Does PTSD moderate the relationship between social support and suicide risk in Iraq and Afghanistan War Veterans seeking mental health treatment?

Schizotypy Moderates the Relationship Between Sleep Quality and Social Cognition

ABSTRACT

Poor sleep quality has been tied to worse social cognition. Social cognitive deficits have been noted in those with high schizotypy. Yet, no study has assessed whether schizotypy moderates the relationship between sleep quality and social cognition, which may be vital to our understanding of contributors to social functioning. We conducted a cross-sectional analysis of associations of sleep quality and social cognition, with potential moderation by schizotypy. Participants ( n = 906) completed self-report measures of schizotypy, sleep quality, and social cognition. Levels of schizotypy significantly moderated some of the relationships between sleep and social cognition. For participants low in total or interpersonal schizotypy, worse sleep quality was associated with worse theory of mind scores. For participants low in total, disorganized, or cognitive perceptual schizotypy, worse sleep quality was associated with worse self-reported cognitive empathy. For those high in these facets of schizotypy, worse sleep quality was associated with better self-reported cognitive empathy. These results suggest that the individual facets of schizotypy provide additional information and, therefore, are important to assess when examining social cognition and sleep.

The role of military service in preventing depression in China: evidence from a nationally representative longitudinal survey

BACKGROUND

Despite recognition in the West that military veterans experience more mental health issues than the general population, little research has focused on this subject in China. This study examined the associations between male veterans' military experience and depression in China.

METHODS

A sample of 12,914 men including 669 veterans was included in the final analysis and propensity score matching, multivariable regressions and fixed effect model were used.

RESULTS

The military experience was associated with a lower likelihood of depression in male veterans. In the subgroup analysis, military experience was associated with a lower likelihood of depression among married and urban male veterans. Military experience was also associated with a lower likelihood of depression in both "junior college and above" and "below junior college" groups. In contrast, evidence was lacking regarding the associations between military experience and depression for unmarried and rural veterans.

CONCLUSIONS

Individual characteristics could influence the relationship between military experience and depression in male veterans, and the mental health of veterans should be paid more attention and guaranteed.

Marital Quality and Loneliness Among Aging Vietnam-Era Combat Veterans: The Moderating Role of PTSD Symptom Severity

OBJECTIVES

We examined links between marital quality and loneliness among aging veterans and explored whether veterans' PTSD symptom severity moderated these associations.

METHODS

Data came from 269 Vietnam-Era combat veterans who had a spouse/partner (M age = 60.50). Utilizing two waves of data spanning six years, we estimated multiple regression models that included positive and negative marital quality, PTSD symptom severity, and loneliness in 2010 as predictors of loneliness in 2016.

RESULTS

Facets of positive (but not negative) marital quality were associated with veterans' loneliness. Companionship - spousal affection and understanding - was associated with lower subsequent loneliness among veterans with low/moderate - but not high - PTSD symptom severity. Conversely, sociability - the degree to which one's marriage promotes socializing with others - was associated with lower subsequent loneliness regardless of PTSD symptom severity.

CONCLUSIONS

Companionship and sociability were each associated with veterans' subsequent loneliness. Whereas benefits of companionship were attenuated at higher levels of PTSD symptom severity, benefits of sociability were not.

CLINICAL IMPLICATIONS

For veterans with higher PTSD symptoms, recommending mental health treatment to decrease symptom severity may help them to reap the benefits of close/intimate relationships. However, bolstering veterans' social participation more broadly may provide an additional means of reducing their loneliness.

Association between modifiable social determinants and mental health among post-9/11 Veterans: A systematic review

Introduction

As U.S. Veterans reintegrate from active duty to civilian life, many are at risk for negative modifiable social determinants of health. The prevalence of mental health conditions among Veterans is also high. Awareness of the associations between these two factors is growing. This systematic review provides a comprehensive analysis of the current state of knowledge of the associations between modifiable social determinants and mental health among U.S. Veterans.

Methods

The authors systematically searched four databases and identified 28 articles representing 25 unique studies that met inclusion criteria. Findings from the studies were extracted and synthesized on the basis of modifiable social determinants. Study quality and risk of bias were assessed using the Methodological Quality Questionnaire.

Results

The studies identified in the systematic review examined three modifiable social determinants of health: 1) housing stability, 2) employment and finances, and 3) social support. Although the lack of validity for measures of housing stability, employment, and finances compromised study quality, the overall evidence suggests that Veterans with access to supportive social determinants had better mental health status. Evidence was particularly robust for the association between strong social support and lower symptoms of posttraumatic stress disorder.

Discussion

Current evidence suggests the need to consider modifiable social determinants of health when designing mental health interventions. However, more research encompassing a wider range of modifiable social determinants such as food security, education, and transportation and using comprehensive methods and validated instruments is needed. Future research also needs to intentionally include Veterans from diverse racial-ethnic groups.

"It's a sign of weakness": Masculinity and help-seeking behaviors among male veterans accessing posttraumatic stress disorder care

OBJECTIVE

Male veterans delay posttraumatic stress disorder (PTSD) treatment and are less likely to engage in help-seeking behaviors or receive adequate mental health treatment. Male veterans face additional stigma seeking mental health care due to traditional masculine ideologies perpetuated by military culture. This study presents the perspectives of male veterans accessing Veterans Affairs (VA) PTSD services, focusing particularly on help-seeking behaviors and barriers to care.

METHOD

Semistructured interviews were conducted with 13 United States male veterans seeking treatment in VA primary care. Qualitative data analysis was coded using Atlas.ti, and thematic analysis was used to develop and refine themes. This study is part of a larger study examining veterans' initiation of PTSD treatment.

RESULTS

Findings indicate that male veterans in this sample may be reluctant to initiate PTSD care due to stigma, distrust of the military or mental health care, and a desire to avoid reliving their trauma. Significant others may encourage help-seeking behaviors among this population. Veterans also reported a need for mental health services that address PTSD from noncombat trauma and from military sexual trauma (MST).

CONCLUSIONS

Findings indicate that male veterans face unique challenges accessing mental health services and may benefit from increased VA services focused on MST and noncombat specific PTSD. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Less dropout from prolonged exposure sessions prescribed at least twice weekly: A meta-analysis and systematic review of randomized controlled trials

Trauma-focused psychotherapies, such as prolonged exposure (PE), are strongly recommended to treat posttraumatic stress disorder due to their effects in reducing symptoms. However, such therapies may also suffer from high dropout rates. To investigate how clients might benefit from trauma-focused therapy while minimizing dropout, we conducted a meta-analysis of 1,508 adults from 35 randomized controlled trials (RCTs) of outpatient PE programs to evaluate treatment frequency as a predictor of dropout. When an RCT prescribed PE sessions at least twice weekly compared to less frequently, the dropout rate was significantly lower at 21.0%, 95% CI [13.9%, 30.4%], compared to 34.0%, 95% CI [28.9%, 39.4%], OR = 0.52, 95% CI [0.30, 0.89], p = .018. It was not possible to draw causal conclusions, as only one RCT compared two PE treatment frequencies head-to-head. Nonetheless, the findings remained significant after controlling for study characteristics. These data invite reconsideration of the common practice of weekly psychotherapy in favor of twice-weekly sessions in standard outpatient treatment.

The impact of political violence on posttraumatic stress symptomology: a longitudinal analysis

OBJECTIVE

The current paper uses the Conservation of Resources Theory to frame an examination of the impact of exposure to political violence on posttraumatic stress symptomology among three groups within Israeli society: (1) Native Born Jews; (2) Foreign Born Jews; and (3) Palestinian Citizens of Israel.

