J, & Bonn-Miller M.
J Nerv Ment Dis. 2013 Jan;201(1):48-51 PMID: 23274295 [PubMed - in process]

A cardinal feature of posttraumatic stress disorder (PTSD) is decreased sleep quality. Anxiety sensitivity (AS) is one factor that has shown early theoretical and empirical promise in better understanding the relation between sleep quality and PTSD outcomes. The current study is the first to test the independent and interactive effects of sleep quality and AS on PTSD symptoms.
Consistent with hypotheses, AS and sleep quality were found to be independent and interactive predictors of PTSD symptom severity in our sample of male military veterans seeking treatment for PTSD. Slope analyses revealed that AS was differentially related to PTSD symptom severity as a function of quality of sleep. The veterans with good sleep quality and relatively lower levels of AS had the lowest level of PTSD symptoms, whereas the veterans with poor sleep quality and low AS evidenced severity of PTSD symptoms similar to those with high AS.
Diagnosis and healing in veterans suspected of suffering from post-traumatic stress disorder (PTSD) using reward gene testing and reward circuitry natural dopaminergic activation.
Blum K, Giordano J, Oscar-Berman M, Bowirrat A, Simpatico T, & Barh D.
J Genet Syndr Gene Ther. 2012 May 31;3(3): PMID: 23264885 [PubMed - as supplied by publisher]

There is a need for understanding and treating post-traumatic stress disorder (PTSD), in soldiers returning to the United States of America after combat. Likewise, it would be beneficial to finding a way to reduce violence committed by soldiers, here and abroad, who are suspected of having post-traumatic stress disorder (PTSD). We hypothesize that even before combat, soldiers with a childhood background of violence (or with a familial susceptibility risk) would benefit from being genotyped for high-risk alleles. Such a process could help to identify candidates who would be less suited for combat than those without high-risk alleles.

Of secondary importance is finding safe methods to treat individuals already exposed to combat and known to have PTSD. Since hypodopaminergic function in the brain's reward circuitry due to gene polymorphisms is known to increase substance use disorder in individuals with PTSD, it might be parsimonious to administer dopaminergic agonists to affect gene expression (mRNA) to overcome this deficiency.
On the homefront- Assessing the well-being of Canada's military families in the New Millenium.
Canada. National Defence and Canadian Forces Ombudsman.
Ottawa: November, 2013.

Special report to the Minister of National Defence The Canadian Forces has been engaged in almost continuous operations since 1990 - more than 20 major operational missions the world over (most of which required multiple ‘troop’ rotations). Within a single professional generation, Canadian sailors, soldiers and air force personnel have adapted to increasingly more complex and challenging conflict environments, seamlessly morphing from peacekeepers to peacemakers to warriors. This transition required much of Canadian Forces members. Considerably more was also asked of their families. The current (relative) respite in operations tempo provides a unique opportunity to take stock of how military families are faring.

During the past few years there has been a noteworthy increase in family-related complaints to the Department of National Defence and Canadian Forces (DND/CF) Ombudsman. As a result of this trend, as well as feedback given during Ombudsman visits to bases and wings across the country, the Ombudsman launched a systemic review into the well-being of military families in April 2012. Research was completed in June 2013. The report itself was finalized in September 2013. The review focused exclusively on the families of Regular Force members due to the substantial disparities in the nature and scope of the Regular Force and Reserve Force family communities. Full text: http://www.ombudsman.forces.gc.ca/assets/OMBUDSMAN_Internet/docs/en/mf-fm-eng.pdf
Minister Blaney joins The Royal in Launching New Mobile App for Veterans.
by Veterans Affairs Canada , OTTAWA, June 18, 2013.
The Honourable Steven Blaney, Minister of Veterans Affairs and Minister for La Francophonie, today joined Dr. Raj Bhatla, Psychiatrist-in-Chief and Chief of Staff of the Royal Ottawa Health Care Group (The Royal), to launch a new mobile application that will assist Veterans, personnel of the Canadian Armed Forces (CAF), and members of the Royal Canadian Mounted Police (RCMP) with operational stress injuries (OSIs).

The app, called OSI Connect, provides information and assistance for people living with post-traumatic stress disorder (PTSD), anxiety, depression, substance abuse and other types of OSIs, as well as their family members. Read more here: http://www.heraldonline.com/2013/06/18/4956370/minister-blaney-joins-the-royal.html#storylink=cpy Full text: http://www.heraldonline.com/2013/06/18/4956370/minister-blaney-joins-the-royal.html
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