Deployment-related Posttraumatic Stress Disorder Research Articles

Heart rate during sleep in PTSD patients: Moderation by contact with a service dog

There is growing interest in the potential health benefits of dog ownership in both the lay and scientific communities. Large reductions in risk for cardiovascular disease and all-cause mortality in dog owners relative to non-owners have been observed in epidemiological samples. Persons diagnosed with posttraumatic stress disorder exhibit elevated risk for cardiovascular disease. The current study tested a sample of 45 U.S. military veterans with deployment-related posttraumatic stress disorder employing an intensive, longitudinal, within-subjects design contrasting sleep heart rate on nights with and without a service dog. As participants were engaged in residential psychiatric treatment, sleep opportunities, waking activities, meals, and medications, were consistently scheduled. The primary recording methodology, mattress actigraphy, enabled passive quantification of heart rate over a total sample of 1097 nights. Service dog contact was associated with reduced sleep heart rate especially in participants with more severe PTSD. Longer-term longitudinal studies will be needed to assess the durability and asymptotic magnitude of this effect. An unexpected effect of nights in study was associated with increased heart rate consistent with hospitalization-associated deconditioning.

Deployment-related PTSD symptomatology and social functioning: Probing the mediating roles of emotion regulation and mentalization in an outpatient veteran sample

Deployment-related posttraumatic stress disorder (PTSD) impacts social functioning in families. Therefore, it is important to examine the factors that contribute to social functioning in families that are confronted with deployment-related PTSD. The goal of this study was to assess the association between PTSD symptom severity and social functioning using self-report questionnaires in an outpatient veteran sample and to test the mediating roles of emotion regulation (Study 1, N = 100) and mentalization (Study 2, N = 38). Study 1 demonstrated that emotion regulation problems fully mediated PTSD associated family dysfunctioning. Study 2 did not demonstrate a mediation role of mentalization, but also did not demonstrate an association between PTSD and social dysfunctioning. Maladaptive mentalization was associated with poor child adjustment. Critically, a between-study comparison revealed that PTSD symptom severity was significantly higher in Study 1 than in Study 2. Overall, our findings suggest that social dysfunctioning may only appear when a given severity threshold of PTSD is reached, in which emotion regulation might be a key clinical factor. Maladaptive mentalization may be critical for post-deployment child adjustment. Future research should further examine social functioning in samples with different PTSD severity profiles and include the role of mentalization. Longitudinal data are needed to gain further insight into the causal relationships among the factors considered and the etiological pathways that lead to developing social dysfunction over time.

Associations between the development of PTSD symptoms and longitudinal changes in the DNA methylome of deployed military servicemen: A comparison with polygenic risk scores

ObjectiveMilitary servicemen deployed to war zones are at increased risk of developing posttraumatic stress disorder (PTSD) and successful adaptation to stress is important. Epigenetic alterations in response to trauma have been identified as mechanism of adaptation and may therefore predict deployment-related PTSD symptoms. To date, human studies of epigenetic marks for traumatic stress have been largely constrained by short-term analyses of one or two time points. MethodThis study in a prospective Dutch military cohort (N ​= ​125) examined longitudinal changes of DNA methylation profiles before, as well as one and six months after deployment-related combat exposure in relation to the development of PTSD symptoms over a period of up to five years after deployment. We investigated the predictive value of specific methylation changes for immediate and delayed-onset PTSD symptoms and recovery. This epigenetic prediction was compared to polygenic risk score predictions obtained from the currently available largest genome-wide association study of PTSD. ResultsA total of fourteen genomic regions were identified in which PTSD symptom levels were associated with methylation changes over time (pre-deployment, one, and six months post-deployment). Of these regions, four were significant determinants of longitudinal development of PTSD symptoms. In addition, we observed that, together with risk level during deployment (operating inside or outside the military base) and physical childhood trauma, post-deployment decreases in methylation at a genomic region in EP300/miRNA1281 was associated with a delayed onset of PTSD compared to a resilient profile. Polygenic risk, in contrast, was related to PTSD onset within six months after deployment but was not associated with long term outcomes. ConclusionThe present study suggests predictive utility of changes in DNA methylation for the subsequent development of PTSD symptoms and showed that the currently available measure of polygenic risk is primarily related to non-delayed disease onset.

