Military Sample Research Articles

Hope, Religiosity, and Mental Health in U.S. Veterans and Active Duty Military with PTSD Symptoms.

Many studies have linked hope with better mental health and lower risk of suicide. This is especially true in those who have experienced severe physical or emotional trauma. Religious involvement is associated with greater hope. We examine here the relationship between hope, religiosity, and mental health in a sample of Veterans and Active Duty Military (ADM) with PTSD symptoms. A cross-sectional multi-site study was conducted involving 591 Veterans and ADM from across the United States. Inclusion criteria were having served in a combat theater and the presence of PTSD symptoms. Measures of religiosity, PTSD symptoms, depression, and anxiety were administered, along with a single question assessing the level of hope on a visual analog scale from 1 to 10. Bivariate and multivariate relationships were examined, along with the moderating effects of religiosity on the relationship between hope and symptoms of PTSD, depression, and anxiety. Hope was inversely related to PTSD, depression, and anxiety symptoms (r = -0.33, -0.56, and -0.40, respectively, all p < 0.0001), but was positively related to religiosity (r = 0.32, p < 0.0001). Religiosity remained significantly related to hope (p < 0.0001) after controlling for demographics, military characteristics, as well as PTSD, depression, and anxiety symptoms, and this relationship was partly but not entirely mediated by social factors (marital status, relationship quality, community involvement). Religiosity did not, however, moderate the strong inverse relationships between hope and PTSD, depression or anxiety symptoms. Hope is inversely related to PTSD, depression, and anxiety in Veterans and ADM with PTSD symptoms. Although religiosity is positively related to hope, independent of demographic, military, social, and psychological factors, it does not buffer the negative relationships between hope and PTSD, depression, or anxiety. While further research is warranted, particularly longitudinal studies capable of addressing questions about causality, providing support for the existing religious beliefs of current and former military personnel may help to enhance hope and mental health in the setting of severe combat-related trauma.

Exploring the Content of Suicidality among Military Personnel and Veterans

Previous research and theorizing have long sought to describe reliable typologies of suicide risk, particularly regarding soldier and veteran military samples. In the present study, we examined suicidal content from two samples of outpatient suicidal military personnel—one a sample of active-duty infantry soldiers (n = 89) and the other a sample of veterans (n = 62), using the first page of the Suicide Status Form (SSF; Jobes, 2016). Descriptive statistics examined both the qualitative and quantitative SSF-based responses between these cohorts. Preliminary findings showed different psychological content profiles between these samples: active-duty soldiers reported being more “self-focused” and “escape-oriented” in responses related to suicide, whereas veterans reported being more “other-focused” in responses related to suicide. This study suggests that despite similarities resulting from military experience, active-duty soldiers and veterans likely experience suicide risk differently. The main goal of this study was to differentiate clinically relevant suicidal responses on the exact same stimulus tool, which can be useful in generating hypotheses to be tested in future research about similarities and differences in suicide risk presentations between active-duty soldiers and veterans.

Perceived motivational climate and unit cohesion: The case of French soldiers in training

ABSTRACTUsing a correlational design, this exploratory research investigates the relationships between soldiers’ perceptions of the motivational climate created by platoon leaders and unit cohesion in a French military sample. Conducted among 257 soldiers, the findings indicate that new recruits perceive motivational climate as significantly more task- than ego-involved. Moreover, multiple regressions show that a task-involving motivational climate predicts higher measures of cohesion than does an ego-involving motivational climate. Implications for the professionalization of military forces and exercising command in training are discussed.

Suicide Typologies in the United States Air Force: A Hierarchical Cluster Analysis.

