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Grover LE, Williamson C, Burdett H, Palmer L, Fear NT. Level of perceived social support, and associated factors, in combat-exposed (ex-)military personnel: a systematic review and meta-analysis. Soc Psychiatry Psychiatr Epidemiol 2024:10.1007/s00127-024-02685-3. [PMID: 38771350 DOI: 10.1007/s00127-024-02685-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 05/03/2024] [Indexed: 05/22/2024]
Abstract
PURPOSE Combat deployment increases exposure to potentially traumatic events. Perceived social support (PSS) may promote health and recovery from combat trauma. This systematic review and meta-analysis aimed to synthesize studies investigating the level of PSS and associated factors among (ex-)military personnel who served in the Iraq/Afghanistan conflicts. METHODS Five electronic databases were searched in August 2023 and searches were restricted to the beginning of the Iraq/Afghanistan conflicts in 2001. The search was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A quality assessment was carried out, and a meta-analysis and narrative synthesis were performed. RESULTS In total, 35 papers consisting of 19,073 participants were included. Of these, 31 studies were conducted in the United States (US) and 23 were cross-sectional. The pooled mean PSS score was 54.40 (95% CI: 51.78 to 57.01). Samples with probable post-traumatic stress disorder had a lower mean PSS score (44.40, 95% CI: 39.10 to 49.70). Approximately half of the included studies (n = 19) investigated mental health in relation to PSS, whilst only four explored physical health. The most frequently reported risk factors for low PSS included post-traumatic stress disorder, depression and anxiety, whilst post-traumatic growth and unit support were protective factors. CONCLUSION Higher levels of PSS were generally associated with more positive psychosocial and mental health-related outcomes following deployment. PSS should be targeted in psychosocial interventions and education programmes. Future research should investigate PSS in (ex-)military personnel across other countries and cultures, based on the lack of studies that focused on PSS in countries outside of the US.
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Affiliation(s)
- Laura E Grover
- King's College London, King's Centre for Military Health Research, London, SE5 9RJ, UK.
| | - Charlotte Williamson
- King's College London, King's Centre for Military Health Research, London, SE5 9RJ, UK
| | - Howard Burdett
- King's College London, King's Centre for Military Health Research, London, SE5 9RJ, UK
| | - Laura Palmer
- King's College London, King's Centre for Military Health Research, London, SE5 9RJ, UK
| | - Nicola T Fear
- King's College London, King's Centre for Military Health Research, London, SE5 9RJ, UK
- Academic Department of Military Mental Health, King's College London, London, SE5 9RJ, UK
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2
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Sharifian N, Kolaja CA, LeardMann CA, Castañeda SF, Carey FR, Seay JS, Carlton KN, Rull RP, Cohort Study Team FTM. Racial, Ethnic, and Sex Disparities in Mental Health Among US Service Members and Veterans: Findings From the Millennium Cohort Study. Am J Epidemiol 2024; 193:500-515. [PMID: 37968361 DOI: 10.1093/aje/kwad221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 11/02/2023] [Accepted: 11/13/2023] [Indexed: 11/17/2023] Open
Abstract
Although disparities in mental health occur within racially, ethnically, and sex-diverse civilian populations, it is unclear whether these disparities persist within US military populations. Using cross-sectional data from the Millennium Cohort Study (2014-2016; n = 103,184; 70.3% male; 75.7% non-Hispanic White), a series of logistic regression analyses were conducted to examine whether racial, ethnic, and/or sex disparities were found in mental health outcomes (posttraumatic stress disorder (PTSD), depression, anxiety, and problematic anger), hierarchically adjusting for sociodemographic, military, health-related, and social support factors. Compared with non-Hispanic White individuals, those who identified as American Indian/Alaska Native, non-Hispanic Black, Hispanic/Latino, or multiracial showed greater risk of PTSD, depression, anxiety, and problematic anger in unadjusted models. Racial and ethnic disparities in mental health were partially explained by health-related and social support factors. Women showed greater risk of depression and anxiety and lower risk of PTSD than men. Evidence of intersectionality emerged for problematic anger among Hispanic/Latino and Asian or Pacific Islander women. Overall, racial, ethnic, and sex disparities in mental health persisted among service members and veterans. Future research and interventions are recommended to reduce these disparities and improve the health and well-being of diverse service members and veterans.