Attentional bias in veterans with deployment-related posttraumatic stress disorder before and after internet-based cognitive behavioral therapy – An eye-tracking investigation

Abstract Veterans with posttraumatic stress disorder (PTSD) often exhibit an attentional bias towards trauma-relevant or generally threatening and negative stimuli. Internet-based cognitive behavioral therapy (ICBT) has been demonstrated to be efficacious in the treatment of PTSD. However, a previous study by our own group failed to find a symptom reduction following ICBT in a sample of traumatized veterans. No previous studies have examined the usefulness of ICBT in terms of modifying attentional bias in PTSD. In an eye-tracking experiment, veterans with deployment-related PTSD were presented with combat-related pictures and general threat-related pictures. These target stimuli were simultaneously displayed with neutral pictures. Additionally, participants were presented with pairs of emotional and neutral faces. Participants received ICBT, and attentional bias was examined pre- and post-intervention and at three-month follow-up. No significant changes in attentional bias were observed, either from pre- to post-intervention or at follow-up. The findings suggest that attentional bias reduction is associated with, rather than being separable from, overall PTSD symptom improvement. The present eye-tracking study was the first longitudinal investigation to examine the effect of ICBT on PTSD-related attentional bias in a sample of veterans. More research is needed to gain a deeper understanding of the underlying mechanisms of attentional bias in PTSD and its modifiability.

Intimate Partner Violence Predicts Posttraumatic Stress Disorder Severity Independent of Early Life and Deployment-Related Trauma in Deployed Men and Women Veterans

Intimate partner violence (IPV) refers to emotional, physical, and/or sexual abuse perpetrated by a current or former partner. IPV affects both genders, though little is known about its effects on men as victims. The aims of this study were to determine if IPV is a factor contributing to posttraumatic stress disorder (PTSD) severity independently of deployment-related trauma, and to determine if there are gender differences in these associations. Participants were 46 female and 471 male post-9/11 veterans. Four sequential regressions were employed to examine the independent contribution of IPV among multiple trauma types on PTSD severity in men and women at two epochs, post-deployment (participants were anchored to deployment-related PTSD symptoms) and current (within the past month). Models were significant for both epochs in men (ps < .001) but not in women (ps > .230). In men, IPV independently predicted PTSD severity in both epochs (β > .093). However, in women, early life trauma (β = .284), but not IPV was a significant and independent predictor for current PTSD. Thus, there are distinct gender differences in how trauma type contributes to PTSD symptom severity. Although the statistical models were not significant in women, we observed similar patterns of results as in men and, in some cases, the β was actually higher in women than in men, suggesting a lack of power in our analyses. More research is clearly needed to follow-up these results; however, our findings indicate that IPV is a contributing factor to PTSD severity in veterans.

Pre-deployment risk factors for PTSD in active-duty personnel\xa0deployed to Afghanistan: a machine-learning approach for analyzing multivariate predictors

Active-duty Army personnel can be exposed to traumatic warzone events and are at increased risk for developing post-traumatic stress disorder (PTSD) compared with the general population. PTSD is associated with high individual and societal costs, but identification of predictive markers to determine deployment readiness and risk mitigation strategies is not well understood. This prospective longitudinal naturalistic cohort study—the Fort Campbell Cohort study—examined the value of using a large multidimensional dataset collected from soldiers prior to deployment to Afghanistan for predicting post-deployment PTSD status. The dataset consisted of polygenic, epigenetic, metabolomic, endocrine, inflammatory and routine clinical lab markers, computerized neurocognitive testing, and symptom self-reports. The analysis was computed on active-duty Army personnel (N = 473) of the 101st Airborne at Fort Campbell, Kentucky. Machine-learning models predicted provisional PTSD diagnosis 90–180 days post deployment (random forest: AUC = 0.78, 95% CI = 0.67–0.89, sensitivity = 0.78, specificity = 0.71; SVM: AUC = 0.88, 95% CI = 0.78–0.98, sensitivity = 0.89, specificity = 0.79) and longitudinal PTSD symptom trajectories identified with latent growth mixture modeling (random forest: AUC = 0.85, 95% CI = 0.75–0.96, sensitivity = 0.88, specificity = 0.69; SVM: AUC = 0.87, 95% CI = 0.79–0.96, sensitivity = 0.80, specificity = 0.85). Among the highest-ranked predictive features were pre-deployment sleep quality, anxiety, depression, sustained attention, and cognitive flexibility. Blood-based biomarkers including metabolites, epigenomic, immune, inflammatory, and liver function markers complemented the most important predictors. The clinical prediction of post-deployment symptom trajectories and provisional PTSD diagnosis based on pre-deployment data achieved high discriminatory power. The predictive models may be used to determine deployment readiness and to determine novel pre-deployment interventions to mitigate the risk for deployment-related PTSD.

