Postdeployment Readjustment Research Articles

A - 172 STEP-Home Intervention Improves Inhibitory and Anger Control, Reintegration, and Neurobehavioral Symptoms in Post-9/11 Veterans with TBI and Other Common Comorbidities.

Post-9/11U.S. Veterans are clinically complex with multiple co-occurring health conditions contributing to morbidity/mortality and decreased quality of life. TBI diagnosis can worsen these outcomes. STEP-Home is a cognitive-behavioral transdiagnostic intervention for TBI and common comorbidities. This study determines if STEP-Home improves anger control, frontal system function, civilian readjustment, neurobehavioral symptoms, and work/life functioning in post-9/11 Veterans. TBI may influence Veterans' ability to learn core skills and, thus, impact response to treatment. Treatment outcomes for Veterans with and without TBI will be explored. 56 (39M/17F; mean age = 39.9) post-9/11 Veterans with high rates of psychiatric comorbidity, with and without TBI received 12weeks of the STEP-Home cognitive-behavioral intervention. Assessments at baseline, posttreatment (12weeks), and follow-up (12weeks posttreatment) included: State-Trait Anger Expression Inventory 2 (STAXI-2); Military to Civilian Questionnaire (M2CQ); Post-Deployment Readjustment Inventory (PDRI); Frontal Systems Behavioral Scale (FrSBe); Neurobehavioral Symptom Inventory (NSI); World Health Disability Scale (WHODAS); PTSD Checklist (PCL-5); Depression Anxiety and Stress Scale (DASS-21). STEP-Home significantly improved anger expression (STAXI-2 p = 0.0320), inhibitory control (FrSBe p = 0.0001), and reintegration status (MC2Q p = 0.0001; PDRI p = 0.0097) posttreatment. Similar improvements were seen in neurobehavioral symptoms, work/life functioning, PTSD, depression, and stress (p's < 0.01). Treatment gains were maintained at follow-up (p's < 0.001). Treatment response did not differ by TBI status. STEP-Home teaches Veterans cognitive-behavioral skills to improve anger and impulse control, executive functioning, reintegration, and work/life functioning. Treatment gains were comparable for Veterans with and without TBI. This is critical given TBI prevalence among post-9/11 Veterans and the need for additional palatable treatment options.

“A Woman in A Man’s World”: A Pilot Qualitative Study of Challenges Faced by Women Veterans During and After Deployment

ABSTRACT Women Veterans face gender-specific challenges to military life and post-deployment readjustment, including gender-based discrimination and military sexual trauma. Despite recent military initiatives to address these issues, women still experience unique challenges during military service. This study examines spontaneous comments about gender-specific challenges to military life that were made by participants in a qualitative study of women’s transitions to civilian life after deployment to Iraq or Afghanistan. Methods: Women Veterans who were enrolled at a New England VA hospital and who had deployed to the U.S. conflicts in Iraq and Afghanistan participated in this qualitative study (N = 22). Interview queries and initial coding structure were developed through an extensive literature review. An iterative coding process generated additional themes identified in the data. For this project, codes regarding self-initiated reports of gender-specific challenges that fell outside the scope of the study’s initial interview agenda were reviewed for thematic analysis. Results: The following three self-initiated themes emerged among 12 respondents: 1) gender-based scrutiny and discrimination; 2) the military’s inadequate position and response to military sexual trauma; and 3) disadvantages to women service members living in a male-dominated environment. Across all three themes emerged a sub-theme in which women perceived their unique needs to be inconvenient and/or disregarded. Respondents described how these challenges disrupted their lives during and after military service. Conclusion: Results imply gender-specific challenges and military sexual trauma remain critical concerns for women Veterans well after deployment had ended, and that improved policy may have long-term health implications.