This study describes characteristics of United States Air Force (USAF) suicide decedents and determines subgroups. Retrospective review of demographic, psychiatric, event-related, and psychosocial variables for USAF suicide decedents in the Suicide Event Surveillance System database was conducted between February 1999 and July 2009 (N=376). Hierarchical cluster analysis was used to determine initial clusters and cluster centroids. Analyses identified three clusters. Cluster 1 (n=149) individuals were mostly single or divorced, E-1-E-6 rank, living alone, and less likely to have psychiatric disorder diagnoses or engage with most helping resources. Cluster 2 (n=126) decedents were mostly married, living with a partner, higher ranking, and least likely to communicate suicide intent. Cluster 3 (n=101) individuals were mostly E-4-E-6 rank, with the highest rates of most psychiatric diagnoses, previous suicide-related events, engagement with multiple helping resources, communication of intent, and psychosocial precipitants. Clusters differed significantly in marital status, rank, psychiatric diagnoses, precipitants, service utilization, previous suicide-related events, risk factors, communication of intent, location and method of death, and residential status. This study identifies empirically based suicide typologies within a military decedent sample. While further research and replications of findings are needed, these typologies have clinical and policy implications for military suicide prevention.

Validity of the CES-D for depression screening in military service members with a history of mild traumatic brain injury

ABSTRACTPrimary Objective: To advance knowledge about the value of the Center for Epidemiologic Studies – Depression scale (CES-D) for depression screening in military service members with a history of mild traumatic brain injury (mTBI).Research Design: Retrospective data from 336 military service members with a history of mTBI were extracted from a TBI Repository at a large military medical center. Participants included in this study screened positive for mTBI in a primary care clinic or soldier readiness processing center and were enrolled in the TBI repository from November 6, 2014 to May 31, 2017. At the time of enrollment, participants completed the CES-D and their electronic medical records (EMR) were searched for diagnoses of depressive disorders.Methods and Procedures: Receiver-operating characteristic (ROC) analysis of the CES-D was used to discriminate cases with and without depression diagnoses.Main Outcomes and Results: Area under the ROC curve (AUC) was .897. Sensitivity (.824) and specificity (.826) were maximized at a cut score of 18 or greater, slightly higher than the standard cut of 16 established for civilian samples.Conclusions: Results suggest that the CES-D is a valid screening instrument for depressive disorders in military samples with a history of mTBI.

Does prolonged exposure increase suicide risk? Results from an active duty military sample

The efficacy of prolonged exposure (PE) on suicide ideation (SI) as a secondary outcome among individuals with posttraumatic stress disorder (PTSD) is unclear. The purpose of this study was to compare the efficacy of PE in two formats (spaced, S-PE, 10 sessions over 8 weeks, and massed, M-PE, 10 sessions over 2 weeks) to Present Centered Therapy (PCT) and minimal contact control (MCC) on SI exacerbation among patients without suicide intent or plans. Active duty military personnel (n = 335) were randomized to: (1) S-PE vs. PCT and (2) M-PE vs. MCC. All participants completed the Beck Scale for Suicide Ideation and the Beck Depression Inventory (Suicide item) at baseline, posttreatment, and follow-ups. S-PE and PCT had significant and comparable reductions in SI during treatment. M-PE had significantly steeper reductions in SI during treatment compared to MCC. Specifically, more participants in M-PE compared to MCC had reliable improvement versus reliable exacerbation. Reduction in PTSD symptoms was significantly associated with reduction of SI. PE was associated with significant reductions in SI over time that were comparable to PCT and superior to MCC. These findings suggest that both trauma- and non-trauma-focused treatments are associated with reductions in SI, and that trauma-focused treatments improve SI relative to waitlist.

Psychopathological Correlates and Emotion Regulation as Mediators of Approach and Avoidance Motivation in a Chinese Military Sample.