Successful treatment of post-traumatic stress disorder reverses DNA methylation marks.

Epigenetic mechanisms play a role in the detrimental effects of traumatic stress and the development of post-traumatic stress disorder (PTSD). However, it is unknown whether successful treatment of PTSD restores these epigenetic marks. This study investigated longitudinal changes of blood-based genome-wide DNA methylation levels in relation to trauma-focused psychotherapy for PTSD in soldiers that obtained remission (N = 21), non-remitted PTSD patients (N = 23), and trauma-exposed military controls (N = 23). In an independent prospective cohort, we then examined whether these DMRs were also relevant for the development of deployment-related PTSD (N = 85). Successful treatment of PTSD was accompanied by significant changes in DNA methylation at 12 differentially methylated regions (DMRs) in the genes: APOB, MUC4, EDN2, ZFP57, GPX6, CFAP45, AFF3, TP73, UBCLP1, RPL13P, and two intergenic regions (p values < 0.0001 were confirmed using permutation and sensitivity analyses). Of the 12 DMRs related to PTSD symptom reduction, consistent prospective evidence was found for ZFP57 methylation changes related to changing PTSD symptoms (B = -0.84, t = -2.49, p = 0.014). Increasing ZFP57 methylation related to PTSD symptom reduction was present over and above the relation with symptoms, suggesting that psychological treatments exert biological effects independent of symptom reduction. Together, these data provide longitudinal evidence that ZFP57 methylation is involved in both the development and successful treatment of deployment-related PTSD. This study is a first step to disentangle the interaction between psychological and biological systems to identify genomic regions relevant for the etiology and treatment of stress-related disorders such as PTSD.

Health-Related Quality of Life: A Qualitative Exploration of Employment Concerns of Veterans With Post-Traumatic Stress Disorder

Background/PurposeMilitary veterans experience post-traumatic stress disorder (PTSD) and increased rates of unemployment compared to civilian populations. Health-related quality of life (HRQOL) is identified as a key outcome of long-term health and well-being. The purpose of this article is to (a) explore how employment concerns of veterans with deployment-related (DR) PTSD are associated with HRQOL outcomes, and (b) discuss implications for rehabilitation research, policy, and education.ObjectiveTo (a) explore how employment concerns of veterans with deployment-related (DR) PTSD are associated with HRQOL outcomes and (b) discuss implications for rehabilitation research, policy and education.SettingThree Veterans Health Administration Centers (VHAs).Design/MethodDescriptive qualitative study examining employment-related domains identified through focus groups.FindingsSample consisted of 58 veterans with DR-PTSD (N = 9). Veterans report that HRQOL is affected by PTSD and unemployment. Specifically, themes emerged in the areas of anger, social roles/relationships, task performance, avoidance/isolation, hypervigilance, control over the environment, violence/aggression, and sleep interference.ConclusionCurrently, there are limited measures of HRQOL and employment in veterans with DR-PTSD. This understanding may contribute to development of a more relevant and sensitive measure of DR-PTSD HRQOL, which may facilitate improved research, program evaluation, and clinical practice. Rehabilitation counselors are well positioned to provide services to veterans, but may lack the educational foundation and training needed to support this unique population. Development of military-specific training and curriculum is needed.