Psycho-demographic Factors Influencing Social Well-being among Mobile Police Force

Introduction: There is overwhelming evidence in the increase of dysfunctional social well-being among service members returning from deployment, and this is culminating into a wide range of social challenges. The present study investigated the psycho-demographic factors influencing social well-being among mobile police force in Kwara State, Nigeria. Method: The study adopted a survey method utilizing an ex-post-facto design. The purposive sampling technique was used to sample 200 mobile police officers (152 males and 48 females). They completed a questionnaire pack which included-the Post-Deployment Readjustment Inventory Scale, Emotion Regulation Questionnaire and Mental Health Continuum of Social Well-being-Short Form. Data were analyzed using descriptive statistics, Pearson Product Moment Correlation, ANOVA and Multiple Regression. Results: Findings showed that emotion regulation has a positive relationship with social well-being. Also, age, emotion regulations and post-deployment stress as a whole significantly predicted social well-being among the sampled participants. However, emotion regulation independently predicted social well-being, though marital status did not significantly influence social well-being among the participants. Conclusion: This study presented emotion regulation as a great predictor of social well-being. It is recommended that; emotion regulation should be built into the training and debriefing of mobile police before and after deployment to aid their better social well-being.

Indirect Relations Between Transgressive Acts and General Combat Exposure and Moral Injury.

Moral injury describes the deleterious effects of acts of commission (e.g., killing noncombatants), omission (e.g., failing to prevent a massacre), or betrayal (i.e., by a trusted authority figure) during military service that transgress accepted behavioral boundaries and norms. Transgressive acts are proposed to lead to a guilt- and shame-based syndrome consisting of post-traumatic stress disorder (PTSD) symptoms, demoralization, self-handicapping, and self-injury. In this study, we tested a frequently cited model of moral injury and assessed the associations between potentially transgressive acts, moral injury outcomes, and guilt and fear. Additionally, we sought to clarify the relative contribution of transgressive and nontransgressive/general combat exposure to moral injury. On the basis of previous research and theory, we anticipated that the transgressive acts would be related to outcomes through guilt and that nontransgressive combat exposure would be related to outcomes through fear. Secondary analysis was conducted on data from a sample of combat-exposed male veterans at a Midwestern Veterans Affairs (VA) medical center (N = 190) who participated in a larger parent study on postdeployment readjustment. Structural equation modeling was used to test the pathways from transgressive and nontransgressive combat exposure to PTSD symptoms and suicidality through combat-related guilt and combat-related fear. The institutional review boards of the Midwestern VA medical center and the university of the affiliated researchers approved the study. In total, 38% (n = 72) of the sample reported a potentially transgressive act as one of their three worst traumatic events. The most common potentially transgressive act was killing an enemy combatant (17%; n = 32). In structural equation modeling analyses. potentially transgressive acts were indirectly related to both suicidality (β = 0.09, p < 0.01) and PTSD symptoms (β = 0.06, p < 0.05) through guilt. General combat exposure was indirectly related to PTSD through fear, β = 0.19, p < 0.01. Combat exposure was not directly or indirectly related to suicidality. Overall, these findings suggest that veterans with a history of potentially transgressive acts may present to the VA with a constellation of symptoms that are associated with combat-related guilt. Transgressive acts were identified using a qualitative approach, allowing a broader sampling of this domain. Results were limited by the use of self-report data and by gathering data from participants who were Veterans seeking compensation and pension evaluations for PTSD. The clinical implications suggest that focusing on fear-related outcomes and ignoring guilt- and shame-based reactions may lead to an incomplete case conceptualization. Clinicians working with veterans with moral injury are encouraged to prepare themselves for the discomfiting therapeutic experiences of bearing witness to and empathizing with clients' memories of their actions, which may include atrocities. Effective and empathic treatments that address the guilt and shame associated with transgressive acts are needed to adequately care for returning veterans.