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3
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Moskal D, Bennett ME, Marks RM, Roche DJO. Associations among Trauma Exposure, Post-Traumatic Stress Symptoms and Alcohol Use in Black/African American Treatment-Seeking Adults. J Dual Diagn 2024; 20:5-15. [PMID: 38113919 PMCID: PMC10842739 DOI: 10.1080/15504263.2023.2286025] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2023]
Abstract
OBJECTIVE Black/African American (AA) individuals are a group at risk for co-occurring posttraumatic stress disorder (PTSD) symptoms and alcohol use due to unique cultural and system-level barriers. Although associations between trauma exposure, PTSD symptoms, and alcohol use are well established across various populations, Black/AA individuals are underrepresented in this literature, and related findings in this population are inconclusive. Thus, the goal of this study was to examine the associations among trauma exposure, PTSD symptoms, and alcohol use in a sample of treatment-seeking, Black/AA adults. We hypothesized that trauma exposure and alcohol use would be positively associated and that this relationship would be mediated by PTSD symptoms. METHODS This study conducted secondary analysis of screening data from a PTSD and alcohol use disorder clinical trial. Participants were 96 Black/AA adults (57.3% male; 2.0% Hispanic; M age = 44.73, SD = 11.83) who were seeking treatment for alcohol use and endorsed trauma exposure. Associations between trauma exposure, PTSD symptom severity, and quantity and frequency of alcohol use were tested using bivariate correlations and linear regressions. Hypothesized indirect effects were tested using IBM SPSS Statistics Version 27 PROCESS model 4 with bootstrapping. RESULTS Findings illustrated a significant positive association between trauma exposure and PTSD symptoms and between PTSD symptoms and drinks per typical drinking day. PTSD symptoms were not significantly associated with number of drinking days. Tests of indirect effects were significant for trauma exposure on drinks per typical drinking day through PTSD symptoms. CONCLUSIONS Results from the test of indirect effects suggest that among Black/AA adults with heavy alcohol use and trauma exposure, trauma exposure is associated with PTSD symptoms, which in turn is associated with quantity of alcohol use. These findings are consistent with research conducted with White/mixed groups and align with tenets of the self-medication model of PTSD-AUD comorbidity. These findings support current practices that highlight the importance of screening for and addressing PTSD and alcohol use in individuals exposed to trauma. Findings from this paper provide initial data on understudied relationships in an underserved sample and several suggestions are made to generate future research and improve clinical care for Black/AA adults. CLINICAL TRIALS REGISTRY NAME Pharmacogenetic Treatment With Anti-Glutaminergic Agents for Comorbid PTSD & AUD; ClinicalTrials.gov Identifier: NCT02884908.
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Affiliation(s)
- Dezarie Moskal
- VA Center for Integrated Healthcare, VA Western New York Healthcare System, Buffalo, New York, USA
- Department of Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo, Buffalo, New York, USA
| | - Melanie E Bennett
- VA VISN 5 Mental Illness Research, Education and Clinical Center, Baltimore VA Medical Center, Baltimore, Maryland, USA
- Department of Psychiatry, University of Maryland, Baltimore, Baltimore, Maryland, USA
| | - Russell M Marks
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Daniel J O Roche
- Department of Psychiatry, University of Maryland, Baltimore, Baltimore, Maryland, USA
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4
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Holder N, Holliday R, Ranney RM, Bernhard PA, Vogt D, Hoffmire CA, Blosnich JR, Schneiderman AI, Maguen S. Relationship of social determinants of health with symptom severity among Veterans and non-Veterans with probable posttraumatic stress disorder or depression. Soc Psychiatry Psychiatr Epidemiol 2023; 58:1523-1534. [PMID: 37173595 DOI: 10.1007/s00127-023-02478-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 03/30/2023] [Indexed: 05/15/2023]
Abstract
PURPOSE Social determinants of health (SDoH) refer to the conditions in the environments in which people live that affect health outcomes and risks. SDoH may provide proximal, actionable targets for interventions. This study examined how SDoH are associated with posttraumatic stress disorder (PTSD) and depression symptoms among Veterans and non-Veterans with probable PTSD or depression. METHODS Four multiple regressions were conducted. Two multiple regressions with Veterans examined the impact of SDoH on PTSD symptoms and on depression symptoms. Two multiple regressions with non-Veterans examined the impact of SDoH on PTSD symptoms and on depression symptoms. Independent variables included demographic characteristics, adverse experiences (in childhood and adulthood), and SDoH (discrimination, education, employment, economic instability, homelessness, justice involvement, and social support). Correlates that were statistically significant (p < 0.05) and clinically meaningful (rpart >|0.10|) were interpreted. RESULTS For Veterans, lower social support (rpart = - 0.14) and unemployment (rpart = 0.12) were associated with greater PTSD symptoms. Among non-Veterans, greater economic instability (rpart = 0.19) was associated with greater PTSD symptoms. In the depression models, lower social support (rpart = - 0.23) and greater economic instability (rpart = 0.12) were associated with greater depression for Veterans, while only lower social support was associated with greater depression for non-Veterans (rpart = - 0.14). CONCLUSION Among Veterans and non-Veterans with probable PTSD or depression, SDoH were associated with PTSD and depression symptoms, particularly social support, economic instability, and employment. Beyond direct treatment of mental health symptoms, addressing social support and economic factors such as instability and employment in the context of PTSD and depression are potential intervention targets that would benefit from future research.