Multifeature Mismatch Negativity in Patients With Posttraumatic Stress Disorder.

The mismatch negativity (MMN) component of the event-related brain potential has been used to examine auditory monitoring in various mental disorders. Previous research with posttraumatic stress disorder (PTSD) patients has revealed contradictory results. Enhanced as well as diminished MMNs have been obtained. The multifeature protocol was employed to investigate the pattern of MMN in 17 military deployment-related PTSD patients and a group of healthy university student controls. Our results suggest no general effect of PTSD on the MMN involving the majority of acoustic features. There were slightly reduced MMNs in patients relative to controls for 2 of the features (duration, location). On the other hand, the N1 component was reduced in patients compared with controls. Choice of the stimulus protocol might be an important factor to explain inconsistent results in previous research. Differences in the auditory context between stimulus protocols and deficits in the formation of larger (auditory) contexts in PTSD might account for the results. This study adds to the small number of studies on PTSD and MMN and revealed valuable information to guide future, related studies.

Association of suicidal ideation with trajectories of deployment-related PTSD symptoms

This study examined the association between suicidal ideation and posttraumatic stress disorder (PTSD) symptom trajectories in a nationally representative sample of United States Reserve Component soldiers. PTSD symptoms related to a traumatic event during the most recent deployment were assessed in four annual waves in 2010–2013 among 682 Reserve Component soldiers. Latent Growth Mixture Modeling (LGMM) was used to examine the longitudinal trajectories of PTSD symptoms. The association between the PTSD trajectories and suicidal ideation at waves 2 to 4 was examined in logistic regression analyses. Four trajectories were identified: resilience (73.0%), recovery (11.7%), late onset (11.6%) and chronic (3.6%). Pairwise comparisons demonstrated significant differences between trajectories in risk of suicidal ideation. Among the chronic trajectory group, 50.9% reported suicidal ideation (25.8% late onset group; 11.3% recovery group; 4.0% resilience group). After controlling for baseline characteristics, the late onset and chronic trajectory groups were more likely to have suicidal ideation than the resilience and recovery trajectories, respectively. Findings suggest the late onset and chronic trajectories of PTSD symptoms are associated with higher risk of suicidal ideation. They support the importance of follow-up assessment of suicide risk even among individuals with low PTSD symptoms at homecoming.

Deployment-related trauma and post-traumatic stress disorder: does gender matter?

ABSTRACTObjective: Military research has attempted to identify whether women have an increased vulnerability to mental health issues following deployment-related trauma, but findings have been mixed. Most studies have controlled for childhood abuse, but not other non-deployment trauma (e.g. life-threatening illness), which may partly explain previous mixed results. This study assessed gender differences in the association between deployment-related trauma and post-traumatic stress disorder (PTSD) while controlling for non-deployment trauma.Methods: Data came from the 2013 Canadian Forces Mental Health Survey. Regular or reserve personnel who had been deployed at least once were included in this study (n = 5980). Logistic regression was used to examine the interaction between gender and deployment-related trauma in predicting lifetime PTSD.Results: After controlling for non-deployment trauma, the association of gender with PTSD went from being significant to being marginally significant. The interaction between gender and deployment-related trauma was not significant.Conclusion: Though controlling for non-deployment trauma did not completely dissipate gender differences in PTSD, such differences were greatly reduced, indicating that these may be partly related to traumatic experiences outside deployment. As gender did not moderate the link between deployment-related trauma and PTSD, the findings suggest that trauma experienced while on deployment does not disproportionately affect women compared to their male counterparts.

Gender Differences in Trauma Types and Themes in Veterans with Posttraumatic Stress Disorder

ABSTRACTBackground: This study aimed to determine whether there were gender differences in trauma types and cognitive-emotional themes among veterans with deployment-related posttraumatic stress disorder (PTSD). Methods: Case notes or writing excerpts from two pilot studies were reviewed to determine types of traumas and emerging themes, with 20 women and 31 men comprising the sample. Results: Most women developed PTSD after sexual assault, with reactions emphasizing mistrust, betrayal, and anger. Men experienced more combat, with reactions including survivor guilt, moral injury, and horror. Conclusions: Both genders developed PTSD, but the causes of and reactions to their traumas differed. Emerging themes can be useful treatment foci.