METHODS

The study population was a large nationally representative sample of 1613 respondents collected during The Second Intifada. The sample consists of approximately 40% Jews born in Israel (n = 652), 30% (n = 484) were Jews who immigrated to Israel, and close to 30% (n = 477) were Palestinian Citizens of Israel. Mediation analyses explored the role of resource loss in the relationship between social status and posttraumatic stress disorder (PTSD) symptom severity.

RESULTS

Compared to native born Jews, foreign born Jews and Palestinian Citizens of Israel reported greater PTSD symptom severity at wave III. These relationships were not mediated by psychosocial resource loss or economic resource loss.

CONCLUSIONS

We discuss the importance of tailored interventions with minority groups in the context of ongoing political violence.

COVID-19 Pandemic and Stress: Coping with the New Normal

COVID-19 is the new face of pandemic. Since the discovery of COVID-19 in December 2019 in Wuhan, China, it has spread all over the world and the numbers are increasing day by day. Anyone can be susceptible to this infection but children, older adults, pregnant women, and people with comorbidity are more vulnerable. The spread of coronavirus resulted in closures of schools, businesses, and public spaces worldwide and forced many communities to enact stay at home orders, causing stress to all irrespective of their age, gender, or socioeconomic status. The sudden and unexpected changes caused by the outbreak of coronavirus are overwhelming for both adults and children, causing stress and evoking negative emotions like fear, anxiety, and depression, among different populations. The aim of the paper is to ascertain how stress during this pandemic inculcates various psychological health issues like depression anxiety, OCD, panic behavior, and so on. Further, the paper is an attempt to identify different general as well as population specific coping strategies to reduce the stress level among individuals and prevent various stress-induced psychological disorders with reference to different theories and research articles.

Is Gratitude Associated With Suicidal Ideation in Veterans With Mental Illness and Student Veterans With PTSD Symptoms?

ABSTRACT

The present study is aimed to identify the effect of gratitude as an adaptive regulating mechanism from suicidal ideation (SI) for veterans with mental illness (study 1) and student veterans with posttraumatic stress disorder (PTSD) symptoms (study 2) in the United States. Descriptive statistics and regression analyses were used to examine sociodemographic characteristics and relationships between gratitude and SI. Our study 1 consisted of 156 veterans with mental illness. The mean age for study 1 was 37.85. Our study 2 consisted of 232 student veterans with PTSD symptoms. The mean age for study 2 was 28.43. Higher gratitude scores in study 1 and study 2 were significantly associated with lower SI scores after adjusting for demographics and depression. This study partially supports the association between gratitude and SI in veterans with mental illness. Based on the results from this study, gratitude interventions may be effective in reducing SI when working with veterans with mental illness.

Measuring Social Support among Soldiers with the Experienced Post-Deployment Social Support Scale (EPSSS): A Rasch-Based Construct Validity Study

Perceived social support following deployment is a known buffer against post-deployment adverse mental health outcomes. Given contextual sensitivity of social support measures, scales that address specific social support needs of soldiers in the first months after home coming should be developed and validated. In a sample of 553 soldiers deployed to Afghanistan at two different time points (2009 and 2013, respectively), we selected items for and tested the construct validity of an 8-item measure of experienced post-deployment social support (experienced post-deployment social support scale; EPSSS). Within the item response theory framework, we used Rasch models (RM) to conduct item analysis with an emphasis on testing for differential item functioning (DIF) across background variables such as previous deployments and cohort. In short, we found that the scale did not fit the Rasch model, but with exclusion of two items, a 6-item version of the scale did fit an extended graphical loglinear Rasch model (GLLRM) with only one instance of DIF, for which the score can be adjusted. We also demonstrated that when applied as a scale, the DIF will not affect the results substantially. Hence, we conclude that the constructed 6-item EPSSS can be validly applied without score correction to assess the level of social support in Danish soldiers after home coming.

Probable post-traumatic stress disorder and harmful alcohol use among male members of the British Police Forces and the British Armed Forces: a comparative study

Background: British Armed Forces' and Police Forces' personnel are trained to operate in potentially traumatic conditions. Consequently, they may experience post-traumatic stress disorder (PTSD), which is often comorbid with harmful alcohol use. Objective: We aimed to assess the proportions, and associations, of probable PTSD and harmful alcohol use among a covariate-balanced sample of male military personnel and police employees. Methods: Proportions of probable PTSD, harmful alcohol use, and daily binge drinking, were explored using data from the police Airwave Health Monitoring Study (2007-2015) (N = 23,826) and the military Health and Wellbeing Cohort Study (phase 2: 2007-2009, phase 3: 2014-2016) (N = 7,399). Entropy balancing weights were applied to the larger police sample to make them comparable to the military sample on a range of pre-specified variables (i.e. year of data collection, age and education attainment). Multinomial and logistic regression analyses determined sample differences in outcome variables, and associated factors (stratified by sample). Results: Proportions of probable PTSD were similar in military personnel and police employees (3.67% vs 3.95%), although the large sample size made these borderline significant (Adjusted Odds Ratio (AOR): 0.84; 95% Confidence Intervals (CI): 0.72 to 0.99). Clear differences were found in harmful alcohol use among military personnel, compared to police employees (9.59% vs 2.87%; AOR: 2.79; 95% CI: 2.42 to 3.21). Current smoking, which was more prevalent in military personnel, was associated with harmful drinking and binge drinking in both samples but was associated with PTSD in military personnel only. Conclusions: It is generally assumed that both groups have high rates of PTSD from traumatic exposures, however, low proportions of PTSD were observed in both samples, possibly reflecting protective effects of unit cohesion or resilience. The higher level of harmful drinking in military personnel may relate to more prominent drinking cultures or unique operational experiences.

Examining moderators of the relationship between social support and self-reported PTSD symptoms: A meta-analysis

Social support is one of the most robust predictors of posttraumatic stress disorder (PTSD). Yet, little is known about factors that moderate the relationship between social support and PTSD symptom severity. This meta-analysis estimated the overall effect size of the relationship between self-reported social support and PTSD severity and tested meaningful demographic, social support, and trauma characteristics that may moderate this association using both cross-sectional and longitudinal effect sizes. A comprehensive search identified 139 studies with 145 independent cross-sectional effect sizes representing 62,803 individuals and 37 studies with 38 independent longitudinal effect sizes representing 25,792 individuals. Study samples had to comprise trauma-exposed, nonclinical adult populations to be included in the analysis. Cross-sectional and longitudinal analyses revealed a near medium overall effect size (rcross = -.27; 95% CI [-.30, -.24]; rlong = -.25; 95% CI [-.28, -.21]) with a high degree of heterogeneity (cross-sectional I2 = 91.6, longitudinal I2 = 86.5). Both cross-sectional and longitudinal moderator analyses revealed that study samples exposed to natural disasters had a weaker effect size than samples exposed to other trauma types (e.g., combat, interpersonal violence), studies measuring negative social reactions had a larger effect size than studies assessing other types of social support, and veteran samples revealed larger effect sizes than civilian samples. Several other methodological and substantive moderators emerged that revealed a complex relationship between social support and PTSD severity. These findings have important clinical implications for the types of social support interventions that could mitigate PTSD severity. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Hyperarousal symptoms and perceived burdensomeness interact to predict suicidal ideation among trauma-exposed individuals