Background: Approach and avoidance motivation have been thoroughly studied in common mental disorders, which are prevalent in the military context. Approach/avoidance motivational dispositions underlie emotion responses and are thought to influence emotion dysregulation. However, studies on the mediating role of emotion regulation (ER) between motivational dispositions and mental disorders have been insufficient. We examined the psychopathological correlates of motivational dispositions and explored the mediating role of ER.Methods: The Behavioral Inhibition System and Behavioral Activation System (BIS/BAS) scales and measures of mood disorders (depression, anxiety, OCD, and PTSD) were administered to a nonclinical sample of 3,146 Chinese military service members. The Emotion Regulation Questionnaire for Armymen (ERQ-A) (Chinese version) was used to measure ER styles. We examined the reliability and construct validity of the BIS/BAS scales. Approach/avoidance motivations were correlated with symptoms of mood disorders. Mediation analysis was conducted to confirm the mediating role of ER between motivation and mood disorders.Results: The results showed acceptable internal reliability and construct validity of the BIS/BAS scales. Gender (female), family status (single-parent family), and social relationships (having fewer good friends) were significant predictors of high BIS sensitivity. More years of education, an older age, being an only child and being in a single-parent family all significantly predicted high BAS sensitivity. The BIS/BAS scales were predictive of various DSM-V-based mental disorders (depression, anxiety, OCD, and PTSD). Immersion exacerbated the impact of BAS/BIS sensitivities on depressive/PTSD symptoms, while reinterpretation and talking out alleviated the impact of BAS/BIS sensitivities on these symptoms.Conclusions: Motivational dispositions have an impact on mood symptoms under specific conditions. ER strategies (immersion, reinterpretation, and talking out) were shown to be partial mediators between approach/avoidance motivation and mood disorders. These findings highlight the importance of ER in altering the impact of motivational dispositions on mood disorders and as a promising target of psychotherapies.

Rape myth acceptance, male gender role norms, attitudes towards women, and psychopathic traits in a military sample

Rape myth acceptance (RMA) demonstrates association with psychopathic traits, traditional gender role norms, and negative attitudes towards women. However, these RMA correlates have rarely been studied in combination, or examined within military populations. The present study investigated RMA, psychopathic traits, attitudes towards women, and male gender role norms using a convenience sample of 85 active and veteran military personnel recruited through social media. As hypothesized, males and females with in the military did not differ in level of RMA. Results revealed significant associations between the Affective and Interpersonal facets of psychopathy and RMA. Hierarchical linear regression models indicated that traditional male norm ideology and Interpersonal psychopathic features significantly predicted RMA. Affective features to also trended in the prediction of RMA. Results suggest that Affective and Interpersonal traits of psychopathy are salient in account for RMA in a military sample.

Factor Analysis of the Texas Functional Living Scale in an Outpatient Clinical Sample.

Prior factor analysis of the Texas Functional Living Scale (TFLS), a performance-based measure of functional abilities, in a military veteran sample supported four factors discrepant from the published subscales. This study analyzed TFLS factor structure in a non-veteran clinical sample. Two hundred seventy adult outpatients completed the TFLS during neuropsychological evaluation. Principal axis factor analysis with oblique promax rotation was conducted with age and education effects partialed out. Parallel analysis indicated five factors for extraction that accounted for a combined 48% of the variance. The first factor independently explained 26% of the total variance. Inspection of factor loadings suggested the following factor interpretations: complex calculations/time, complex visual search, praxis, memory, and basic calculations/math concepts. Five items did not significantly load onto any of the factors. Current results did not entirely correspond to the published subscales or prior results in a veteran sample. Further clarification of the TFLS factor structure is warranted.

Sleep-Related Practices, Behaviors, and Sleep-Related Difficulties in Deployed Active-Duty Service Members Performing Security Duties

ABSTRACTObjective: To assess sleep-related difficulties (e.g., trouble staying asleep, oversleeping, falling asleep while on duty, disturbing dreams, sleep paralysis) and behavioral patterns of active-duty service members (ADSMs) performing security duties. Participants: The participants were 1,169 ADSMs (20–44 years of age). Methods: ADSMs completed an online survey (67.3% response rate) with items assessing demographics, the occupational environment, sleep-related attributes, habits, or difficulties, factors affecting sleep, aids and techniques used to improve sleep, and the use of sleep-related products. Results: ADSMs reported sleeping ~6.5 hr/day (~56% reported sleeping < 6 hr). Sleep-related difficulties were reported by ~72% of the ADSMs (i.e., 55.1% had problems staying asleep, 33.1% reported experiencing sleep paralysis, 25.6% reported oversleeping, 21.6% had disturbing dreams, and 4.79% reported falling asleep while on duty). Daily sleep duration and quality, occupational factors (shift work, operational commitments, collateral duties, habitability, taking antimalarial medication, years deployed), and personal factors or behaviors (history of sleep problems, problems in personal life, late exercise times, altering sleep schedule to talk or text with family or friends) were associated with sleep-related difficulties. Some ADSMs reported using alcohol (~14%) or exercising prior to bedtime (~34%) in an attempt to fall sleep faster. Conclusions: We identified a high prevalence of sleep-related difficulties in our military sample. Even though most ADSMs used sleep hygiene practices to improve their sleep, some ADSMs used methods not recommended. Improving ADSMs’ daily schedule (to include periods for exercising, and protected sleep periods), and further emphasis on sleep hygiene practices may be viable methods to reinforce behaviors promoting healthy sleep and improve performance.

