Women who served in Iraq seeking mental health services: Relationships between military sexual trauma, symptoms, and readjustment.

Eighteen women who served in Operation Iraqi Freedom/Operation Enduring Freedom (OIF/OEF) sought mental health services at a Veterans' Affairs (VA) medical center. Ten of the 18 women (56%) reported military sexual trauma (MST) while serving in OIF/OEF. All 10 with MST reported sexual harassment, 6 of the 10 (33% of the sample) reported unwanted physical advances, and 3 (17%) reported completed assault or rape. Fifteen women also completed a questionnaire about their experiences and the Iraq Readjustment Inventory (IRI) developed for this study. High reliability and high correlations with clinician ratings make the IRI a promising measure for future research. A comparison between those with and without MST revealed that those with MST had higher clinician ratings and IRI scores, suggesting greater difficulty with readjustment. And, while MST was significantly correlated with clinician ratings and readjustment scores, the variables "being injured" and "witnessing others injured or killed" were not. These preliminary data suggest that MST OIF/OEF women seeking mental health services is a critical factor for predicting symptoms and difficulty with readjustment to civilian life. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Concussive and psychological symptom predictors of aeromedical evacuation following possible brain injury among deployed military personnel.

Over 2.5 million U.S. military members have deployed in support of Operation Iraqi Freedom (OIF) and Operation Enduring Freedom (OEF), and more than 48,000 service members have been aeromedically evacuated (A/E'ed) from both theaters for both battle and nonbattle injuries. The purpose of this study was to consider differences in clinical presentation associated with dispositional status among a sample of 157 deployed service members evaluated subsequent to a suspected brain injury and to identify which symptomatic variables are most associated with the decision to recommend A/E. Results from an in-theater hospital suggest that symptoms persisting to the point of clinical evaluation were associated more strongly with disposition than symptoms reported immediately postinjury. When considering a range of common concussive and psychological symptoms associated with brain injury, only memory problems, irritability, and hearing problems were associated with increased likelihood for A/E from a combat zone following suspected brain injury. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Assessment and diagnosis of mild traumatic brain injury, posttraumatic stress disorder, and other polytrauma conditions: Burden of adversity hypothesis.

Objective/Method: Military personnel returning from Iraq and Afghanistan have been exposed to physical and emotional trauma. Challenges related to assessment and intervention for those with posttraumatic stress disorder (PTSD) and/or history of mild traumatic brain injury (TBI) with sequelae are discussed, with an emphasis on complicating factors if conditions are co-occurring. Existing literature regarding cumulative disadvantage is offered as a means of increasing understanding regarding the complex symptom patterns reported by those with a history of mild TBI with enduring symptoms and PTSD. Implications: The importance of early screening for both conditions is highlighted. In addition, the authors suggest that current best practices include treating symptoms regardless of etiology to decrease military personnel and veteran burden of adversity. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Invisible wounds, visible savings? Using microsimulation to estimate the costs and savings associated with providing evidence-based treatment for PTSD and depression to veterans of Operation Enduring Freedom and Operation Iraqi Freedom.

This research used microsimulation modeling to estimate the social costs of depression and posttraumatic stress disorder (PTSD) for the 261,827 troops deployed on June 30, 2008, for Operations Enduring Freedom and Iraqi Freedom. Given current standards of care, roughly half of these individuals will be treated for these conditions in the 2 years after they return, and 30% of those treated will receive evidence-based treatment (EBT). Our results suggest that the 2-year social costs of depression and PTSD for this cohort will be $923 million. Policy simulations evaluating the savings associated with universal access to EBT suggest that such access would generate cost savings of $138 million (15%). (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Depressive symptoms and mechanisms of relational turbulence as predictors of relationship satisfaction among returning service members.

In contrast to romanticized portrayals of reunion after deployment, U.S. military personnel may contend with the harsh reality of both depressive symptoms and upheaval in their romantic relationships during the postdeployment transition. This study employed the relational turbulence model to evaluate mechanisms linking depressive symptoms with relationship satisfaction. Cross-sectional, self-report data were collected from 220 service members living in 27 states who had returned home from deployment within the past six months. As hypothesized, the negative association between depressive symptoms and relationship satisfaction was mediated by relational uncertainty and interference from partners. These findings advance scholarship on depressive symptoms and relational turbulence, and they also suggest guidelines for helping service members with depressive symptoms maintain satisfying romantic relationships upon reentry. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Post-acute polytrauma rehabilitation and integrated care of returning veterans: Toward a holistic approach.