The association between posttraumatic stress disorder (PTSD) and suicidal ideation is well-established and recent prospective studies have demonstrated the unique role of hyperarousal symptoms. In particular, over-arousal may elevate suicide risk in the presence of interpersonal vulnerability factors including thwarted belongingness, perceived burdensomeness, and acquired capability. Therefore, the current study sought to examine the differential associations between PTSD symptom clusters and suicidality and the impact of interpersonal risk factors. Trauma-exposed adults (N = 247) completed a questionnaire battery at baseline and three-month follow-up, as part of a larger randomized controlled trial of computerized interventions for suicide risk. Given the focus of the current study, treatment condition was controlled for in all analyses. Results indicated that hyperarousal symptoms significantly predict suicidality, while reexperiencing and avoidance symptoms do not. Specifically, greater hyperarousal symptoms predicted increased suicidal ideation among individuals with high perceived burdensomeness. Although the interaction effect was not significant, hyperarousal symptoms were also pertinent among individuals with high acquired capability. Taken together, findings suggest that assessment of hyperarousal symptoms and perceived burdensomeness may serve to identify trauma-exposed individuals at greater risk for suicide. Additionally, these factors may serve as effective intervention targets.

The Role of Perceived Social Support in Assessing Posttraumatic Stress Disorder and Mental Health-Related Quality of Life in Veterans

This study aims to establish the effect of self-perceived social support on the intensity of Post-Traumatic Stress Disorder (PTSD) symptoms and Mental Health-Related Quality of Life (MHRQoL) in veterans more than two decades after exposure to trauma in the Homeland War in Croatia, which took place from 1990 to 1995. The sample comprised 259 Croatian Homeland War veterans diagnosed with PTSD, with at least 6 months of combat experience. Among them, 90 subjects had also experienced imprisonment in enemy prison camps (at least 1 month of captivity). The subjects were evaluated using the questionnaire on self-perceived social support, sociodemographic questionnaire, PTSD self-report checklist (PCL-5) and Short Form (SF-36) Health Survey questionnaire. A general regression model analysis was performed to determine whether social support affected patients' MHRQoL and intensity of the PTSD symptoms. The obtained results showed that veterans who had a more positive perception of social support after the events of the war had less intense PTSD symptoms and better MHRQoL. Furthermore, captivity and socioeconomic status were shown to be important predictors of PTSD and MHRQoL. The nonimprisoned veteran group was more likely to develop more severe PTSD symptoms and have poorer MHRQoL compared to the group of former prisoners of war (ex-POWs). This could be due to better post-war care and social support, which ex-POWs received after their release from captivity.

PTSD and post-traumatic stress spectrum in the Italian Navy Operational Divers Group and corps of Coast Guard Divers employed in search and rescue activities in the Mediterranean refugees emergences and Costa Concordia shipwreck

Rescue personnel is at high risk for Post-traumatic Stress Disorder (PTSD) because of the possible repetitive exposition to "cruel details of traumatic events" (DSM-5). Literature reported PTSD rates in combat exposed veterans, although the Italian Navy military personnel has been frequently involved in no-war activities in most recent years, such as Search and Rescue (SAR) activities of civilians involved in catastrophic events. The study aimed at exploring the prevalence of PTSD and its impact on social and work functioning among divers of the Italian Navy employed in the SAR activities for the Costa Concordia shipwreck (2012), the collapsed control tower of the Genoa harbour (2013), and the "Mare Nostrum" and "Triton" immigrant emergency Operations in the Mediterranean Sea. The 85 Italian Navy and Coast Guard Divers on duty for these activities were involved in the study and forty fulfilled the assessments, including the: Impact Event Scale (IES-r), Trauma and Loss Spectrum Self-Report (TALS-SR) and Work and Social Adjustment Scale (WSAS). In the three years before enrollment 77.5% of the sample (n = 31) performed at least one rescue operation, with full and partial DSM-5 PTSD rates being 7.5% and 22.5%, respectively. A correlation emerged between WSAS domains or total scores and TALS-SR score domains for PTSD. Rescue Navy personnel resulted to be at risk for post-traumatic stress symptoms, and these subthreshold PTSD manifestations appear to impact on functioning. Further studies are needed to better investigate PTSD risk and resilience factors in this particular group of workers.

Unit Cohesion and Social Support as Protective Factors Against Suicide Risk and Depression Among National Guard Service Members

Introduction: Suicide and depression continue to be pervasive problems across military populations, including within the National Guard. Existing literature highlights the protective effects of social support and unit cohesion for both suicide risk and depression, yet to our knowledge, these associations have never been confirmed in National Guard populations. Thus, the aim of this study was to investigate the impacts of social support resources (i.e., general social support and unit cohesion) on depression and suicide risk among a large sample (n = 877) of National Guard service members.

Methods: Multilevel modeling was used to examine the impact of social support resources on depression and suicide ideation at both the individual and unit level.

Results: Results indicated that higher levels of perceived social support were associated with lower levels of depression and suicide ideation at both the individual and unit levels. Additionally, higher levels of perceived unit cohesion significantly predicted lower levels of depression and suicide ideation at the individual, but not unit level.

Discussion: Limitations include self-report measurement and cross-sectional nature of the data. These findings hold implications for improvement of operational climate within military units and reduction of suicide risk and depressive symptoms among National Guard service members.

Informal caregiving experiences in posttraumatic stress disorder: A content analysis of an online community

This study explored the experiences of individuals who self-identify as providing support to a friend, family member, or significant other with posttraumatic stress disorder (PTSD). We analyzed and coded a total of 345 posts from an online support forum, with reference to 13 categories (finances, life interference, venting/emotional expression, maltreatment, sexual behavior, distress, prevented expression, physical health, communication, no personal space, isolation, and compassion fatigue). Categories for coding were established a priori and based on previous literature about caregiving and supporting. Results suggested that informal PTSD caregivers experience concerns involving interpersonal relations, emotional turmoil, and barriers to care for themselves and the individual they are caring for. This study provides a preliminary examination of the experiences and concerns of PTSD caregivers. Implications and suggestions for future research are discussed.

Protective correlates of suicidality among veterans with histories of posttraumatic stress disorder and major depressive disorder: Results from the National Health and Resilience in Veterans Study

BACKGROUND

Although several studies have identified risk factors for suicidal behaviors in general samples of Veterans, fewer studies have examined protective factors, particularly in high-risk samples. To address this gap, we examined protective correlates of suicidal ideation (SI) and suicide attempts (SA) in a sample of Veterans with histories of posttraumatic stress disorder (PTSD) and/or major depressive disorder (MDD).

METHOD

Data were analyzed from a nationally representative sample of 3157 U.S. Veterans who completed the first wave of a web-based survey as part of the National Health and Resilience in Veterans Study (NHRVS). Of this sample, 577 Veterans met criteria for history of PTSD, MDD or both.

RESULTS

Multivariable logistic regression analyses were used to examine relationships between protective factors (curiosity, resilience, purpose in life, dispositional gratitude, optimism, and community integration) and suicidal behaviors (SI and SA). The prevalence of any SI during the previous two weeks was 29.4% and the prevalence of lifetime SA was 28.0%. After adjusting for relevant sociodemographic and military characteristics, greater purpose in life, curiosity, and optimism were negatively associated with SI. None of the protective correlates were associated with SA.

LIMITATIONS

Given the cross-sectional nature of this study, conclusions about causality cannot be made. The assessment of suicidality also was limited to three self-report items.

