Veterans Research Articles

U.K. Veterans in Prison: Attitudes Toward Authority, Legitimacy and Compliance With Regime

Despite an increase in academic research over recent years into military veterans in the criminal justice system, little of this has focused on U.K. veterans’ views and attitudes toward authority in prison or how veterans respond to prison regime. This study used semistructured qualitative interviews with 35 ex-military prisoners to explore their views and attitudes toward the authority and legitimacy of the prison and to assess their behavior toward prison regime. It found that participants expressed positive attitudes toward authority and the legitimacy of the prison, reportedly influenced by previous military experiences. This was accompanied by an acceptance of one’s prison sentence and a generally high compliance with prison regime. Findings suggest that research participants’ previous military service may have lasting effects on how they engage with authority within the prison by providing resilience toward the effects of imprisonment. Possible areas of future research are also discussed.

Sexual orientation moderates the association between health care utilization-related factors and mental health service nonutilization among United States military veterans.

This study examined mental health treatment nonutilization among sexual minority versus heterosexual Veterans with demonstrated psychiatric need. Data were analyzed from 820 Veterans with psychiatric need who participated in the National Health and Resilience in Veterans Study, which surveyed a nationally representative sample of U.S. military Veterans. Results revealed that current mental health service nonutilization did not differ between sexual minority versus heterosexual Veterans (70.5% vs. 74.0%). Significant interactions between sexual orientation and sex assigned at birth, primary source of health care (Veteran Affairs [VA] vs. non-VA), and beliefs that peers would blame them for their mental health problems were observed in analyses predicting current mental health treatment utilization. Among Veterans primarily utilizing VA health care, sexual minority Veterans were less likely than heterosexual Veterans to engage in mental treatment; among those primarily using non-VA, this pattern was reversed. Sexual minority Veterans were significantly more likely than heterosexual Veterans to report not knowing where to get help, not having adequate transportation, and having difficulty scheduling an appointment. Taken together, the results of this study suggest that rates of mental health nonutilization are high for both sexual minority and heterosexual Veterans, and that factors that influence utilization may differ by sexual orientation. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

National Guard Command Authority and the Black Lives Matter Protests of 2020: Domestic Security Debates for a New Generation of Military Veterans

This study explores connections between the military experiences of a new generation of War on Terror (WoT) veterans elected to the U.S. Congress and controversial policy decisions on domestic security during the Black Lives Matter (BLM) protests. WoT veterans became the largest cohort of lawmakers with common military experiences on Capitol Hill in 2020, and this article examines their engagement through two original case studies of legislative debates over command and control of the National Guard mobilization during BLM protests. Confrontations between federal law enforcement officers and BLM protestors led some WoT veterans to propose legislation to restrict executive authority over National Guard deployments, including reforms of Titles 10 and 32 of the U.S. Code and the Insurrection Act, but other WoT veterans challenged these positions. This exploratory study of events and circumstances links the timely topic of domestic security to traditional debates in the civil–military relations literature on whether veterans are more or less likely to support the use of military force and try to expand congressional oversight of presidential powers. By bridging the gap between research areas and crossing generations, this article offers lessons for past, present, and potentially future debates about the use of troops for domestic security operations.

Forgotten Victims of War: A Rapid Review of Counseling Needs and a Proposed Intervention Model for Civilian Survivors

The counseling needs of civilian war victims, particularly those not classified as refugees, have been largely neglected in academic counseling research. This study addresses this gap by conducting a rapid literature review to evaluate the current state of counseling services available to these individuals. Using Google Scholar and Web of Science, we identified and reviewed studies on counseling services for war veterans, refugees, and civilians in conflict zones. This review revealed a significant lack of structured counseling support for non-refugee civilian war victims, despite their high vulnerability. Findings indicate that while substantial efforts have been made to support refugees and veterans, the mental health needs of civilians who remain in conflict areas are often unmet, with existing services being sparse and inadequately documented. To address this issue, we propose a preliminary model that includes culturally sensitive counseling programs, training for local counselors, and international collaboration to provide sustainable support. This study highlights the urgent need for focused research and practical interventions to develop comprehensive counseling programs for these overlooked victims of war, and encourages researchers to address this critical gap in mental health services.