Comparing Correlates of Posttraumatic Growth for Military Veteran versus Non-military Veteran Samples

Background: There has been a great deal of research on studying variables affecting posttraumatic growth (PTG) after a crisis or traumatic event across different samples. However, there has been little research comparing common correlates of PTG for military veteran versus non-military veteran samples. Using common demographic, trauma-related and coping style variables, the research question tested if there were common correlates of PTG between a military veteran versus non-military veteran sample. Methods: Using an on-line survey we recruited 153 military veterans and 99 non-military veterans to compare on the study variables. The research design was cross-sectional. Results: Controlled-for demographic (gender, race, age, highest education level) and traumatic event variables (total number of traumatic events, how long ago most powerful traumatic event) had minimal impact on PTG. Three coping scales, positive reframing, self-distraction, and alternative work, were measured. Positive reframing was positively related to PTG for both samples. Self-distraction was a positive correlate to PTG for the non-military veteran sample, while alternative work was a positive correlate for the military veteran sample. Conclusion: Further study of the motivation factors that contribute to positive reframing and alternative work could prove interesting to determine how PTG is gained. That self-distraction was a positive correlate to PTG for the non-military veteran sample suggests that such focusing away from the trauma/crisis may be helpful. Continued research on investigating common versus differentiating correlates of PTG for different samples is needed.

A Preliminary Study Examining the Prevalence and Perceived Intensity of Morally Injurious Events in a Veterans Affairs Chaplaincy Spiritual Injury Support Group

The aim of this descriptive study was to examine the prevalence and perceived intensity of potentially morally injurious events (PMIEs) in a group of VA chaplaincy service users. A secondary aim was to examine the relationship between PMIEs, spiritual injury, and religiosity. A convenience sample of veterans (n = 84), participants in a spiritual injury support group, completed the Moral Injury Events Scale (MIES). Most individuals also completed the Duke University Religion Index (as a measure of religiosity) and Spiritual Injury Scale. Results suggest a high prevalence of PMIEs among participants. These PMIEs were also higher in perceived intensity compared to other military and veteran samples. No significant correlations were identified between MIES scores and either religiosity or spiritual injury. These findings draw attention to the engagement of chaplains in supporting veterans affected by PMIEs. Implications for future research are discussed.

Identification of Functioning Domains in the Presurgical Period and Their Relationships with Opioid Use and Pain Catastrophizing.

The National Institutes of Health Patient-Reported Outcomes Measurement Information System (PROMIS) is a multidimensional screening system evaluating biopsychosocial factors affecting pain and functioning. Using a military sample, the current study 1) examined the structure and domains of the PROMIS, the Defense and Veterans Pain Rating Scale 2.0 (DVPRS), and the Pain Catastrophizing Scale (PCS) within a presurgical setting and 2) examined the relationship of these variables to pre- and postsurgical opioid use. This cross-sectional study included 279 adult patients scheduled for surgery at the Walter Reed National Military Medical Center and a validation sample of 79 additional patients from the Naval Medical Center, San Diego. PROMIS, DVPRS, PCS, and opioid use data were collected before surgery. Exploratory factor analysis and confirmatory factor analysis identified the latent structure for the measures. A structural equation model (SEM) examined their relationship to pre- and postsurgical opioid use. Two latent factors represented Psychosocial Functioning (PROMIS Depression, PROMIS Anxiety, and PROMIS Social Isolation) and Pain Impact (DVPRS, PROMIS Pain Interference, PROMIS Physical Functioning). The remaining PROMIS scales did not load onto a single factor. In the SEM, the two latent factors and PCS were significantly related to pre- and postsurgical opioid use. This study highlights the utility and relative ease of using a convenient multidimensional assessment in presurgical settings. Using such an assessment can help provide targeted interventions for individuals who may be at greatest risk for negative postsurgical outcomes.