Understanding Post-Deployment Reintegration Concerns Among En Route Care Nurses: A Mixed-Methods Approach

The objective of this study was to better understand the post-deployment behavior health symptoms and readjustment/reintegration experienced by military nurses who provided en route care while serving in Operation Enduring Freedom/Operation Iraqi Freedom. Employing an exploratory, concurrent, mixed-methods design with an electronic survey consisting of several valid instruments and single, face-to-face interviews; data were gathered from 119 surveys and 22 interviews. Four qualitative themes aligned with the Post-Deployment Readjustment Inventory items. Findings from interviews support and illuminate the outcomes of the Post-Deployment Readjustment Inventory. Behavioral health usage was high in the quantitative sample. Nearly 74% (n = 88) of respondents indicating they had used Military Behavioral Health services following deployment. Statistically significant differences were noted among all subscales except Intimate Relationship Problems. Combined results indicated en route care nurses encountered difficulties when attempting to return to predeployment roles; behavioral health problems mirrored those of combat warriors. Interventions to assist post-deployment reintegration of en route care nurses should be conducted at the peer, leader, and health care provider levels. Embedding military mental health providers into en route care units is needed. It is imperative to gather lessons learned and identify ways to improve preparation for future conflicts and behavioral health of en route care nurses.

Randomized controlled trial of a brief Internet-based intervention for families of Veterans with posttraumatic stress disorder.

Clinical Trials Identifier: NCT01554839.

Perspectives of family and veterans on family programs to support reintegration of returning veterans with posttraumatic stress disorder.

Combat deployment and reintegration are challenging for service members and their families. Although family involvement in mental health care is increasing in the U.S. Department of Veterans Affairs (VA) system, little is known about family members' preferences for services. This study elicited the perspectives of returning Afghanistan and Iraq war veterans with posttraumatic stress disorder and their families regarding family involvement in veterans' mental health care. Semistructured qualitative interviews were conducted with 47 veterans receiving care for posttraumatic stress disorder at the Central Arkansas Veterans Healthcare System or Oklahoma City VA Medical Center and 36 veteran-designated family members. Interviews addressed perceived needs related to veterans' readjustment to civilian life, interest in family involvement in joint veteran/family programs, and desired family program content. Interview data were analyzed using content analysis and constant comparison. Both groups strongly supported inclusion of family members in programs to facilitate veterans' postdeployment readjustment and reintegration into civilian life. Both desired program content focused on information, practical skills, support, and gaining perspective on the other's experience. Although family and veteran perspectives were similar, family members placed greater emphasis on parenting-related issues and the kinds of support they and their children needed during and after deployment. To our knowledge, this is the first published report on preferences regarding VA postdeployment reintegration support that incorporates the perspectives of returning male and female veterans and those of their families. Findings will help VA and community providers working with returning veterans tailor services to the needs and preferences of this important-to-engage population.

Personality assessment inventory internalizing and externalizing structure in veterans with posttraumatic stress disorder: associations with aggression.

Posttraumatic stress disorder (PTSD) is associated with aggressive behavior in veterans, and difficulty controlling aggressive urges has been identified as a primary postdeployment readjustment concern. Yet only a fraction of veterans with PTSD commit violent acts. The goals of this study were to (1) examine the higher-order factor structure of Personality Assessment Inventory (PAI) scales in a sample of U.S. military veterans seeking treatment for PTSD; and (2) to evaluate the incremental validity of higher-order latent factors of the PAI over PTSD symptom severity in modeling aggression. The study sample included male U.S. Vietnam (n = 433) and Iraq/Afghanistan (n = 165) veterans who were seeking treatment for PTSD at an outpatient Veterans Affairs (VA) clinic. Measures included the Clinician Administered PTSD Scale, the PAI, and the Conflict Tactics Scale. The sample was randomly split into two equal subsamples (n's = 299) to allow for cross-validation of statistically derived factors. Parallel analysis, variable clustering analysis, and confirmatory factor analyses were used to evaluate the factor structure, and regression was used to examine the association of factor scores with self-reports of aggression over the past year. Three factors were identified: internalizing, externalizing, and substance abuse. Externalizing explained unique variance in aggression beyond PTSD symptom severity and demographic factors, while internalizing and substance abuse did not. Service era was unrelated to reports of aggression. The constructs of internalizing versus externalizing dimensions of PTSD may have utility in identifying characteristics of combat veterans in the greatest need of treatment to help manage aggressive urges.