Effectiveness of Residential and Intensive Outpatient Programs for the Treatment of Post-Traumatic Stress Disorder in Active Military Personnel and Veterans: A Meta-Analytical Review

ABSTRACT The care and services offered in the treatment of active military personnel and veterans with PTSD take a variety of forms, ranging from residential to outpatient treatment programs. The differences in the organization of care between these programs make comparisons difficult; however, an intermediate alternative exists in the form of intensive outpatient programs (IOPs), whose organization and range of care are closer to that offered in residential programs. This review compares and evaluates the effectiveness of residential programs to that of IOPs in the treatment of PTSD in active military personnel and veterans. Nine databases were searched from September/November 2022 to include primary studies evaluating the treatment of PTSD in active military personnel and veterans in residential programs and IOPs. Results were summarized in a narrative synthesis. A meta-analysis using a random effects model examined changes in standardized mean differences in PTSD symptom scores at baseline and discharge. Thirty-two studies in 41 publications were included. There was a notable decrease in PTSD symptom scores at the end of treatment in both programs, and no significant difference was found between them. However, IOPs effectiveness may be influenced by patient type (active military personnel or veterans). Regardless, our results suggest a positive effect of both types of programs on reducing PTSD symptoms. It is essential to be aware of the constraints inherent in the literature on the subject, including the lack of comparative studies, the potential impact of comorbidities, and the differential response of active military personnel and veterans to similar treatments.

Single-dose psilocybin for U.S. military Veterans with severe treatment-resistant depression – A first-in-kind open-label pilot study

BackgroundThe enduring and severe depression often suffered by Veterans causes immense suffering and is associated with high rates of suicide and disability. This is the first study to evaluate the efficacy and safety of psilocybin in Veterans with severe treatment-resistant depression (TRD). Methods15 Veterans with severe TRD (major depressive episode failing to respond to ≥5 treatments, or lasting >2 years) received 25 mg of psilocybin. Primary outcome was change in Montgomery-Åsberg Depression Rating scale (MADRS) at 3 weeks posttreatment. Response was defined s ≥ 50 % reduction in MADRS, and remission as ≤10 MADRS score. Psychedelic experience was assessed using the Five-Dimensional Altered States of Consciousness scale (5D-ASC). Safety measures included assessment of suicidality and adverse events. Participants on antidepressants were tapered to avoid drug interactions. ResultsOf 15 participants, 60 % met response and 53 % met remission criteria at Week 3. At 12 weeks, 47 % maintained response, and 40 % remission. Co-morbid PTSD did not significantly influence study outcomes. The psychedelic experience reported in 5D-ASC did not correlate with response. Participants judged to need antidepressants were restarted and considered non-responders from that timepoint (n = 4). No unexpected adverse events occurred. LimitationsLimitations include the small sample size, and the uncontrolled and unblinded nature of the study. ConclusionsIn this first study on psilocybin for Veterans with severe TRD, a surprising response and remission was seen. Many Veterans had PTSD though no moderating impact of response was observed. The degree of psychedelic experience did not correlate with depression changes. Further study is warranted.TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT04433858.

Contribution of Professor Oleg N. Trofimov to the Concept of Physical Education Development in the Pharmaceutical Education System

The biographical sketch is dedicated to Professor Oleg Nikolaevich Trofimov (1927-2013), PhD in Pedagogic Sciences, who headed the Department of Physical Education at the Leningrad Institute Chemical Pharmaceuticals from 1973 to 1995. The main stages of O.N. Trofimov's professional activity corresponded to the general context of the development of priority areas of physical education in the system of secondary and higher education. O.N. Trofimov skillfully combined managerial activities with research and educational-methodological work. He made a significant contribution to the development of the health-improving direction of physical education at the university, to the organization and conduct of research aimed at solving the problems of improving health and increasing the physical fitness of students. The scientific activity of O.N. Trofimov was devoted to the theory and methods of physical education, issues of physical development, dynamics of physical fitness of students, the development of comprehensive training programs in vocational-applied physical training and additional public specialty within the framework of the Faculty of Public Professions. The results of the research carried out at the department were widely introduced into the educational process of physical education and served as the basis for the development of innovative technologies for constructing the educational process in «Elective Physical Culture: Health-Improving Physical Education», as well as the program for the development of physical culture and sports, the formation of a healthy lifestyle at the Saint Petersburg Chemical and Pharmaceutical University. O.N. Trofimov was a war veteran, awarded government awards, including the medal «For the Defense of Leningrad». The essay uses archival data, bibliographic publications, specialized journals and collections of materials from scientific and methodological conferences, materials from the department and the personal archives of O.N. Trofimov.