CONCLUSION

Results provide a characterization of protective factors for suicidality, and may help inform prevention and treatment approaches designed to mitigate suicide risk among high-risk military Veterans.

Differences in protective factors among U.S. Veterans with posttraumatic stress disorder, alcohol use disorder, and their comorbidity: Results from the National Health and Resilience in Veterans Study

BACKGROUND

Comorbid posttraumatic stress disorder (PTSD) and alcohol use disorder (AUD) are associated with greater clinical and functional impairments than either disorder alone, including higher rates of suicidality and reduced functioning and quality of life. Although PTSD/AUD is associated with more severe risk factors relative to either disorder alone, it is unclear whether PTSD/AUD and its related impairments are also associated with lower levels of protective factors.

METHODS

We examined two composite factors of protective qualities derived from exploratory factor analyses-social connectedness (i.e., structural social support, perceived social support, secure attachment style) and protective psychosocial characteristics (i.e., resilience, purpose in life, dispositional optimism and gratitude, and community integration), in a nationally representative sample of U.S. Veterans (using data from the National Health and Resilience in Veterans Study) with PTSD alone, AUD alone, and comorbid PTSD/AUD.

RESULTS

Veterans with PTSD and PTSD/AUD scored significantly lower than those with AUD alone but did not differ from each other on measures of social connectedness and protective psychosocial characteristics (ps < .001). Both factors partially mediated the relationship between diagnostic status (PTSD or PTSD/AUD vs. AUD alone) and suicidal ideation (ORs = 0.58-0.62), as well as between diagnostic status and functioning/quality of life (psychosocial protective characteristics, β = 0.39; social connectedness, β = 0.16). Only protective psychosocial characteristics (OR = 0.54) emerged as a partial mediator between diagnostic status and lifetime suicide attempts.

CONCLUSIONS

U.S. Veterans with PTSD and PTSD/AUD score lower on measures of protective factors than Veterans with AUD. These factors may be important targets for prevention and treatment efforts.

Abnormal metabolite concentrations and amygdala volume in patients with recent-onset posttraumatic stress disorder

BACKGROUND

Previous psychoradiological studies of posttraumatic stress disorder (PTSD) were mainly of patients at a chronic stage, focusing on brain regions outside the amygdala. The goals of this study were to investigate the early biochemical and structural changes of anterior cingulate cortex (ACC) and amygdala in patients with PTSD and to explore their relationships.

METHODS

Seventy-eight drug-naïve PTSD subjects and 71 non-PTSD age- and sex-matched control subjects were enrolled, all of whom had suffered the same earthquake about one year before. Single-voxel proton magnetic resonance spectroscopy (¹H-MRS) was performed and absolute metabolite concentrations in ACC and bilateral amygdalae were estimated with LCModel. Bilateral amygdalae were manually outlined and their volumes were calculated and corrected for the total intracranial volume.

RESULTS

The PTSD group showed significantly increased N-acetylaspartate (NAA) concentration in the ACC, increased creatine (Cr) concentration in the left amygdala, and increased myo-inositol (mI) concentration in the right amygdala, compared to non-PTSD controls. The NAA concentration in ACC was negatively correlated with the time since trauma. The PTSD group showed significantly decreased volumes of bilateral amygdalae compared to non-PTSD controls, but amygdala volumes were not correlated with metabolite concentrations.

LIMITATIONS

Longitudinal studies are needed to explore the metabolic and structural changes of PTSD at different stages. The volume of ACC was not measured.

CONCLUSIONS

This concurrent increase in some metabolite concentrations and decrease of amygdala volumes may represent a pattern of biochemical and morphological changes in recent-onset PTSD which is different from that reported in chronic PTSD.

Intervention effects on reflectivity explain change in positive parenting in military families with young children

Military families with young children often experience stress related to the unique circumstances of military families (e.g., deployment), and there is a need for interventions that are specifically tailored to military families with young children. The Strong Military Families (SMF) intervention responds to this need, and consists of two versions: A Multifamily Group (N = 34), and a Homebased psychoeducational written material program (N = 42; treated as the comparison group in this report). The Multifamily Group utilized an attachment-based parenting education curriculum and in vivo support of separations and reunions, encouraged peer support among parents, and connected families to additional services. In the present nonrandomized trial, we examine intervention effects on observed parenting behavior and affect, and test whether changes in parenting reflectivity account for intervention-related changes in observed parenting. Observed parenting behavior and affect were coded from the Caregiver-Child Structured Interaction Procedure (Crowell & Fleischmann, 1993), and parenting reflectivity was coded from the Working Model of the Child Interview (Zeanah & Benoit, 1995). Results suggest that relative to Homebased participants, Multifamily Group participants showed pre- and post- improvements in aspects of positive parenting (Emotional Responsivity, Positive Affect), but no decreases in negative parenting. The efficacy of the SMF Multifamily Group intervention does not appear to depend on parent risk level or preintervention parent behavior and affect. Further, a mediation model demonstrated that the intervention effects on parents' observed positive affect in an interaction task with their child were partially accounted for by intervention-related changes in their parenting reflectivity. (PsycINFO Database Record

The Link between Posttraumatic Stress Disorder and Functionality among United States Military Service Members Psychiatrically Hospitalized Following a Suicide Crisis

Posttraumatic stress disorder (PTSD) is one of the most commonly diagnosed psychiatric disorders in the United States and has been linked to suicidal thoughts and behaviors, yet the role of a PTSD diagnosis on functional impairment among suicidal individuals remains unknown. This study examined the association between PTSD status and functional impairment among military psychiatric inpatients admitted for acute suicide risk (N = 166) with a lifetime history of at least one suicide attempt. Measures of functionality included: (1) alcohol use; (2) sleep quality; (3) social problem-solving; and (4) work and social adjustment. Thirty-eight percent of the sample met criteria for PTSD. Women were more likely than men to meet criteria for PTSD (p = 0.007), and participants who met PTSD criteria had significantly more psychiatric diagnoses (p < 0.001). Service members who met PTSD criteria reported more disturbed sleep (p = 0.003) and greater difficulties with work and social adjustment (p = 0.004) than those who did not meet PTSD criteria. However, functionality measures were not significantly associated with PTSD status after controlling for gender and psychiatric comorbidity. Gender and number of psychiatric comorbidities other than PTSD were significant predictors of PTSD in logistic regression models across four functionality measures. Future studies should assess the additive or mediating effect of psychiatric comorbidities in the association between impaired functioning and PTSD. Clinicians are encouraged to assess and address functionality during treatment with suicidal individuals, paying particular attention to individuals with multiple psychiatric diagnoses.

The relationship between PTSD and suicidality among Wenchuan earthquake survivors: The role of PTG and social support

BACKGROUND

Previous studies have found that suicide rates are likely to increase after the occurrence of earthquakes. Most existing studies that examined the relationship between PTSD and suicidality focus on risk factors. It remains unclear whether protective factors, such as post-traumatic growth (PTG) and social support, play a role in this relationship.

OBJECTIVES

The aim of this study was to investigate the role of PTG and social support in the association between PTSD and suicidality, using data from a cross-sectional study conducted in China.

METHODS

1,369 participants were recruited from two study sites that were severely affected by the Wenchuan earthquake. Univariate and multivariate regression analyses were conducted to examine the relationship between PTSD, PTG, social support, and suicidality.