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Affiliation(s)
- Nicholas Holder
- San Francisco Veterans Affairs Health Care System, 4150 Clement Street (116-P), San Francisco, CA, 94121, USA.
- University of California San Francisco, San Francisco, USA.
| | - Ryan Holliday
- Rocky Mountain Mental Illness Research, Education and Clinical Center for Suicide Prevention, Aurora, USA
- Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, USA
| | - Rachel M Ranney
- San Francisco Veterans Affairs Health Care System, 4150 Clement Street (116-P), San Francisco, CA, 94121, USA
- University of California San Francisco, San Francisco, USA
- Sierra Pacific Mental Illness Research, Education and Clinical Center, San Francisco, USA
| | - Paul A Bernhard
- Health Outcomes Military Exposures Epidemiology Program, Patient Care Services, U.S. Department of Veterans Affairs, Washington, D.C., USA
| | - Dawne Vogt
- Women's Health Sciences Division of the National Center for Posttraumatic Stress Disorder, VA Boston Healthcare System, Boston, USA
- Boston University School of Medicine, Boston, USA
| | - Claire A Hoffmire
- Rocky Mountain Mental Illness Research, Education and Clinical Center for Suicide Prevention, Aurora, USA
- Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, USA
| | - John R Blosnich
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, USA
- Center for Health Equity Research and Promotion, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, USA
| | - Aaron I Schneiderman
- Health Outcomes Military Exposures Epidemiology Program, Patient Care Services, U.S. Department of Veterans Affairs, Washington, D.C., USA
| | - Shira Maguen
- San Francisco Veterans Affairs Health Care System, 4150 Clement Street (116-P), San Francisco, CA, 94121, USA
- University of California San Francisco, San Francisco, USA
- Sierra Pacific Mental Illness Research, Education and Clinical Center, San Francisco, USA
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5
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Gross GM, Smith N, Holliday R, Rozek DC, Hoff R, Harpaz-Rotem I. Racial Disparities in Clinical Outcomes of Veterans Affairs Residential PTSD Treatment Between Black and White Veterans. Psychiatr Serv 2022; 73:126-132. [PMID: 34369806 DOI: 10.1176/appi.ps.202000783] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Racial disparities across various domains of health care are a long-standing public health issue that affect a variety of clinical services and health outcomes. Mental health research has shown that prevalence rates of posttraumatic stress disorder (PTSD) are high for Black veterans compared with White veterans, and some studies suggest poorer clinical outcomes for Black veterans with PTSD. The aim of this study was to examine the impact of racial disparities longitudinally in the U.S. Department of Veterans Affairs (VA) residential rehabilitation treatment programs (RRTPs). METHODS Participants included 2,870 veterans treated nationally in VA PTSD RRTPs in fiscal year 2017. Veterans provided demographic data upon admission to the program. Symptoms of PTSD and depression were collected at admission, discharge, and 4-month follow-up. Hierarchical linear modeling was used to examine symptom change throughout and after treatment. RESULTS Black veterans experienced attenuated PTSD symptom reduction during treatment as well as greater depression symptom recurrence 4 months after discharge, relative to White veterans. CONCLUSIONS This study adds to the body of literature that has documented poorer treatment outcomes for Black compared with White veterans with PTSD. Although both Black and White veterans had an overall reduction in symptoms, future research should focus on understanding the causes, mechanisms, and potential solutions to reduce racial disparities in mental health treatment.