Posttraumatic growth trajectories and the psychopathological response to Covid-19: A longitudinal study of former prisoners of war and combat veterans

BackgroundPosttraumatic Growth (PTG) is the subjective experience of positive psychological change following exposure to trauma. Yet, researchers have discussed whether PTG is a positive outcome or a self-deceptive coping mechanism. The present study investigates PTG-trajectories and their ability to predict psychopathology in response to the Covid-19 pandemic in a longitudinal study of former prisoners of war (ex-POWs) and combat veterans from the 1973 Yom Kippur War in Israel. MethodsData was collected in five waves from 1991 to 2020 (NT5 = 256). To identify latent profiles of change in PTG over time, Group-Based Trajectory Modeling was applied. Logistic regression examined whether study group and PTSD-clusters predict latent trajectories of change. Boostrap MANOVA was applied to examine if the latent trajectories predict veterans’ psychopathological response to Covid-19. ResultsA 2-class solution was the best representation of the data. Being ex-POW significantly predicted the likelihood of developing high PTG over time. The High PTG group had significantly higher Acute Stress Disorder, Posttraumatic Stress Symptoms, and general psychopathology in response to Covid-19. ConclusionIn conclusion, PTG is associated with greater vulnerability for psychopathology in response to later adversities. Hence, the subjective experience of positive change does not appear to signify higher resilience in trauma victims.

Multi-modal risk factors differentiate suicide attempters from ideators in military veterans with major depressive disorder

BackgroundThe suicide rate for United States military veterans is 1.5× higher than that of non-veterans. To meaningfully advance suicide prevention efforts, research is needed to delineate factors that differentiate veterans with suicide attempt/s, particularly in high-risk groups, e.g., major depressive disorder (MDD), from those with suicidal ideation (no history of attempt/s). The current study aimed to identify clinical, neurocognitive, and neuroimaging variables that differentiate suicide-severity groups in veterans with MDD. MethodsSixty-eight veterans with a DSM-5 diagnosis of MDD, including those with no ideation or suicide attempt (N = 21; MDD-SI/SA), ideation-only (N = 17; MDD + SI), and one-or-more suicide attempts (N = 30; MDD + SA; aborted, interrupted, actual attempts), participated in this study. Participants underwent a structured diagnostic interview, neurocognitive assessment, and 3 T-structural/diffusion tensor magnetic-resonance-imaging (MRI). Multinomial logistic regression models were conducted to identify variables that differentiated groups with respect to the severity of suicidal behavior. ResultsRelative to veterans with MDD-SI/SA, those with MDD + SA had significantly higher left cingulum fractional anisotropy, decreased attentional control on emotional-Stroop, and faster response time with intact accuracy on Go/No-Go. Relative to MDD + SI, MDD + SA had higher left cingulum fractional anisotropy and faster response time with intact accuracy on Go/No-Go. LimitationsFindings are based on retrospective, cross-sectional data and cannot identify causal relationships. Also, a healthy control group was not included given the study's focus on differentiating suicide profiles in MDD. ConclusionsThis study suggests that MRI and neurocognition differentiate veterans with MDD along the suicide-risk spectrum and could inform suicide-risk stratification and prevention efforts in veterans and other vulnerable populations.