RESULTS

The results indicate that the prevalence of suicidal ideation, suicide plans, and suicide attempts among adult survivors were 9.06%, 2.97% and 3.31%, respectively, even after 8 years following the Wenchuan earthquake. Furthermore, the findings show that PTSD was significantly associated with suicidality (OR = 1.96; 95% CI = 1.53, 2.52). Additionally, individuals reporting lower levels of social support and the acquisition of PTSD (OR = 5.99; 95% CI = 1.66, 21.56) were significantly related to suicidality. Moreover, compared to individuals who reported no presence of PTSD and high PTG, those who lived with PTSD and lower levels of PTG (OR = 2.33; 95%CI = 1.00, 5.42) were more likely to report suicidality.

LIMITATIONS

The cross-sectional design of this study limits our ability to determine causal relationships. Effects of other related factors, such as cultural and life events, were not examined in this study.

CONCLUSIONS

Suicidality is a long-term health issue among survivors of the Wenchuan earthquake. PTG and social support play important roles on the association between PTSD and suicidality and are important contributing factors to understanding this relationship. These results contribute new knowledge of suicidal risk for a number of years after an earthquake and have implications for further mental health promotion following earthquakes.

Posttraumatic stress disorder, depression, and suicidal ideation in veterans: Results from the mind your heart study

Veterans with PTSD or depression are at increased risk for suicidal ideation. However, few studies have examined that risk in those with comorbid PTSD and depression, instead focusing on these disorders individually. This study investigates the association of suicidal ideation with comorbid PTSD and depression and examines the role of military and psychosocial covariates. We evaluated 746 veterans using the CAPS to assess PTSD and the PHQ-9 to measure depression and suicidal ideation. Covariates were assessed via validated self-report measures. 49% of veterans with comorbid PTSD and depression endorsed suicidal ideation, making them more likely to do so than those with depression alone (34%), PTSD alone (11%), or neither (2%). In multivariate logistic regression models, this association remained significant after controlling for demographics and symptom severity. Anger, hostility, anxiety, alcohol use, optimism and social support did not explain the elevated risk of suicidal ideation in the comorbid group in fully adjusted models. As suicidal ideation is a known risk factor for suicide attempts and completions, veterans with comorbid PTSD and depression represent a vulnerable group who may need more intensive monitoring and treatment to reduce risk of suicide.

Suicidality in Subjects With Anxiety or Obsessive-Compulsive and Related Disorders: Recent Advances

PURPOSE OF REVIEW

Historically, anxiety disorders have not been considered as important determinants of suicide, but in the last years, many works have challenged this assumption. Here, we will review the available evidence on the relationship between suicide and anxiety disorders (e.g., obsessive-compulsive disorder, post-traumatic stress disorder, generalized anxiety disorder, panic disorder, and body dysmorphic disorder), with special emphasis on findings published in the last years.

RECENT FINDINGS

Overall, anxiety disorders increase the risk of suicide. Specifically, 16% of patients with social anxiety disorder reported suicidal ideation in the previous month, and 18% of them had a history of suicide attempts. Similarly, in patients with panic disorder, suicidal ideation prevalence ranged between 17 and 32%, and 33% of them had a history of suicide attempts. Generalized anxiety disorder (GAD) was the most frequent anxiety disorder in completed suicides (present in 3% of people who committed suicide) and also subthreshold GAD was clearly linked to suicide ideation. Post-traumatic stress disorder was positively associated with suicidal ideation, and in patients with obsessive-compulsive disorder, suicide ideation rates ranged from 10 to 53% and suicide attempts from 1 to 46%. Body dysmorphic disorders presented a suicide ideation prevalence of about 80%. Suicide risk is increased in subjects with anxiety disorder. This risk is higher in the presence of comorbidities, but it is not clear whether it is independent from such comorbidities in some disorders.

Depression in Female Veterans Returning from Deployment: The Role of Social Factors

Objective

Women are serving in the armed forces and deployed to areas of conflict in increasing numbers. Problems such as depressive symptoms and risks related to combat exposure can have negative effects on adjustment following service; understanding the relationship between these problems may contribute to strategies providers can use to facilitate healthy adjustment after deployment. The purpose of this study is to examine social factors as they relate to mental health adjustment, namely depressive symptoms among female veterans who served in Iraq and Afghanistan as part of Operation Enduring Freedom, Operation Iraqi Freedom, and Operation New Dawn (OND). We hypothesized that combat exposure would predict higher levels of depressive symptoms and that social support would moderate the relationship between combat exposure and depression.

Methods

In a cross-sectional design, 128 female Operation Enduring Freedom/Operation Iraqi Freedom/Operation New Dawn veterans completed an online survey about combat experience, social support, depression, demographic characteristics, and behavioral health symptom history. We conducted multiple regression analyses to examine linear and moderating relationships.

Results

There was no significant relationship between combat exposure and depression; social support did not significantly moderate the relationship between combat exposure and depression. However, higher levels of social support and financial comfort were significantly related to lower levels of depression.

Conclusion

This study highlights the role of social factors, specifically social support and perceived financial status, as potential barriers to healthy emotional readjustment following deployment. These findings suggest that it may be beneficial for mental health providers to screen female veterans and refer them to appropriate services to reduce financial stressors and strengthen their use of social support. More research should continue to examine more fully the impact of combat exposure on female service members' mental health and work to isolate the factors most strongly related to depression.

The Effect of Social Support Skill-training Group Intervention on Perceived Social Support in Veterans with Posttraumatic Stress Disorder

Background:

Traumatic events related to war have long effects on psychiatric psychopathologies. From these disturbing conditions, posttraumatic stress disorder (PTSD) is considered to be the most characteristic feature of psychiatric traumatic experience. The current study was designed to assess the effect of two social support skill-training group interventions on perceived social support in veterans with PTSD.

Materials and Methods:

The study was conducted with the clinical trial method. According to the inclusion criteria, 60 of 367 veterans with PTSD were selected and randomly allocated into two intervention groups and a control group. The two training programs on social support skills consisting of three sessions, each being 1.5–2 h, were held weekly for 3 weeks. The Multidimensional Scale of Perceived Social Support was filled by samples before and 6 weeks after intervention. The data were analyzed by descriptive and analytical statistics using PASW Statistics 18.

Results:

The ANOVA results showed that after intervention, there were significant differences in perceived social support between intervention groups and control group (F = 1.06, p = 0.001), but there was no significant difference between intervention groups by t-test (t = 28.05, p < 0.10). The paired t-test showed a significant difference in all subscale scores of perceived social support between two intervention groups before and after intervention (p < 0.05).

Conclusions:

The results of the current study agreed with the positive effects of social support skill training on perceived social support in veterans with PTSD. It is suggested that these training courses should be included in the community re-entry programs of veterans with PTSD.

STRONG MILITARY FAMILIES INTERVENTION ENHANCES PARENTING REFLECTIVITY AND REPRESENTATIONS IN FAMILIES WITH YOUNG CHILDREN

Military families face many challenges due to deployment and parental separation, and this can be especially difficult for families with young children. The Strong Military Families (SMF) intervention is for military families with young children, and consists of two versions: the Multifamily Group, and a Home-based psychoeducational written materials program. The Multifamily Group was designed to enhance positive parenting through both educational components and in vivo feedback and support during separations and reunions between parents and children (n = 78 parents). In the present study, we examine parenting reflectivity and mental representations in mothers versus fathers in military families, service members versus civilian spouses/parenting partners, and before versus after participation in the SMF Multifamily Group and Home-based interventions. Parenting reflectivity and mental representations were coded from the Working Model of the Child Interview (WMCI; C.H. Zeanah & D. Benoit, 1995). Results suggest that neither parenting reflectivity nor WMCI typology differs between mothers and fathers in military families, or between service members and civilian parenting partners. Furthermore, there was substantial stability in parenting reflectivity and WMCI typology from baseline to posttest, but participation in the Multifamily Group, relative to Home-based, was associated with improvements in both parenting reflectivity and WMCI ratings from baseline to postintervention.