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Affiliation(s)
- Georgina M Gross
- U.S. Department of Veterans Affairs Northeast Program Evaluation Center, West Haven, Connecticut (Gross, Smith, Hoff, Harpaz-Rotem); Yale University School of Medicine, New Haven, Connecticut (Gross, Smith, Hoff, Harpaz-Rotem); Rocky Mountain Mental Illness Research, Education and Clinical Center for Veteran Suicide Prevention, Aurora, Colorado (Holliday); University of Colorado Anschutz Medical Campus, Aurora (Holliday); UCF RESTORES, University of Central Florida, Orlando (Rozek)
| | - Noelle Smith
- U.S. Department of Veterans Affairs Northeast Program Evaluation Center, West Haven, Connecticut (Gross, Smith, Hoff, Harpaz-Rotem); Yale University School of Medicine, New Haven, Connecticut (Gross, Smith, Hoff, Harpaz-Rotem); Rocky Mountain Mental Illness Research, Education and Clinical Center for Veteran Suicide Prevention, Aurora, Colorado (Holliday); University of Colorado Anschutz Medical Campus, Aurora (Holliday); UCF RESTORES, University of Central Florida, Orlando (Rozek)
| | - Ryan Holliday
- U.S. Department of Veterans Affairs Northeast Program Evaluation Center, West Haven, Connecticut (Gross, Smith, Hoff, Harpaz-Rotem); Yale University School of Medicine, New Haven, Connecticut (Gross, Smith, Hoff, Harpaz-Rotem); Rocky Mountain Mental Illness Research, Education and Clinical Center for Veteran Suicide Prevention, Aurora, Colorado (Holliday); University of Colorado Anschutz Medical Campus, Aurora (Holliday); UCF RESTORES, University of Central Florida, Orlando (Rozek)
| | - David C Rozek
- U.S. Department of Veterans Affairs Northeast Program Evaluation Center, West Haven, Connecticut (Gross, Smith, Hoff, Harpaz-Rotem); Yale University School of Medicine, New Haven, Connecticut (Gross, Smith, Hoff, Harpaz-Rotem); Rocky Mountain Mental Illness Research, Education and Clinical Center for Veteran Suicide Prevention, Aurora, Colorado (Holliday); University of Colorado Anschutz Medical Campus, Aurora (Holliday); UCF RESTORES, University of Central Florida, Orlando (Rozek)
| | - Rani Hoff
- U.S. Department of Veterans Affairs Northeast Program Evaluation Center, West Haven, Connecticut (Gross, Smith, Hoff, Harpaz-Rotem); Yale University School of Medicine, New Haven, Connecticut (Gross, Smith, Hoff, Harpaz-Rotem); Rocky Mountain Mental Illness Research, Education and Clinical Center for Veteran Suicide Prevention, Aurora, Colorado (Holliday); University of Colorado Anschutz Medical Campus, Aurora (Holliday); UCF RESTORES, University of Central Florida, Orlando (Rozek)
| | - Ilan Harpaz-Rotem
- U.S. Department of Veterans Affairs Northeast Program Evaluation Center, West Haven, Connecticut (Gross, Smith, Hoff, Harpaz-Rotem); Yale University School of Medicine, New Haven, Connecticut (Gross, Smith, Hoff, Harpaz-Rotem); Rocky Mountain Mental Illness Research, Education and Clinical Center for Veteran Suicide Prevention, Aurora, Colorado (Holliday); University of Colorado Anschutz Medical Campus, Aurora (Holliday); UCF RESTORES, University of Central Florida, Orlando (Rozek)
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6
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Perez LG, Dong L, Beckman R, Meadows SO. Movement behaviors associated with mental health among US military service members. MILITARY PSYCHOLOGY 2021. [DOI: 10.1080/08995605.2021.1987084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
| | - Lu Dong
- The RAND Corporation, Santa Monica, California, USA
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7
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Bird CM, Webb EK, Schramm AT, Torres L, Larson C, deRoon-Cassini TA. Racial Discrimination is Associated with Acute Posttraumatic Stress Symptoms and Predicts Future Posttraumatic Stress Disorder Symptom Severity in Trauma-Exposed Black Adults in the United States. J Trauma Stress 2021; 34:995-1004. [PMID: 33715212 PMCID: PMC9123835 DOI: 10.1002/jts.22670] [Citation(s) in RCA: 54] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 02/16/2021] [Accepted: 02/19/2021] [Indexed: 12/20/2022]
Abstract