Phenotypic heterogeneity of the B lymphocyte population in the context of post-traumatic stress disorder in veterans of modern wars

Post-traumatic stress disorder in combat veterans has certain characteristics common to combatants. B lymphocytes may aggravate neurocognitive impairment by demonstrating a significant proinflammatory tendency through the production of immunoglobulins and a number of proinflammatory factors. Objective: to study the phenotypic heterogeneity of B lymphocyte subpopulations in veterans with post-traumatic stress disorder. Studies were conducted in a cohort of veterans of the special military operation in Ukraine (SVO), including 26 combatants with clinically verified PTSD who made up the main (1) group, and 30 veterans were included in the comparison group (2). The diagnosis was verified on the basis of neuropsychological and pathopsychological examination. Determination of IL-10 levels (pg/mL) using a multiplex analysis on a Luminex Magpix 100 immunoanalyzer (USA) using the Bio-Plex multiplex analysis test system (MERZ, Germany) was performed. Gating of the B lymphocyte population was performed on a Navios flow cytofluorimeter (Beckman Coulter, USA) using a standardized technology for assessing the lymphocyte component of immunity. In the group of SVO veterans with PTSD, we showed an increase in blood cells with the CD45+CD3-CD19+CD5+ phenotype in comparison with the indicators of groups 2 and 3. B lymphocytes expressing the CD5+ marker are found in various human tissues and can also produce autoantibodies. Analysis of subpopulations of B lymphocytes with markers of memory cells showed a significant decrease in the blood of SVO veterans in the total number of memory B lymphocytes (CD45+CD3-CD19+CD27+), against the background of an increase in the concentration of cells positive for CD5 and CD27 with the phenotype CD45+CD3-CD19 +CD5+CD27+CD27+. B cells play a critical role in the mechanisms of intercellular interaction. The phenotypic diversity of B lymphocyte subpopulations that we have established in veterans with post-traumatic stress disorder is characterized by an increase in the circulation of B lymphocytes with CD5 and CD27 molecules, against the background of a general decrease in memory B cells. This indicates a possible autoimmune orientation of neuroinflammatory processes in the brain, associated both with a stress-induced increase in the permeability of the blood-brain barrier, and with the need to control excessive activation of immunocompetent cells.

A potential target for noninvasive neuromodulation of PTSD symptoms derived from focal brain lesions in veterans.

Neuromodulation trials for the treatment of posttraumatic stress disorder (PTSD) have yielded mixed results, and the optimal neuroanatomical target remains unclear. Here we analyzed three datasets to study brain circuitry causally linked to PTSD in military veterans. In veterans with penetrating traumatic brain injury, lesion locations that reduced probability of PTSD were preferentially connected to a circuit including the medial prefrontal cortex, amygdala and anterolateral temporal lobe. In veterans without lesions, PTSD was specifically associated with increased connectivity within this circuit. Reduced functional connectivity within this circuit after transcranial magnetic stimulation correlated with symptom reduction, even though the circuit was not directly targeted. This lesion-based 'PTSD circuit' may serve as a target for clinical trials of neuromodulation in veterans with PTSD.

Posttraumatic Growth in War Captives

Numerous studies have investigated the various consequences of traumatic experiences during the war. The most significant disorder that occurs as a result of war traumatization is posttraumatic stress disorder, in addition to which other psychological disorders often can occur. In the last few decades, the number of studies researching the occurrence of posttraumatic growth as a positive outcome of trauma, including that of war veterans, has been growing. Among war veterans, prisoners of war stand out for the intensity of their traumatic experience but also for the appearance and intensity of the pathological outcomes of the trauma. Studies show that in this group of veterans, posttraumatic stress disorder and comorbidity disorders often persist for decades after their release from captivity.There is not much research about the positive outcomes of trauma in these particularly vulnerable populations, and this paper is a review of several different studies, the results of which show that posttraumatic growth is possible even after challenging traumatic experiences such as war captivity.

"Holy Cow, Where do I Sign up?" Attitudes of Military Veterans Toward Epigenomic Biomarker Toxic Exposure Testing.