Throughout the history of war, exposure to combat has been associated with clusters of physical and psychological symptoms labeled in various ways, from “hysteria” to “shell shock” in World War I to “polytrauma” in Operations Enduring Freedom (OEF) and Iraqi Freedom (OIF). Objective: To describe the historical conceptualizations of combat injury and the ways they are relevant to developing current rehabilitation strategies, discuss the symptom complex presented by OEF/OIF veterans, and describe key elements and principles of holistic, integrated care for post-acute OEF/OIF veterans. Conclusions: A conceptualization of rehabilitation recognizing a final common pathway of functional disability and suffering is proposed, and both systematic and treatment-specific aspects at the core of a veteran-centered holistic approach are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The impact of PTSD, depression, and substance use disorders on disease burden and health care utilization among OEF/OIF veterans.

Growing evidence suggests that posttraumatic stress disorder (PTSD) is associated with poorer health status (e.g., more medical disease, physical symptoms, and sick visits to health care professionals) among veterans who served in Operation Enduring Freedom (OEF) in Afghanistan and Operation Iraqi Freedom (OIF) in Iraq. We investigated whether PTSD, depression, and substance use disorders independently predicted health status over time among OEF/OIF veterans. Information regarding psychiatric and medical conditions and health care utilization was culled for 4,463 OEF/OIF veterans enrolled in Veterans Administration primary care for a period of 6 years. Data were analyzed using multilevel modeling and generalized estimating equations. Results suggest that PTSD, depression, and substance use disorders are independently associated with increased medical disease burden and mental health care utilization but not increased medical health care utilization. The association between PTSD and medical disease burden strengthened over time. These data suggest that OEF/OIF veterans with PTSD may be at risk for increasingly poorer physical health in terms of medical disease burden over time. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Welcoming them home: Supporting service members and their families in navigating the tasks of reintegration.

To date, more than 1.3 million service members have served in the Global War on Terrorism. These men and women and their families face a range of stressful situations and must navigate many important tasks after a deployment. This article outlines four of the tasks of reintegration: redefining roles, expectations, and division of labor; managing strong emotions; abandoning emotional constriction and creating intimacy in relationships; and creating shared meaning. For each task, potential challenges are discussed and suggestions for how psychologists can support families are described. In addition, potential red flags and indicators that more intensive services may be warranted are reviewed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Posttraumatic stress symptoms among National Guard soldiers deployed to Iraq: Associations with parenting behaviors and couple adjustment.

Objective: In this article, we report findings from a 1-year longitudinal study examining the impact of change in posttraumatic stress disorder (PTSD) symptoms following combat deployment on National Guard soldiers' perceived parenting and couple adjustment 1 year following return from Iraq. Method: Participants were 468 Army National Guard fathers from a brigade combat team (mean age = 36 years; median deployment length = 16 months; 89% European American, 5% African American, 6% Hispanic American). Participants completed an in-theater survey 1 month before returning home from Operation Iraqi Freedom deployment (Time 1) and again 1 year postdeployment (Time 2). The PTSD Checklist—Military Version (PCL–M; Weathers, Litz, Herman, Huska, & Keane, 1993) was gathered at both times, and 2 items assessing social support were gathered at baseline only. At Time 2, participants also completed self-report measures of parenting (Alabama Parenting Questionnaire—Short Form; Elgar, Waschbusch, Dadds, & Sigvaldason, 2007), couple adjustment (Dyadic Adjustment Scale—7; Sharpley & Rogers, 1984; Spanier, 1976), parent–child relationship quality (4 items from the Social Adjustment Scale—Self-Report; Weissman & Bothwell, 1976), alcohol use (Alcohol Use Disorders Identification Test; Babor, Higgins-Biddle, Saunders, & Monteiro, 2001), and items assessing injuries sustained while deployed. Results: Structural equation modeling analyses showed that increases in PTSD symptoms were associated with poorer couple adjustment and greater perceived parenting challenges at Time 2 (both at p     

Protective buffering and psychological distress among couples coping with breast cancer: The moderating role of relationship satisfaction.

This study examined whether the association between protective buffering and psychological distress was moderated by relationship satisfaction. Protective buffering is defined as hiding worries, denying concerns, and yielding to one's partner in an effort to avoid disagreement and reduce one's partner's upset and burden. Two hundred thirty-five women diagnosed with early stage breast cancer and their partners completed measures of protective buffering, psychological distress, and relationship satisfaction at 3 time points over an 18-month period after cancer diagnosis. The authors hypothesized that protective buffering would result in more distress among patients and partners reporting higher relationship satisfaction than among patients and partners reporting lower levels of relationship satisfaction. Patients' protective buffering predicted more distress among patients rating their relationships as more satisfactory, whereas the patients' buffering did not predict distress among patients rating their relationships as less satisfactory. Partner relationship satisfaction also moderated the association between patients' buffering and partners' distress. These findings elucidate conditions under which protective buffering may have detrimental effects. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The differential association between change request qualities and resistance, problem resolution, and relationship satisfaction.