Educating Family Court Judges on the Front Lines of Combat Readjustment: Toward the Formulation and Delivery of a Core Curriculum on Military Family Issues

This article considers the results of the first national survey of family court judges, in which they ranked key concerns for cases involving military families. Consistent with estimates recognizing the significant number of service members with operational stress injuries and the link between such unseen injuries and military family turmoil, judges who initially had little experience with military families have encountered increasing numbers of such cases as the wars in Iraq and Afghanistan intensified. This article reviews current efforts to establish a standardized curriculum that is responsive to judges' foremost concerns. After describing potential approaches for delivery of this core curriculum, the article suggests three factors that will greatly enhance efforts to meet judges' needs: (1) awareness of key aspects of military culture that have a bearing on family functioning, (2) greater incorporation of the U.S. Department of Veterans Affairs and Veterans Service Organizations in family court cases involving military families, and (3) identification of best practices in family courts located near military communities which function as de facto centers of excellence. The article draws on selected experiences and opinions of family court judges in North Carolina, Georgia, Hawaii, and Tennessee military communities and suggests key recommendations for meeting all courts' most dire needs. Key Points for the Family Court Community In a recent national study, family court judges ranked deployment and postdeployment readjustment considerations among their most important needs for training on military family issues. Family courts adjudicating disputes involving veterans with operational stress injuries must often transcend existing scientific studies to craft meaningful parenting plans and family interventions. Courts operating within high‐density military populations have developed uncommon solutions to common problems and can provide a wealth of knowledge to family courts that do not regularly hear such cases. Although family court interactions with veterans service organizations and the U.S. Department of Veterans Affairs are limited or nonexistent—even within large military communities—these organizations possess special knowledge and resources that can enhance the family courts' effectiveness. Family court judges located within jurisdictions that have operational Veterans Treatment Courts can easily draw on the expertise of veterans court judges to obtain necessary knowledge and vital insights. Many approaches to military family deployments and combat‐related mental conditions equally apply to the tens of thousands of families of private contractors who worked in Iraq and Afghanistan, especially on security details.

Feasibility and Desirability of Web‐Based Mental Health Screening and Individualized Education for Female OEF/OIF Reserve and National Guard War Veterans

Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF) Reserve and National Guard (RNG) service members have an increased risk for postdeployment mental health (MH) and readjustment problems, yet most do not access needed care. It is unknown if RNG servicewomen experiencing postdeployment readjustment symptoms are aware these may signify treatable MH concerns or if this knowledge activates care-seeking. The aims of this proof-of-concept study were to determine the feasibility of web-based MH screening for postdeployment MH symptoms to inform individualized psychoeducation, and to assess user perceptions about the online instrument and process, MH care access, and VA and other MH care. A midwestern sample (N = 131) of recently deployed (past 24 months) OEF/OIF RNG Army and Air Force servicewomen participated. High rates of combat experiences (95%) and military sexual trauma (50%) were reported. Positive screens for key symptoms of MH problems were prevalent. One third (31%) of satisfaction survey completers indicated online information reduced discomfort with seeking MH care; 42% reported they would subsequently seek MH assessment. Participants interviewed by telephone indicated that stigma and limited knowledge about women-specific services were key reasons servicewomen do not use MH care. This study demonstrated web-based screenings with individualized psychoeducation are implementable and favorable to RNG servicewomen.

Can mental health and readjustment be improved in UK military personnel by a brief period of structured postdeployment rest (third location decompression)?

ObjectiveThird 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...