The Enriched Life Scale (ELS): Development, exploratory factor analysis, and preliminary construct validity for U.S. military veteran and civilian samples.

The U.S. military veteran serving nonprofit, Team Red, White & Blue (RWB), defined an "enriched life" as having physical, mental, and emotional health; supportive relationships; and a sense of purpose. Until now, no corresponding measure of an "enriched life" existed for the purposes of clinical assessment and research. The primary objective of this study was to explore the psychometric properties of the Enriched Life Scale (ELS) in veteran and civilian samples. Our secondary objective was to examine differences in ELS scores in subgroups of veterans who had combat deployments and service-related injuries. Veteran thought leaders working with social scientists developed the ELS and implemented exploratory factor analysis to determine the underlying dimensions of the "enriched life" construct. One thousand one hundred and eighty-seven veterans and 598 civilians participated in the study. This article describes the development of the ELS, reliability, exploratory factor analysis, and preliminary construct validity. The final ELS had 40 items and consisted of five constructs that were labeled "Genuine Relationships"; "Sense of Purpose"; "Engaged Citizenship"; "Mental Health"; and "Physical Health." Measures had high internal consistency (α = 0.82-0.94). Civilians scored higher than veterans on every ELS item, subscales, and total score, with small to large effect size differences noted between groups. In the veteran subsample, individuals with combat experience scored lower on every ELS subscale than those without combat experience (small effect sizes), as did veterans with service-related injuries in comparison to those without them (small to large effect sizes). This article establishes preliminary psychometric properties of the ELS-a promising instrument to measure an enriched life. Further study is currently underway to establish confirmatory factor analyses and explore extending its usage to diverse military and civilian samples.

The Relationship between Post-Battle Experiences and Thwarted Belongingness and Perceived Burdensomeness in Three United States Military Samples

Suicide rates within the military are elevated relative to the general population; however, research suggests that many of the suicide risk factors for military personnel are similar to the suicide risk factors for civilians. Given that many military specific experiences (e.g., number of deployments) are not considered robust predictors of either suicidal ideation or behavior, it has been posited that deployment specific experiences (e.g., post-battle experiences) may be better able to explain the increased rates of suicide among military personnel. Therefore, the current study aimed to examine the relationship between post-battle experiences and perceived burdensomeness (PB), thwarted belongingness (TB), and suicidal ideation within 3 different military samples: a non-clinical sample of Army National Guard personnel, a non-clinical sample of active duty U.S. Air Force Security Forces personnel, and a clinical sample of U.S. Army personnel receiving outpatient treatment. Post-battle experiences were found to be significantly associated with TB in both non-clinical samples; however, the association between post-battle experiences and TB was non-significant within the clinical sample. Furthermore, results indicated that post-battle experiences were not significantly associated with either PB or suicidal ideation in any of the samples. These findings suggest that in non-clinical samples, post-battle experiences impact a soldier’s ability to feel connected to others. Within clinical samples, results indicate that post-battle experiences may not be a direct contributor to either PB or TB. These results indicate a need for universal intervention promoting interpersonal support of military personnel and their families prior to development of further need for psychological interventions. This upstream approach may decrease further development of TB and potentially prevent suicidal desire.

Negative Life Events (NLEs) Contributing to Psychological Distress, Pain, and Disability in a U.S. Military Sample.

The objective was to explore how negative life events (NLEs, e.g., litigation related to pain and disability, failing most recent physical fitness test, and financial difficulties) are related to pain coping and psychological adjustment to pain in active duty military personnel. Data were gathered as part of the Evaluation of Suicidality, Cognitions, and Pain Experience study, a DoD-funded cross-sectional assessment of chronic pain and emotional coping among a cohort of military members. The investigators examined data from 147 respondents with complete survey and pain assessment data. The sample was active duty, male (62.6%), in a relationship or married (83.0%), and had children (68.7%). The majority of the sample endorsed zero NLEs (72.0%); 23.8% endorsed one NLE, 4.2% endorsed two NLEs, and no one endorsed all three NLEs. A significantly higher proportion of participants endorsing one or more NLEs reported suicidal ideation compared to those who reported no NLEs (χ2(2) = 8.61, p = 0.014). A higher number of endorsed NLEs coincided with higher symptom severity related to psychosocial distress (depression, thwarted belongingness, perceived burdensomeness, PTSD, and suicide cognitions) and poor pain coping (rumination, helplessness, and less acceptance of chronic pain). Findings revealed that NLEs may impart a significant burden on military pain sufferers. Greater numbers of endorsed NLEs are associated with increased psychosocial distress and poor pain coping. Future longitudinal studies examining long-term psychosocial distress/poor pain coping as related to NLEs would help to elaborate the long-term consequences of NLEs on pain coping and psychosocial distress.