Although research supports the negative sequelae of the “demand/withdrawal” pattern, research is scant on the impact of “nondemanding” change requests (e.g., specific, increasing, “we” requests). We hypothesize that such change requests will be associated with less partner withdrawal/resistance, better problem resolution, and greater relationship satisfaction. Seventy-two conversations between couples who were recruited through random digit dialing were coded for change request qualities. Results indicate that wife specific and “we” requests led to less husband resistance, and husband increasing and “we” requests led to less wife resistance. Greater percentages of wife and husband specific and “we” requests were related to better problem resolution in the conversation, and greater percentages of wife specific and “we” requests were related to greater wife satisfaction. Research and clinical implications are detailed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The effects of initial trauma exposure on the symptomatic response to a subsequent trauma.

The effect of initial trauma on the symptomatic response to a subsequent trauma was investigated in a cross-sectional study of urban bus drivers. Comparisons were made among 175 drivers (mean age 42.2 yrs) who had developed either high or low symptoms of posttraumatic stress disorder (PTSD) as a result of the initial trauma, and a third group exposed to only a single trauma. The group with high levels Of PTSD symptoms after the initial trauma reported high PTSD symptoms for a subsequent trauma (75%) significantly more often than the other two groups who did not differ from each other (Low PTSD symptoms group 49%, No prior trauma group 41 %). These results suggest that unless trauma exposure leads to significant PTSD symptoms, it is not a risk factor for high PTSD symptoms after exposure to a subsequent traumatic event. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The need for inclusion of psychological trauma in the professional curriculum: A call to action.

An appreciable disparity exists between the need for services by professionals with expertise in psychological trauma and the availability of these services. Despite the establishment of a solid base of scientific literature on trauma and the growing attunement of society and the media to the adverse psychological impact of traumatic events, this area has yet to be decisively incorporated into the core curriculum of graduate training in psychology and other professions. This paper provides an overview of the prevalence, scope, and impact of trauma in the general population and the current lack of adequate resources to address the psychological difficulties engendered by traumatic experiences. Existing models of trauma training are discussed, and strategies for expanding the availability of trauma training are recommended. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychological symptoms and marital satisfaction in spouses of Operation Iraqi Freedom veterans: Relationships with spouses' perceptions of veterans' experiences and symptoms.

Much research has shown that spouses of combat veterans with posttraumatic stress disorder (PTSD) have higher rates of psychological and marital distress than do spouses of veterans without PTSD; however, very few studies have examined potential mechanisms of this increased vulnerability. The current study examined spouses of National Guard soldiers recently returned from deployments in Iraq. In addition to documenting elevated levels of psychological symptoms in these spouses, the authors found that spouses experienced greater symptom severity when they perceived high levels of symptoms in soldiers but the soldiers endorsed low levels of symptoms. Furthermore, spouses' marital satisfaction was negatively linked to soldiers' self-reported symptom severity only when spouses perceived that soldiers had experienced low levels of combat activity while deployed. When spouses perceived high levels of such activity, soldiers' self-reported symptoms had no relationship with spouses' marital satisfaction. These findings highlight the importance of interpersonal perceptions in intimate relationships and are consistent with the notion that uncontrollable attributions for a relative's mental health problems may provide a buffer against relationship distress. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The reliability of relationship satisfaction: A reliability generalization meta-analysis.

We conducted a reliability-generalization meta-analysis of 7 of the most frequently used measures of relationship satisfaction: the Locke–Wallace Marital Adjustment Test (LWMAT), the Kansas Marital Satisfaction Scale (KMS), the Quality of Marriage Index, the Relationship Assessment Scale, the Marital Opinion Questionnaire, Karney and Bradbury's (1997) semantic differential scale, and the Couples Satisfaction Index. Six hundred thirty-nine reliability coefficients from 398 articles and 636,806 individuals provided internal consistency reliability estimates for this meta-analysis. We present the average score reliabilities for each measure, characterize the variance in score reliabilities across studies, and consider sample and study characteristics that are predictive of score reliability. Overall, the KMS and the LWMAT appear to be the strongest and weakest measures, respectively, from a reliability perspective. We discuss the importance of considering reliability invariance when making cross-group comparisons and provide recommendations for researchers when electing a measure of relationship satisfaction. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Dating couples' attachment styles and patterns of cortisol reactivity and recovery in response to a relationship conflict.