Cognitive Emotion Regulation Strategies Associated With the DSM-5 Posttraumatic Stress Disorder Criteria.

Maladaptive cognitive emotion regulation strategies have been proposed to contribute to the maintenance of posttraumatic stress disorder (PTSD). Prior work has focused on the relationship between these strategies and PTSD as a whole, rather than on how they are related to each PTSD symptom cluster. The purpose of the current study was to determine whether cognitive emotion regulation strategies are predictive of certain PTSD symptom clusters under the Diagnostic and Statistical Manual of Mental Disorders 5th ed. (DSM-5; American Psychiatric Association, 2013) criteria (intrusive thoughts, avoidance, negative alterations in cognitions and mood, and hyperarousal). Participants included 365 treatment-seeking, active-duty military personnel with PTSD. The negative alterations in cognitions and mood cluster were associated with dysfunctional cognitions: greater negative cognitions about the self, negative cognitions about the world, and self-blame, as well as catastrophizing (Rc2 = .519). The negative alterations in cognitions and mood cluster did not show a strong relationship with blaming others, possibly due to the complex nature of self- and other-blame in this primarily deployment-related PTSD sample. Finally, the intrusive thoughts cluster was associated with catastrophizing (Rc2 = .211), suggesting an association between frequent intrusive memories and excessively negative interpretation of those memories.

1074 POSTTRAUMATIC STRESS DISORDER, CANINE COMPANIONSHIP, AND SLEEP: PRELIMINARY FINDINGS

Large numbers of Veterans with post-deployment psychological disorders have reported improvements in sleep in association with canine companionship. Studies have also provided support for an association between canine companionship and lower baseline heart rate. We tested both possibilities in a sample of combat Veterans undergoing inpatient treatment for posttraumatic stress disorder (PTSD) and participating in a Service Animal Training Intervention in which they shared custody of a service canine with another Veteran. Alternating custody enabled within-subjects modeling of associations between canine companionship and sleep. 18 military Veterans with deployment-related PTSD underwent mattress actigraphy for up to four weeks yielding 493 nights of sleep data. Mattress actigraphy relies upon accelerometers embedded in a mattress topper. The intended sleep period is delimited manually by blind raters after which sleep parameters are calculated automatically. Participants also rated morning restedness on a five-point scale following a total of 329 nights. Whether or not participants had custody of their service canines was carefully tracked. Linear mixed modeling was applied to the longitudinal data, controlling for AHI, snoring, and body movements. A random intercept was specified for each participant. Modeling morning restedness detected only main effects of minutes of actigraphic quiescence (F(1,324) = 4.44, p = 0.036) and canine presence (F(1,313) = 3.89, p = 0.049), both predictors having positive coefficients. Modeling of sleep heart rate also detected main effects of actigraphic quiescence (F(1,476) = 5.38, p = 0.021) and of canine presence (F(1,472) = 5.55, p = 0.018), as well as an effect of snoring (F(1,478) = 13.23, p = 0.0003). Quiescence and canine presence were negatively associated with sleep heart rate, while snoring was positively associated. After accounting for other predictors, canine presence was associated with lower sleep heart rate and greater morning restedness in Veterans with PTSD. Preliminarily, these results are consistent with Veterans’ reports of positive effects of a familiar canine presence on their sleep. This research was supported by Contract W81XWH-15-2-0005 to Steven H. Woodward, PhD, from the Defense Health Program, Military Operational Medical Research Program, and U.S. Army Medical Research and Materiel Command.