A Prospective Investigation of the Impact of Distinct Posttraumatic (PTSD) Symptom Clusters on Suicidal Ideation

Inconsistent findings have been reported by previous cross-sectional studies regarding the association between specific posttraumatic stress disorder (PTSD) symptom clusters and suicidality. To advance the understanding of the role of specific PTSD symptoms in the development of suicidality, the primary aim of this study was to investigate the predictive effects of the three specific PTSD symptom clusters on suicidal ideation prospectively. Fifty-six individuals diagnosed with PTSD completed a two-stage research design, at baseline and 13–15 months follow-up. The clinician administered PTSD scale (CAPS) was used to assess the severity of the PTSD symptom clusters and validated self-report measures were used to assess suicidal ideation, severity of depressive symptoms and perceptions of defeat entrapment. The results showed that only the hyperarousal symptom cluster significantly predicted suicidal ideation at follow-up after controlling for baseline suicidal ideation, severity of depressive symptoms and perceptions of defeat and entrapment. These findings suggest that both disorder-specific and transdiagnostic factors are implicated in the development of suicidal ideation in PTSD. Important clinical implications are discussed in terms of predicting and treating suicidality in those with PTSD.

Predictors of suicidal ideation among active duty military personnel with posttraumatic stress disorder

BACKGROUND

Given the alarming rate of military suicides, it is critical to identify the factors that increase risk of suicidal thoughts and behaviors among active duty military personnel.

METHODS

This study examined a predictive model of suicidal ideation among 366 treatment-seeking active duty military personnel with posttraumatic stress disorder (PTSD) following deployments to or near Iraq or Afghanistan. Structural equation modeling was employed to examine the relative contribution of combat exposure, social support, PTSD severity, depressive symptoms, guilt, and trauma-related cognitions on suicidal ideation.

RESULTS

The final structural equation model had a highly satisfactory fit [χ² (2) =2.023, p=.364; RMSEA =.006; CFI =1; GFI =.998]. PTSD severity had an indirect effect on suicidal ideation via trauma-related cognitions. Depression had a direct positive effect on suicidal ideation; it also had an indirect effect via trauma-related cognitions and interpersonal support. Among participants who had made a previous suicide attempt, only depression symptom severity was significantly linked to suicidal ideation.

LIMITATIONS

Data are cross-sectional, precluding causal interpretations. Findings may only generalize to treatment seeking active duty military personnel with PTSD reporting no more than moderate suicidal ideation.

CONCLUSIONS

These findings suggest that depression and trauma-related cognitions, particularly negative thoughts about the self, play an important role in suicidal ideation among active duty military personnel with PTSD. Negative cognitions about the self and interpersonal support may be important targets for intervention to decrease suicidal ideation.

Nature and determinants of suicidal ideation among U.S. veterans: Results from the national health and resilience in veterans study

BACKGROUND

Suicidal thoughts and behaviors among U.S. military veterans are a major public health concern. To date, however, scarce data are available regarding the nature and correlates of suicidal ideation (SI) among U.S. veterans. This study evaluated the prevalence and correlates of suicidal ideation in a contemporary, nationally representative, 2-year prospective cohort study.

METHOD

Data were analysed from a total of 2157 U.S. veterans who participated in the National Health and Resilience Veterans Study (NHRVS; Wave 1 conducted in 2011; Wave 2 in 2013). Veterans completed measures assessing SI, sociodemographic characteristics, and potential risk and protective correlates.

RESULTS

The majority of veterans (86.3%) denied SI at either time point, 5.0% had SI onset (no SI at Wave 1, SI at Wave 2), 4.9% chronic SI (SI at Waves 1 and 2), and 3.8% had remitted SI (SI at Wave 1, no SI Wave 2). Greater Wave 1 psychiatric distress was associated with increased likelihood of chronic SI (relative risk ratio [RRR]=3.72), remitted SI (RRR=3.38), SI onset (RRR=1.48); greater Wave 1 physical health difficulties were additionally associated with chronic SI (RRR=1.64) and SI onset (RRR=1.47); and Wave 1 substance abuse history was associated with chronic SI (RRR 1.57). Greater protective psychosocial characteristics (e.g., resilience, gratitude) at Wave 1 were negatively related to SI onset (RRR=0.57); and greater social connectedness at Wave 1, specifically perceived social support and secure attachment style, was negatively associated with SI onset (RRR=0.75) and remitted SI (RRR=0.44), respectively.

LIMITATIONS

Suicidal ideation was assessed using a past two-week timeframe, and the limited duration of follow-up precludes conclusions regarding more dynamic changes in SI over time.

CONCLUSIONS

These results indicate that a significant minority (13.7%) of U.S. veterans has chronic, onset, or remitted SI. Prevention and treatment efforts designed to mitigate psychiatric and physical health difficulties, and bolster social connectedness and protective psychosocial characteristics may help mitigate risk for SI.

The impact of neighborhood disorganization on neighborhood exposure to violence, trauma symptoms, and social relationships among at-risk youth

Previous research has demonstrated that exposure to violence (ETV) is a serious concern across the north-south socioeconomic divide. While studies have found that social support is a protective factor for youth exposed to violence and trauma, little is known about the impact of trauma symptoms on forming and maintaining social relationships which are key to accessing a vital social resource that fosters resilience in youth experiencing trauma symptomatology. Building on previous models that examine the impact of neighborhoods on exposure to violence and trauma, the current study examines the impact of neighborhood disorganization on ETV among youth and ETV's effects on trauma symptoms and social relationships. Data were collected on 2242 juvenile justice-involved youth with behavioral health issues in 11 urban and rural counties in the Midwestern United States. Using structural equation modeling (SEM), our data demonstrated that living in highly disorganized neighborhoods was associated with higher levels of ETV and that ETV was positively associated with trauma symptoms. Mediational analysis showed that trauma symptoms strongly mediated the effect of ETV on social relationships. Freely estimating structural paths by gender revealed that hypothesized associations between these variables were stronger for females than males. Findings here highlight the need to provide trauma-informed care to help youth to build and maintain social relationships. Identification and treatment of trauma symptoms that is culturally informed is a critical first step in ensuring that identified protective factors in local contexts, such as social relations and social support, have opportunities to minimize the impact of ETV among youth across northern and southern nations.

Military Service and Suicidal Thoughts and Behaviors in a National Sample of College Students

Background: As a result of the post-9/11 GI Bill, increasing numbers of veterans are enrolling in college. However, little is known regarding suicidal outcomes among this group. In prior research, college student veterans reported high rates of suicidal ideation and attempt. Nonetheless, no research has examined whether military service is associated with increased suicide risk among college students. Aims: Our primary aims were to examine whether a history of military service was related to past-year suicidal ideation, plan, and attempt among college students. On the basis of previous research with college students, we hypothesized that students with a history of military service (i.e., current or prior) would report a higher percentage of past-year suicidal ideation, plan, and attempt. Our secondary aims were to examine the associations between military service and major depression and nonsuicidal self-injury. Method: Our sample included 3,290 college students with and without a history of military service who participated in the Healthy Minds Study in 2011 and 2012. Results: Military service was not significantly associated with past-year suicidal ideation, plan, or attempt. Students without a history of military service were more likely to report nonsuicidal self-injury. There was no significant difference in screening positive for major depression. Conclusions: These findings conflict with previous research that identified student veterans as being at elevated risk.