This study investigated theoretically predicted links between attachment style and a physiological indicator of stress, salivary cortisol levels, in 124 heterosexual dating couples. Cortisol was assessed at 7 points before and after an experimental conflict negotiation task, creating a trajectory of stress reactivity and recovery for each participant. Growth modeling of cortisol data tested hypotheses that (a) insecurely attached individuals show patterns of greater physiological stress reactions to interpersonal conflict than do securely attached individuals and (b) people with insecurely attached partners show patterns of greater stress in reaction to relationship conflict than those with securely attached partners. Hypothesis 1 was supported, but men and women differed in the type of insecure attachment that predicted stress trajectories. Hypothesis 2 was supported for men, but not for women. The discussion emphasizes the role of gender role norms and partner characteristics in understanding connections between adult attachment and patterns of cortisol responses to interpersonal stress. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Pretreatment predictors of dropout from cognitive behavioral therapy for PTSD in Iraq and Afghanistan war veterans.

Cognitive–behavioral therapies (CBTs) can be effective treatments for posttraumatic stress disorder (PTSD) but their effectiveness is limited by high rates of premature dropout. Few studies have compared pretreatment characteristics of treatment completers and dropouts, and only one has examined these factors in Operations Iraqi Freedom and Enduring Freedom (OIF/OEF) Veterans. This study analyzed archival clinical data from 117 OEF/OIF Veterans evaluated and treated through a Veterans Affairs PTSD clinic. High numbers dropped out of treatment (68%). Treatment dropouts (n = 79) and completers (n = 38) differed significantly on Minnesota Multiphasic Personality Inventory-2 (MMPI-2) scales, PTSD symptom severity, and age. Regression analyses identified one MMPI-2 scale, TRT (negative treatment indicators), and age as unique but modest predictors of dropout. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Breaking up is hard to do: The impact of unmarried relationship dissolution on mental health and life satisfaction.

This study examined the impact of unmarried relationship break-up on psychological distress and life satisfaction using a within-subjects design. Among unmarried 18- to 35-year olds (N = 1295), 36.5% had one or more break-ups over a 20-month period. Experiencing a break-up was associated with an increase in psychological distress and a decline in life satisfaction (from pre- to postdissolution). In addition, several characteristics of the relationship or of the break-up were associated with the magnitude of the changes in life satisfaction following a break-up. Specifically, having been cohabiting and having had plans for marriage were associated with larger declines in life satisfaction while having begun to date someone new was associated with smaller declines. An interesting finding, having higher relationship quality at the previous wave was associated with smaller declines in life satisfaction following a break-up. No relationship or break-up characteristics were significantly associated with the magnitude of changes in psychological distress after a break-up. Existing theories are used to explain the results. Implications for clinical work and future research on unmarried relationships are also discussed. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Longitudinal effects of conflict behaviors on depressive symptoms in young couples.

This study investigated relationship dynamics contributing to gender differences in depression by testing longitudinal associations between observed conflict behaviors and depressive symptoms in young couples. Direct effects of psychological aggression, positive engagement, and withdrawal, as well as indirect effects via relationship satisfaction were considered. Participants were 68 heterosexual couples involving men from the Oregon Youth Study who remained in a stable relationship across at least 2 and up to 10 years from their early 20s to early 30s. Hierarchical linear modeling was used to test both between-couples differences in symptom trajectories predicted by partner behaviors and within-couple covariation between behaviors and depressive symptoms across 5 time points. Higher levels of women’s positive engagement predicted lower symptom levels for both partners, and higher women’s withdrawal predicted higher own symptom levels. Relative increases in couples’ psychological aggression and decreases in positive engagement were additionally associated with increases in women’s symptoms over time. Whereas between-couples behavior effects on women’s symptoms were mediated by relationship satisfaction, within-couple effects proved independent of satisfaction. Implications for mechanisms of depression risk and maintenance in couples are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The relationship of ambivalent coping to depression symptoms and adjustment.

Objective: To assess the influence of mental distancing and venting emotions on depressive symptoms and health-related quality of life (HRQOL). Participants: Seventy-six individuals hospitalized with acute burn injuries. Design: Prospective longitudinal study. Measures: Beck Depression Inventory (A. T. Beck, E. Ward, M. Mendelson, J. Mock, & J. Erbaugh, 1961), COPE (C. S. Carver, M. F. Scheier, & J. K. Weintraub, 1989), and Short Form--36 Health Survey (J. E. Ware, K. K. Snow, M. Kosinski, & B. Gandek, 1993). Results: Ambivalent coping at baseline (i.e., using both mental distancing and venting emotions, relative to using only 1 or neither) led to more symptoms of depression at follow-up, even when baseline symptoms were controlled. Ambivalent coping was related to postburn psychosocial HRQOL, and baseline symptoms of depression only slightly attenuated this relationship. Conclusions: Ambivalent coping appears to result from vacillation between motives. Decreasing inconsistent coping or reducing antithetical motivation may reduce depression and improve adjustment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)