The Posttraumatic Cognitions Inventory (PTCI) – Development and Validation of a Shortened Military Version Based on a Sample of German Soldiers with Deployment- Related Trauma

Abstract Background: Differentiated and economical diagnostic methods are in ever greater demand in the treatment of soldiers traumatised by war. In the context of cognitive-behavioural approaches, the Posttraumatic Cognitions Inventory (PTCI) serves to identify dysfunctional cognitions that play a key role in the development and persistence of trauma-related disorders such as posttraumatic stress disorder (PTSD). Objectives: The aim of this study is develop and validate an efficient shortened version of the PTCI for soldiers traumatised on deployment in order to provide an improved and practical instrument for use in everyday clinical practice. Methodology: A total of 352 Bundeswehr soldiers diagnosed with deployment-related mental health problems were examined using the PTCI, with the number of items covered by the original instrument being reduced from 33 to 12. The resulting military version of the PTCI (PTCI –Short Version / PTCI-SV) was then validated using a sample of 109 personnel with deployment-related PTSD. Results: The overall scale of the PTCI-SV showed good internal consistency with α=0.86. (Subscales: “negative cognitions about the self” α=0.89; “negative cognitions about the world” α=0.86; “self-blame” α=0.61). Discussion: The possibility of improving trauma therapy for soldiers with deployment-related mental health issues by further developing existing screening instruments is discussed.

Randomized controlled trial of prolonged exposure using imaginal exposure vs. virtual reality exposure in active duty soldiers with deployment-related posttraumatic stress disorder (PTSD).

Prolonged exposure (PE) is an evidence-based psychotherapy for posttraumatic stress disorder (PTSD) but there is limited research with active-duty military populations. Virtual reality exposure (VRE) has shown promise but randomized trials are needed to evaluate efficacy relative to existing standards of care. This study evaluated the efficacy of VRE and PE for active duty soldiers with PTSD from deployments to Iraq and Afghanistan. Active-duty soldiers (N = 162) were randomized to 10-sessions of PE, VRE, or a minimal attention waitlist (WL). Blinded assessors evaluated symptoms at baseline, halfway through treatment, at posttreatment, and at 3- and 6-month follow-ups using the Clinician Administered PTSD Scale (CAPS). Intent-to-treat analyses found that both PE and VRE resulted in significant reductions in PTSD symptoms relative to those in the WL. The majority of patients demonstrated reliable change in PTSD symptoms. There was no difference between PE and VRE regarding treatment drop out before completing 10 sessions (44 and 41% for VRE and PE, respectively). Contrary to hypotheses, analyses at posttreatment did not show that VRE was superior to PE. Post hoc analyses found that PE resulted in significantly greater symptom reductions than VRE at 3- and 6-month follow-up. Both treatments significantly reduced self-reported stigma. PE is an efficacious treatment for active-duty Army soldiers with PTSD from deployments to Iraq or Afghanistan. Results extend previous evidence supporting the efficacy of PE to active-duty military personnel and raise important questions for future research on VRE. (PsycINFO Database Record

Guilt, Shame and Compassionate Imagery in War: Traumatized German Soldiers with PTSD, a Pilot Study.

Background: The consideration of specific trauma-associated emotions poses a challenge for the differential treatment planning in trauma therapy. Soldiers experiencing deployment-related posttraumatic stress disorder often struggle with emotions of guilt and shame as a central component of their PTSD. Objective: The purpose of this study was to examine the extent to which soldiers’ PTSD symptoms and their trauma-related guilt and shame may be affected as a function of their ability to develop compassionate imagery between their CURRENT SELF (today) and their TRAUMATIZED SELF (back then). Method: The sample comprised 24 male German soldiers diagnosed with PTSD who were examined on the Posttraumatic Diagnostic Scale (PDS) and two additional measures: the Emotional Distress Inventory (EIBE) and the Quality of Interaction between the CURRENT SELF and the TRAUMATIZED SELF (QUI-HD: Qualität der Interaktion zwischen HEUTIGEN ICH und DAMALIGEN ICH) at pre- and post-treatment and again at follow-up. The treatment used was imagery rescripting and reprocessing therapy (IRRT). Results: Eighteen of the 24 soldiers showed significant improvement in their PTSD symptoms at post-treatment and at follow-up (on their reliable change index). A significant change in trauma-associated guilt and shame emerged when compassionate imagery was developed towards one’s TRAUMATIZED SELF. The degree and intensity of the guilt and shame felt at the beginning of treatment and the degree of compassionate imagery developed toward the TRAUMATIZED SELF were predictors for change on the PDS scores. Conclusions: For soldiers suffering from specific war-related trauma involving PTSD, the use of self-nurturing, compassionate imagery that fosters reconciling with the traumatized part of the self can effectively diminish trauma-related symptoms, especially when guilt and shame are central emotions.