A qualitative investigation into the relationships between social factors and suicidal thoughts and acts experienced by people with a bipolar disorder diagnosis

BACKGROUND

The prevalence rate of completed suicide in bipolar disorder is estimated to be as high as 19%. Social factors or influences, such as stigmatisation and family conflict, contribute to the development of suicidal ideation in clinical and non-clinical populations. Yet, there is a lack of studies examining suicidality from a psychosocial perspective in people who experience bipolar disorder.

METHOD

Semi-structured interviews were used to collect qualitative data from 20 participants with bipolar disorder. The interview focused on the effects of social factors upon participants׳ experiences of suicidality (suicidal thoughts, feelings or behaviours). A thematic analysis was used to understand the data.

RESULTS

Social or interpersonal factors which participants identified as protective against suicidality included, 'the impact of suicide on others' and, 'reflecting on positive social experiences'. Social factors which triggered suicidal thoughts included, 'negative social experiences' and, 'not being understood or acknowledged'. Social factors which worsened suicidal thoughts or facilitated suicidal behaviour were, 'feeling burdensome,' and 'reinforcing negative self-appraisals'.

LIMITATIONS

Some participants had not experienced suicidal thoughts for many years and were recalling experiences which had taken place over ten years ago. The accuracy and reliability of these memories must therefore be taken into consideration when interpreting the results.

CONCLUSIONS

The themes help to enhance current understanding of the ways in which social factors affect suicidality in people who experience bipolar disorder. These results highlight the importance of considering the social context in which suicidality is experienced and incorporating strategies to buffer against the effects of negative social experiences in psychological interventions which target suicide risk in bipolar disorder.

Caregivers of veterans with "invisible" injuries: what we know and implications for social work practice

Today, as a result of the longest volunteer-fought conflict in U.S. history, there are many wounded coming home not only with posttraumatic stress disorder (PTSD), but also with traumatic brain injury (TBI), which together have been called the "signature" or "invisible" injuries of the Iraq and Afghanistan wars. Caregivers are an important part of their recovery, yet little is known about them, as previous research on caregivers mostly focused on geriatric populations. According to one estimate 275,000 to 1 million people are currently caring or have cared for loved ones who have returned from Iraq and Afghanistan. These caregivers are unique in that they are younger, some with children, and they are caring for a unique under-studied population for longer periods of time. This article summarizes literature on caregivers of veterans who suffer from PTSD, TBI, or both; provides a theoretical framework; and discusses implications for social workers in assisting caregivers and their families.

Correlates of suicidal ideation in physically injured trauma survivors

Epidemiologic studies have documented that injury survivors are at increased risk for suicide. We evaluated 206 trauma survivors to examine demographic, clinical, and injury characteristics associated with suicidal ideation during hospitalization and across 1 year. Results indicate that mental health functioning, depression symptoms, and history of mental health services were associated with suicidal ideation in the hospital; being a parent was a protective factor. Pre-injury posttraumatic stress disorder symptoms, assaultive injury mechanism, injury-related legal proceedings, and physical pain were significantly associated with suicidal ideation across 1 year. Readily identifiable risk factors early after traumatic injury may inform hospital-based screening and intervention procedures.

The impact of social support on psychological distress for U.S. Afghanistan/Iraq era veterans with PTSD and other psychiatric diagnoses

This study aimed to examine the degree to which posttraumatic stress disorder (PTSD) affects the relationship between social support and psychological distress for U.S. Afghanistan/Iraq era veterans with and without co-occurring psychiatric disorders. Veterans (N=1825) were administered self-report questionnaires and a structured diagnostic interview as part of a multi-site study of post-deployment mental health through the Department of Veterans Affairs (VA) Mid-Atlantic Mental Illness Research, Education and Clinical Center (MIRECC). Main and interaction effects models assessed the association between psychological distress and social support for three comparisons conditions (Controls vs. PTSD-only, non-PTSD, and PTSD plus co-morbid diagnoses). Having PTSD was a critical factor in attenuating the strength of this association, more so than other diagnoses. Furthermore, those with PTSD plus co-morbid diagnoses did not demonstrate significantly larger attenuation in that association compared to the PTSD-only group, indicating that psychiatric comorbidity may be less important in considering the role of social support in PTSD. By understanding this relationship, new avenues for engaging and enhancing treatment outcomes related to social support for veterans of this cohort may be identified. Additional longitudinal research could help evaluate the effect of PTSD symptom clusters, social support type, and trauma exposure type on these relationships.

Combined PTSD and depressive symptoms interact with post-deployment social support to predict suicidal ideation in Operation Enduring Freedom and Operation Iraqi Freedom veterans

Rates of suicide are alarmingly high in military and veteran samples. Suicide rates are particularly elevated among those with post-traumatic stress disorder (PTSD) and depression, which share overlapping symptoms and frequently co-occur. Identifying and confirming factors that reduce, suicide risk among veterans with PTSD and depression is imperative. The proposed study evaluated, whether post-deployment social support moderated the influence of PTSD-depression symptoms on, suicidal ideation among Veterans returning from Iraq and Afghanistan using state of the art clinical, diagnostic interviews and self-report measures. Operations Enduring and Iraqi Freedom (OEF/OIF) Veterans (n=145) were invited to, participate in a study evaluating returning Veterans׳ experiences. As predicted, PTSD-depression, symptoms had almost no effect on suicidal ideation (SI) when post-deployment social support was high; however, when, post-deployment social support was low, PTSD-depression symptoms were positively associated with, SI. Thus, social support may be an important factor for clinicians to assess in the context of PTSD and, depressive symptoms. Future research is needed to prospectively examine the inter-relationship, between PTSD/depression and social support on suicidal risk, as well as whether interventions to, improve social support result in decreased suicidality.

Meaning made of stress among veterans transitioning to college: examining unique associations with suicide risk and life-threatening behavior

Meaning made of stress has been shown to be a unique predictor of mental and physical health. In this study, we examined the unique associations between two facets of meaning made of stress (comprehensibility and footing in the world) and suicide risk and life-threatening behavior among military veterans who have transitioned to college were examined, controlling for demographic factors, religiousness, combat-related physical injury, combat exposure, depressive symptoms, and posttraumatic stress symptoms. Findings suggest that comprehensibility (having “made sense” of a stressor) is uniquely associated with lower suicide risk and a lower likelihood of driving under the influence of drugs or alcohol and engaging in self-mutilating behaviors.

Perceived social support buffers the impact of PTSD symptoms on suicidal behavior: implications into suicide resilience research

BACKGROUND

A growing body of research has highlighted the importance of identifying resilience factors against suicidal behavior. However, no previous study has investigated potential resilience factors among individuals with Posttraumatic Stress Disorder (PTSD). The aim of this study was to examine whether perceived social support buffered the impact of PTSD symptoms on suicidal behavior.