Social Relations and PTSD Symptoms Influence mTBI Symptom Reporting in a Military Sample

Social Relations and PTSD Symptoms Influence mTBI Symptom Reporting in a Military Sample

Anxiety and Depression Contribute More to TBI Complaints Than Sleep Disturbances in a Military Sample

To examine the extent to which sleep complaints contribute to cognitive and somatosensory symptoms after controlling for anxiety/depression symptoms among SMs with a history of TBI. An estimated 50-97% of military Service Members (SMs) with a history of traumatic brain injury (TBI) have sleep complaints [1, 2]. Sleep-wake disturbances after TBI can adversely impact recovery, cognitive and emotional functioning [3]. Sleep disturbances are also common associates of post-traumatic stress disorder (PTSD) and depression [4], which are often comorbid in those with a history of TBI. It is unknown if sleep disturbances influence post-TBI symptoms beyond the influence of psychiatric symptoms. CorrectionArchives of Physical Medicine and RehabilitationVol. 100Issue 7PreviewResearch Poster 657143 in the in the November 2018 issue (Volume 99, Issue 11, Page e156) 2018 4th Federal Interagency Conference on Traumatic Brain Injury Abstracts contains an incorrect author list. (To view the full issue, please visit the Archives journal website at http://www.archives-pmr.org/issues .) The corrected author list appears below. Full-Text PDF

How Distress Tolerance Mediates the Relationship Between Posttraumatic Stress Disorder and the Interpersonal Theory of Suicide Constructs in a U.S. Military Sample.

Despite the general suicide rate within the military being comparable to the general population when comparing peers, there are certain branches of the military that have elevated risk. Specifically, the U.S. National Guard has suicide rates that are constantly higher than other military branches and civilian peers. The National Guard are a unique military population in which they frequently transition between military and civilian life. With these unique experiences and heightened risk, military suicide prevention efforts may benefit from further research within this population. Posttraumatic stress disorder (PTSD) is another concern amongst military personnel and has been linked to suicidal behavior. The current study examined the indirect effects that distress tolerance, a protective factor against suicide, has on the relationship between PTSD and constructs within a well-validated theory for suicide (the Interpersonal-Psychological Theory for suicidal behaviors) in a sample of U.S. Army National Guard personnel. Results indicated that distress tolerance had a significant indirect effect on the relationship between PTSD and thwarted belongingness, perceived burdensomeness, and capability for suicide. These findings are consistent with previous literature examining the relationship between distress tolerance and our outcome variables. These results could have important clinical implications, mainly that intervention strategies targeting distress tolerance could have significant impacts on suicide-relate thoughts.

Low intellectual ability does not predict violent crime in a military forensic sample

This study examined whether intellectual ability predicts violent crime among a sample of military members charged with criminal offenses. Intellectual ability was measured with the Full-Scale Intelligence Quotient (FSIQ), Verbal Comprehension Index (VCI), and the Perceptual Reasoning Index (PRI) of the Wechsler Adult Intelligence Scale, Fourth Edition (WAIS-IV). The sample was comprised of military members charged with any type of offense and referred for forensic evaluation. A binary logistic regression was performed to see if any or all of the intelligence indices predicted violent crime. Criminal offenses were dichotomized where 0 = non-violent crime and 1 = violent crime. The sample (N = 79) was drawn from a retrospective review of forensic evaluations of military members charged with criminal offenses. These findings support the observation that intellectual ability does not predict likelihood of committing a violent offense in a military forensic population. This study highlights the importance of incorporating military-specific data into forensic assessments of service members.