After the Sergeant First Class Heath Robinson Honoring Our Promise to Address Comprehensive Toxics Promise to Address Comprehensive Toxics (PACT) Act in 2022, there has been a great interest in studying toxic exposures encountered during military service. Development of epigenomic biomarkers for exposures could facilitate understanding of exposure-related health effects, but such testing could also provide unwanted information. We explored attitudes toward epigenomic biomarker research and the potential to test for past exposures using semistructured interviews with Veterans (n = 22) who experienced potentially harmful exposures. Twenty Veterans said they would hypothetically want to receive epigenomic information related to their toxic exposures and potential health impacts as part of a research study. Veterans identified 9 potential benefits, including promoting insights concerning intergenerational health, identification of early health interventions, and additional knowledge or explanation for their experiences. Sixteen participants noted potential risks, including psychological distress, receiving nonactionable, uncertain, or inaccurate results, and privacy and discrimination risks. Ten participants identified at least 1 condition in their children that they thought could be related to their exposure and most said they would be interested in receiving research results related to their children's and grandchildren's risk. Results suggest that Veterans might welcome benefits of epigenomic research related to military exposures, yet have some concerns about potential negative impacts.

To the issue of the legal status of war veterans and their labor guarantees

Problem setting. For war veterans, as a socially vulnerable group of the population, it is extremely important to realize the right to work with the help of labor guarantees established by law, since work can be an effective way to return a war veteran to civilian life, providing him or her with adequate mental and/or physical activity and distraction from the military past. Labor law is faced with the task of defining the specifics of the legal status of war veterans in terms of realization and observance of their labor rights, and ensuring proper protection of their rights in case of violation. Purpose of research is to analyze the concept of “war veterans” and its composition, to study the legal status of persons recognized by law as war veterans and to improve it, and to review labor guarantees for war veterans as an important element of their legal status. Analysis of recent researches and publications. The doctrine of labor law studied the rights, freedoms and obligations of servicemen, for example, we note the monographic study of V. Pashynskyi, L. Medvid, B. Shamrai, devoted to the legal status and social protection of servicemen, the article of M. M. Shumylo, which examined the guarantees of labor rights of persons called up to the Armed Forces of Ukraine during the war, and the article by N. V. Khortiuk, which focused on the concept and features of military personnel as subjects of labor law. At the same time, no scientific research has been conducted on labor rights and guarantees of war veterans as subjects of labor law. The closest in terms of subject matter is the scientific article by V.P. Kokhan, which is devoted to the mechanisms of employment of war veterans based on the results of professional adaptation. Article’s main body. The article analyzes the concept of “war veterans”, its composition, examines the legal status of persons recognized by law as war veterans, and proposes to improve the legal status of war veterans. The author determines that the legislation links the granting of veteran status with the time limits of a particular war. The disadvantage of this approach is that the separation of the time of experience gained by military personnel leads to an unfair comparison of the contribution of the military who stood up for defense in other historical periods, and as a result, these categories of persons and their family members receive different compensation payments and benefits. This situation is a violation of the principles of equality and fairness of social security law and a manifestation of discrimination in the field of social protection against war veterans. Conclusions and prospects for the development. The article proposes to change the legislative approaches to the concept of “war veterans” and to determine the legal status of this category of persons on the basis of their combat experience rather than the timeframe of military conflicts. The author reviews the labor guarantees of war veterans as an important element of their legal status. It is noted that labor guarantees are an important tool for protecting the labor rights of war veterans who have returned to civilian life, since they are an effective legal mechanism for realizing the social and labor rights of this category of persons. In the field of labor, additional labor guarantees established for war veterans help not only to protect labor rights, but also facilitate a painless and quick transition from military service to civilian life.

State support for veteran entrepreneurship

Problem setting. In modern conditions, state support for veteran entrepreneurship plays a key role in the socioeconomic development of Ukraine. At the current stage, the veteran policy of Ukraine is being actively modernized and updated in accordance with the actual problems and challenges that arise during the implementation of state policy mechanisms regarding veteran entrepreneurship, however, the reformation requires attention to possible risks that may hinder the successful implementation of the policy. Involvement of war veterans in business activities is considered by the state and society as one of the most important mechanisms of reintegration of veterans, which corresponds to the state interests of Ukraine and the wishes of veterans according to sociological surveys. Purpose of research is to study the current state of legal regulation in Ukraine in the field of reintegration of veterans, in particular, the possibility of their professional adaptation and employment in entrepreneurial activities. Article’s main body. It has been established that promising directions for attracting veterans to entrepreneurship are: providing financial support to veteran business projects and benefits to veteran businesses in the field of public procurement along with related services (consultations, training, etc.), simplifying complex administrative procedures for veterans when receiving such benefits, ensuring equal access to state support programs for veterans.Evaluation of current initiatives and recommendations for their improvement can become the basis for further steps in the development of veteran entrepreneurship in Ukraine. Conclusions and prospects for the development. Modern Ukrainian legislation has ways to develop in the field of veterans’ rights protection, and the state policy of Ukraine is being modernized and updated in accordance with the current problems and challenges that arise during the implementation of state policy mechanisms for veteran entrepreneurship. However, on the way to reforming, those implementing it should pay attention to countermeasures that would make it impossible to reduce existing risks. In addition, laws could be passed to ensure that veterans receive preference in public contracting processes. This will not only support veterans in their transition to civilian life, but also emphasize their valuable skills and experience.