METHODS

Fifty-six individuals who had previously been exposed to a traumatic event and reported PTSD symptoms in the past month (n = 34, 60.7% participants met the full criteria for a current PTSD diagnosis) completed a range of self-report measures assessing PTSD symptoms, perceived social support and suicidal behavior. Hierarchical regression analyses were conducted to examine whether perceived social support moderates the effects of PTSD symptoms on suicidal behavior.

RESULTS

The results showed that perceived social support moderated the impact of the number and severity of PTSD symptoms on suicidal behavior. For those who perceived themselves as having high levels of social support, an increased number and severity of PTSD symptoms were less likely to lead to suicidal behavior.

CONCLUSIONS

The current findings suggest that perceived social support might confer resilience to individuals with PTSD and counter the development of suicidal thoughts and behaviors. The milieu of social support potentially provides an area of further research and an important aspect to incorporate into clinical interventions for suicidal behavior in PTSD or trauma populations.

The role of military social support in understanding the relationship between PTSD, physical health, and healthcare utilization in women veterans

Posttraumatic stress disorder (PTSD) is a significant predictor of both poorer physical health and increased health care utilization, whereas adequate social support is associated with better physical health and less health care utilization. However, research has not previously examined the simultaneous effects of PTSD and social support on health and health care utilization. This study examined both the independent and interactive effects of PTSD and a particular type of social support (postactive-duty social support from military friends) on self-reported physical health and number of Veterans Health Administration (VHA) visits in the last year. These relationships were examined in a representative, national sample of 3,524 women veterans who completed telephone interviews as part of the National Survey of Women Veterans in 2008-2009. Regression analyses were conducted using these cross-sectional data to examine main effects of PTSD and military social support on physical health and VHA utilization and their interaction. Screening positive for PTSD was associated with poorer health (B = -3.19, SE = 1.47) and increased VHA utilization (B = 0.98, SE = 0.16), whereas greater military social support was associated with better health (B = 0.97, SE = 0.44) and less frequent VHA utilization (B = -0.15, SE = 0.05). Neither moderation model was significant, such that military social support behaved in a similar way regardless of PTSD status.

Help-seeking from clergy and spiritual counselors among veterans with depression and PTSD in primary care

Little is known about the prevalence or predictors of seeking help for depression and PTSD from spiritual counselors and clergy. We describe openness to and actual help-seeking from spiritual counselors among primary care patients with depression. We screened consecutive VA primary care patients for depression; 761 Veterans with probable major depression participated in telephone surveys (at baseline, 7 months, and 18 months). Participants were asked about (1) openness to seeking help for emotional problems from spiritual counselors/clergy and (2) actual contact with spiritual counselors/clergy in the past 6 months. At baseline, almost half of the participants, 359 (47.2%), endorsed being "very" or "somewhat likely" to seek help for emotional problems from spiritual counselors; 498 (65.4%) were open to a primary care provider, 486 (63.9%) to a psychiatrist, and 409 (66.5%) to another type of mental health provider. Ninety-one participants (12%) reported actual spiritual counselor/clergy consultation. Ninety-five (10.3%) participants reported that their VA providers had recently asked them about spiritual support; the majority of these found this discussion helpful. Participants with current PTSD symptoms, and those with a mental health visit in the past 6 months, were more likely to report openness to and actual help-seeking from clergy. Veterans with depression and PTSD are amenable to receiving help from spiritual counselors/clergy and other providers. Integration of spiritual counselors/clergy into care teams may be helpful to Veterans with PTSD. Training of such providers to address PTSD specifically may also be desirable.

Current status on behavioral and biological markers of PTSD: a search for clarity in a conflicting literature

Extensive research has identified stereotypic behavioral and biological abnormalities in post-traumatic stress disorder (PTSD), such as heightened autonomic activity, an exaggerated startle response, reduced basal cortisol levels and cognitive impairments. We have reviewed primary research in this area, noting that factors involved in the susceptibility and expression of PTSD symptoms are more complex and heterogeneous than is commonly stated, with extensive findings which are inconsistent with the stereotypic behavioral and biological profile of the PTSD patient. A thorough assessment of the literature indicates that interactions among myriad susceptibility factors, including social support, early life stress, sex, age, peri- and post-traumatic dissociation, cognitive appraisal of trauma, neuroendocrine abnormalities and gene polymorphisms, in conjunction with the inconsistent expression of the disorder across studies, confounds attempts to characterize PTSD as a monolithic disorder. Overall, our assessment of the literature addresses the great challenge in developing a behavioral and biomarker-based diagnosis of PTSD.

Suicide and war: the mediating effects of negative mood, posttraumatic stress disorder symptoms, and social support among army National Guard soldiers

The mediating effects of posttraumatic stress disorder (PTSD) symptoms, negative mood, and social support on the relationship of war experiences to suicidality were examined. The research literature suggested a sequence among study scales representing these constructs, which was then tested on survey data obtained from a sample of National Guard soldiers (N=4,546). Results from structural equation modeling suggested that war experiences may precipitate a sequence of psychological consequences leading to suicidality. However, suicidality may be an enduring behavioral health condition. War experiences showed no direct effects on postdeployment suicidality, rather its effect was indirect through PTSD symptoms and negative mood. War experiences were, however, predictive of PTSD symptoms, as would be expected. PSTD symptoms showed no direct effect on postdeployment suicidality, but showed indirect effects through negative mood. Results also suggested that suicidality is relatively persistent, at least during deployment and postdeployment. The percentage of those at risk for suicide was low both during and after deployment, with little association between suicidality and time since returning from deployment. Additionally, few soldiers were initially nonsuicidal and then reported such symptoms at postdeployment. Implications of relationships of both negative mood and combat trauma to suicidality are discussed, as well as possible mediating effects of both personal dispositions and social support on relationships of war experiences to PTSD, negative mood, and suicidality.

Suicidal ideation in treatment-seeking Veterans of Operations Enduring Freedom and Iraqi Freedom: the role of coping strategies, resilience, and social support

BACKGROUND

Recent epidemiologic studies have found an increased risk of suicide among Veterans of Operations Enduring Freedom and Iraqi Freedom (OEF-OIF) with psychiatric disorders. However, little is known about whether variables other than psychiatric conditions, such as coping strategies, resilience, and social support, may be related to suicidality in this population.

METHODS

A total of 167 OEF-OIF Veterans seeking behavioral or primary care services completed a survey containing measures of combat exposure, psychopathology, pain, psychological resilience, social support, and cognitive coping strategies.

RESULTS

Thirty-six respondents (21.6%) reported contemplating suicide in the two weeks prior to completing the survey. Compared to suicide non-contemplators, suicide contemplators were older, and more likely to screen positive for depression and posttraumatic stress disorder (PTSD), and to report a deployment-related pain condition or complaint. They also scored higher on measures of worry, self-punishment, and cognitive-behavioral avoidance strategies, and lower on measures of psychological resilience and postdeployment social support. Multivariate analysis revealed that a positive depression screen, and higher scores on measures of self-punishment and cognitive-social avoidance coping were positively associated with suicidal ideation, while higher scores on measures of psychological resilience (i.e., positive acceptance of change) were negatively related to suicidal ideation. Moderator analysis revealed that a positive screen for depression or PTSD significantly diminished the protective effect of postdeployment social support on suicidal ideation.

CONCLUSIONS

1 in 5 treatment-seeking OEF-OIF Veterans may contemplate suicide. Interventions to reduce depressive symptoms, and maladaptive cognitive-behavioral coping strategies of self-punishment and cognitive social avoidance, and to bolster psychological resilience may help mitigate suicidality in this population.