A Case Study of Cognitive-Behavioral Conjoint Therapy for Combat-Related PTSD in a Same-Sex Military Couple

Military deployments to Iraq and Afghanistan are associated with increased risk for posttraumatic stress disorder (PTSD), depression, and relationship impairment. Unfortunately, the perceived stigma associated with seeking deployment-related behavioral health care in military settings has been a significant barrier to care. Historically, active-duty military service members involved in same-sex intimate relationships have experienced further stressors and barriers to care related to additional stigma and lack of social support. Prior federal regulations excluded sexual minorities from openly serving in the military, thereby limiting the available behavioral health services for same-sex couples. Since this ban was lifted after the repeal of the U.S. policy known as "Don’t Ask, Don’t Tell" in 2010, gay and lesbian service members have increased opportunities to obtain behavioral health care. One therapy that is newly available to sexual minority military couples is Cognitive-Behavioral Conjoint Therapy (CBCT), which effectively addresses co-occurring PTSD and relationship dysfunction. This case study illustrates the use of CBCT for the treatment of deployment-related PTSD in a same-sex active-duty military couple. After completing all 15 CBCT sessions, the couple reported clinically meaningful changes in the service member’s PTSD symptoms, which was maintained at the 2-month follow-up. The results of this case study indicate that CBCT for PTSD can have positive treatment outcomes with military same-sex couples. Further clinical implications are discussed.

Gender, Position of Authority, and the Risk of Depression and Posttraumatic Stress Disorder among a National Sample of U.S. Reserve Component Personnel

BackgroundRecent U.S. military operations in Iraq and Afghanistan have seen dramatic increases in the proportion of women serving and the breadth of their occupational roles. General population studies suggest that women, compared with men, and persons with lower, as compared with higher, social position may be at greater risk of posttraumatic stress disorder (PTSD) and depression. However, these relations remain unclear in military populations. Accordingly, we aimed to estimate the effects of 1) gender, 2) military authority (i.e., rank), and 3) the interaction of gender and military authority on a) risk of most recent deployment-related PTSD and b) risk of depression since most recent deployment. MethodsUsing a nationally representative sample of 1,024 previously deployed Reserve Component personnel surveyed in 2010, we constructed multivariable logistic regression models to estimate effects of interest. ResultsWeighted multivariable logistic regression models demonstrated no statistically significant associations between gender or authority, and either PTSD or depression. Interaction models demonstrated multiplicative statistical interaction between gender and authority for PTSD (beta = −2.37; p = .01), and depression (beta = −1.21; p = .057). Predicted probabilities of PTSD and depression, respectively, were lowest in male officers (0.06, 0.09), followed by male enlisted (0.07, 0.14), female enlisted (0.07, 0.15), and female officers (0.30, 0.25). ConclusionsFemale officers in the Reserve Component may be at greatest risk for PTSD and depression after deployment, relative to their male and enlisted counterparts, and this relation is not explained by deployment trauma exposure. Future studies may fruitfully examine whether social support, family responsibilities peri-deployment, or contradictory class status may explain these findings.

Treatment of active duty military with PTSD in primary care: A follow-up report

First-line trauma-focused therapies offered in specialty mental health clinics do not reach many veterans and active duty service members with posttraumatic stress disorder (PTSD). Primary care is an ideal environment to expand access to mental health care. Several promising clinical case series reports of brief PTSD therapies adapted for primary care have shown positive results, but the long-term effectiveness with military members is unknown. The purpose of this study was to determine the long-term outcome of an open trial of a brief cognitive-behavioral primary care-delivered protocol developed specifically for deployment-related PTSD in a sample of 24 active duty military (15 men, 9 women). Measures of PTSD symptom severity showed statistically and clinically significant reductions from baseline to posttreatment that were maintained at the 6-month and 1-year follow-up assessments. Similar reductions were maintained in depressive symptoms and ratings of global mental health functioning.