Review of foreign experience of professional adaptation of war veterans

Problem setting. After the end of the war, most of the veterans will be an economically active stratum of the population, who will need active support from the state when reintegrating into civilian life, but in return will be able to benefit the country by remaining active subjects of the national economy. The preservation and development of this potential is critically important both for the post-war recovery of Ukraine and for the establishment of social justice in relation to defenders. The study of foreign experiences is an important step in order to learn effective practices that can be adapted and applied to the Ukrainian context. Despite the fact that the experience of other countries does not always fully correspond to Ukrainian realities, it contains useful lessons and methods that can be modified to solve the specific challenges that Ukraine faces. Analysis of recent researches and publications. Such domestic researchers as V.P. Kokhan, A.S. Kolisnyk, O.V. Shapovalova, V.I. Sheverdina, T. Zakharina, V.K. Malolitneva, R.A. Jabrailov. M. Bazaeva studied foreign experience using the example of the USA. At the same time, there is no comprehensive overview of foreign policy regarding the support of veterans and their reintegration into civilian life in domestic works. Purpose of research is to carry out a general review of foreign experience in issues of support for veterans using the example of the USA, EU, Germany, France and Great Britain. Article`s main body. The article examines the issue of professional adaptation of veterans as a key element in the successful reintegration of military personnel into civilian life. It outlines the experiences of the United States, the European Union, Germany, France, and the United Kingdom to identify effective veteran support practices that could be adapted to the Ukrainian context. The focus is on the legal and organizational aspects of veteran policies, including legislative support and the involvement of both governmental and non-governmental organizations in the outlined area. The article concludes that the United States has a well-developed system of veteran support, primarily driven by the Department of Veterans Affairs (VA). Special attention is given to the functioning of the U.S. Court of Appeals for Veterans Claims (CAVC). It is suggested that the establishment of a similar specialized judicial body could be an important step for Ukraine to effectively protect veterans’ rights in the post-war period. The article highlights the absence of unified legislation on veterans within the European Union. Nevertheless, it emphasizes the role of pan-European non-governmental organizations in this field, such as the European Confederation of Veterans. The legal and institutional framework for veteran policies in specific EU member states, particularly Germany and France, is also discussed. Special attention is given to the experience of the United Kingdom, which aspires to have the most advanced veteran support system. It is noted that the strategic approach to veteran policy, particularly through the Veterans’ Strategy Action Plan 2022-2024, provides long-term legal certainty for veterans and enhances the effectiveness of state policy. Conclusions and prospects for the development. The article underlines that professional adaptation of veterans is a critical precondition for successful post-war recovery in Ukraine and the preservation of veterans’ economic activity. The use of foreign experience, particularly the creation of specialized judicial bodies, the development of national veteran support strategies, and the active involvement of non-governmental organizations, could become a subject of further discussion aimed at finding the optimal path for building an effective veteran support system in Ukraine.

Posttraumatic growth among Israeli female combat veterans: The mediating roles of posttraumatic stress symptoms and self-efficacy.