Suicidal Ideation Among National Guard Troops Deployed to Iraq

Despite well-documented postdeployment readjustment problems affecting veterans of Operations Enduring Freedom (OEF) and Iraqi Freedom (OIF), few studies have explored the possible relationship of readjustment stressors to the recent increase in military suicide. This study examined associations between suicidal ideation and postdeployment readjustment problems using cross-sectional population-based survey data from 1665 National Guard members who recently returned from Iraq. The findings suggested that readjustment problems are widespread, with 45% of veterans endorsing one or more financial or family problems 3 months postdeployment. After adjusting for mental health and combat exposure, veterans with the highest number of readjustment stressors were at 5½ times greater risk of suicidal ideation than those with no stressors. In a psychiatrically impaired subsample, the high stressor group experienced a fourfold risk of suicide ideation compared with those with no stressors. The findings argue for suicide prevention efforts that more directly target readjustment problems in returning OEF/OIF veterans.

Systematic Review of Women Veterans’ Health: Update on Successes and Gaps

Objective We assessed the state of women veterans’ health research by conducting a systematic review of scientific literature published from 2004 to 2008, updating a prior review spanning the history of this literature to 2004. Methods We identified articles by searching scientific databases and contacting experts. Relevant articles were independently evaluated by two physician reviewers. We categorized 195 articles by study design, funding source, period of military service, research topic, and health condition. Results More research was published during this 5-year review ( n = 195) than in the 25 years beforehand ( n = 182). The 195 studies included five trials, but only one randomized trial, a study that examined treatment outcomes for women with posttraumatic stress disorder (PTSD). The large number of articles focused on Operation Enduring Freedom and Operation Iraqi Freedom (OEF/OIF) soldiers’ health issues ( n = 23) reflects the growing participation of women in these conflicts. High rates of positive PTSD symptoms (range, 10%–19%) and other mental health disorders were found among OEF/OIF returning military women. The recent post-deployment literature underscores the need for repeated PTSD/mental health screening in returning veterans, and points to continuity of care needs for psychiatric and gynecological problems which occur in the field. The psychiatric and access/utilization literature confirmed the positive relationship between military sexual trauma and PTSD and the associated negative health effects. Conclusion Although most VA women’s health research remains observational, methods are evolving toward an analytical focus. Even though successes are evident in the breadth and depth of publications, remaining gaps in the literature include post-deployment readjustment for veterans/families, and quality-of-care interventions/outcomes for physical and mental conditions.

The Role of Emotional Numbing in Sexual Functioning Among Veterans of the Iraq and Afghanistan Wars

Post-traumatic stress disorder (PTSD) negatively impacts sexuality, yet few studies have evaluated which component of PTSD contributes to this known association. The present study examined which of four PTSD clusters (numbing, avoidance, intrusiveness, and hyperarousal) was most closely linked to sexual problems in a sample of 197 veterans from the Iraq or Afghanistan wars. Newly registered veterans completed a packet of questionnaires including standardized measures of PTSD and questions regarding sexual functioning. A stepwise logistic regression was performed to examine the relationship between symptom cluster and sexual functioning. As predicted, only the numbing cluster was retained in the regression model. The numbing cluster appears to be intimately tied to sexual functioning, assessment of which should be part of a comprehensive evaluation during the postdeployment readjustment phase. Those exhibiting numbing symptoms should be thoroughly assessed for sexual functioning problems and referred for treatment as necessary.

Post-Deployment Readjustment Inventory: Reliability, Validity, and Gender Differences

This article describes the development and psychometric properties of the Post-Deployment Readjustment Inventory (PDRI). Items were derived from interviews with post-deployed troops from Operation Iraqi Freedom and Operation Enduring Freedom (OIF/OEF) and clinicians. A diverse sample of 215 post-deployed men (183) and women (32) completed the PDRI, General Information Form, Brief Symptom Inventory (BSI), and Posttraumatic Checklist—Military version (PCL-M). The PDRI Global scale and six subscales (Career Challenges, Social Difficulties, Intimate Relationship Problems, Health Problems, Concerns About Deployment, and PTSD Symptoms) show excellent internal consistency and strong correlations with standardized measures. In addition, the PDRI detected unique patterns of readjustment for those who were exposed to various war stressors: military sexual trauma (MST), witnessing others injured/killed, and being injured. Gender differences revealed that women reported more MST and men reported more witnessing of others injured/killed. No gender differences were found on reports of symptoms or readjustment.