Posttraumatic growth (PTG) is a possible common reaction to exposure to potentially traumatic events (PTEs) during military service. However, knowledge about correlates of PTG among female combat veterans is sparse. This study examines associations between combat exposure, posttraumatic stress symptoms (PTSS), general self-efficacy (GSE), and PTG among Israeli female veterans. This is a cross-sectional studyA volunteer sample of female Israeli combat veterans (n=616) and non-combat veterans (n=484) responded to self-report questionnaires. Combat veterans reported higher levels of combat exposure, PTSS, GSE, and PTG, as compared to non-combat veterans. Among combat veterans, combat exposure and GSE were associated with greater PTG. Importantly, PTSS and GSE mediated the link between combat exposure and PTG. The study's findings are among the first to report about possible psychological growth outcomes among Israeli combat veterans. Clinicians treating female veterans coping with combat trauma should be aware of the heterogeneity of reactions to military service challenges and the importance of enhancing veterans' GSE to facilitate PTG.

Empathy and Listening in Research-Based Theatre

This article shares excerpts from the playscript Unload, which brings to life research on military veterans and the lived experience of civilians carrying trauma. Co-developed by veterans, artists, researchers, and counsellors, the play follows a veteran’s journey to overcome challenges in and out of uniform and sees him guide a civilian friend through unspoken grief that has been haunting him for decades. This research-based play artistically synthesizes extensive data collected from focus groups, interviews, and surveys conducted with veterans, artists, counsellors, and audiences involved in a five-year research project. This article begins by situating the research-based play within the literature on theatre and empathy. Then, alongside excerpts from the playscript, the authors, who were co-writers of the script and members of the cast, offer insights gleaned from the performance of Unload.

Grief on pain and quality of life in combat veterans with PTSD

ABSTRACT Background: Persistent Complex Bereavement Disorder (PCBD) comprises a set of grief symptoms that are often linked to other psychological conditions such as PTSD and depression, may be prevalent in Veterans with combat experience, and may also impact general health. Objective: This study investigated the association between grief and sleep, pain, PTSD, and depression, among Veterans participating in a clinical trial for PCBD treatment. Method: Data from 155 Veterans receiving treatments for PCBD were analysed to explore the association between PCBD and symptoms of sleep pain, PTSD, and depression. Veterans experiencing grief reported symptoms related to physical health, emotional problems, energy, and fatigue, emotional well-being, social functioning, presence of pain, and general health. PCBD appeared to have a specific association with pain and physical functioning, independent of other variables. Conclusions: This study examined the potential independent association of PCBD on physical and mental health in Veterans with PTSD. PCBD appeared to have a very specific and significant association with pain and physical functioning. In other words, the pain of grief was related to ratings of physical pain. Future research on PCBD should address the potentially bidirectional association with bodily pain, particularly chronic pain, in relation to loss, with specific attention to potential mechanisms underlying this relationship.

Biological markers of brain network connectivity and pain sensitivity distinguish low coping from high coping Veterans with persistent post-traumatic headache.

Headache is the most common type of pain following mild traumatic brain injury. Roughly half of those with persistent post-traumatic headache (PPTH) also report neck pain which is associated with greater severity and functional impact of headache. This observational cohort study aimed to identify biological phenotypes to help inform mechanism-based approaches in the management of PPTH with and without concomitant neck pain. Thirty-three military Veterans (mean (SD) = 37±16 years, 29 males) with PPTH completed a clinical assessment, quantitative sensory testing, and magnetic resonance imaging of the brain and cervical spine. Multidimensional phenotyping was performed using a Random Forest analysis and Partitioning Around Medoids (PAM) clustering of input features from three biologic domains: 1) resting state functional connectivity (rsFC) of the periaqueductal gray (PAG), 2) quality and size of cervical muscles, and 3) mechanical pain sensitivity and central modulation of pain. Two subgroups were distinguished by biological features that included forehead pressure pain threshold and rsFC between the PAG and selected nodes within the default mode, salience, and sensorimotor networks. Compared to the High Pain Coping group, the Low Pain Coping group exhibited higher pain-related anxiety (p=0.009), higher pain catastrophizing (p=0.004), lower pain self-efficacy (p=0.010), and greater headache-related disability (p=0.012). Findings suggest that greater functional connectivity of pain modulation networks involving the PAG combined with impairments in craniofacial pain sensitivity, but not cervical muscle health, distinguish a clinically important subgroup of individuals with PPTH who are less able to cope with pain and more severely impacted by headache.