In the United States, Black residents exposed to a traumatic event are at an increased risk of developing posttraumatic stress disorder (PTSD) and experiencing more severe symptoms compared to their non-Hispanic White counterparts. Although previous work has suggested a link between racial discrimination and PTSD symptoms, no studies have assessed this association in a sample of traumatic injury survivors. The current study investigated whether (a) past racial discrimination was associated with acute posttraumatic stress symptoms (PTSS) and (b) discrimination prospectively contributed to the prediction of future PTSD symptoms. African American and/or Black patients (N = 113) were recruited from an emergency department in southeastern Wisconsin. Patients in the acute postinjury phase (i.e., 2 weeks posttrauma) completed self-report measures, with PTSD symptoms assessed using the Clinician-Administered PTSD Scale at 6-month follow-up. Bivariate associations indicated past racial discrimination was significantly related to acute PTSS. A multiple regression analysis revealed that pretrauma exposure to racial discrimination significantly predicted PTSD symptoms at follow-up, even after controlling for age, gender, previous psychiatric diagnosis, social support, and lifetime trauma history. Our results suggest that experiences of racial discrimination add significant additional risk for PTSD symptom development following traumatic injury, R2 = .16, F(6, 106) = 3.25, p = .006. Broadly, these findings add to the body of empirical evidence and personal testimonies of Black individuals in White-centric societies asserting that racial discrimination affects mental health and overall well-being and further highlight the recent call for racism to be classified as a public health crisis.
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Affiliation(s)
- Claire M. Bird
- Department of Psychology, Marquette University, Milwaukee, Wisconsin, USA
| | - E. Kate Webb
- Department of Psychology, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin, USA
| | - Andrew T. Schramm
- Division of Trauma and Acute Care Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Lucas Torres
- Department of Psychology, Marquette University, Milwaukee, Wisconsin, USA
| | - Christine Larson
- Department of Psychology, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin, USA
| | - Terri A. deRoon-Cassini
- Division of Trauma and Acute Care Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
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8
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Zuschlag ZD, Compean E, Nietert P, Lauzon S, Hamner M, Wang Z. Dopamine transporter (DAT1) gene in combat veterans with PTSD: A case-control study. Psychiatry Res 2021; 298:113801. [PMID: 33636518 PMCID: PMC8182484 DOI: 10.1016/j.psychres.2021.113801] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 02/07/2021] [Indexed: 10/22/2022]
Abstract
The dopamine transporter (DAT1) gene has been postulated to be involved in PTSD; however, existing studies have shown inconsistencies when examining genotypic and allelic associations. The primary objective of this study was to examine whether DAT1-40bp-VNTR (DAT1) 9R polymorphism might increase the risk of PTSD development in combat veterans, utilizing a case-control gene association study with both control and PTSD cases having previous exposure to combat traumas. Participants with PTSD (N = 365) and combat-exposed controls without PTSD (N = 298) were included in analysis. After controlling for race, sex and age, when dichotomized, absence of DAT1 10R/10R genotypes was associated with PTSD diagnosis compared to no PTSD diagnosis; these results were not statistically significant when trichotomized 10R/10R, 10R/X, 9R/9R. Similarly, odds ratio for absence of 10R/10R genotype showed a statistically significant increase in the risk of developing PTSD. DAT1 genotype was also associated with statistically significant mean total CAPS scores, both when dichotomized and trichotomized. In conclusion, our results indicate that the absence of 10R/10R is associated with an increased risk of PTSD and higher CAPS total scores.
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Affiliation(s)
- Zachary D Zuschlag
- Mental Health and Behavioral Sciences Service, James A. Haley Veterans' Hospital, Tampa, FL, USA; Department of Psychiatry and Behavioral Neurosciences, University of South Florida, Tampa, FL, USA
| | - Ebele Compean
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Paul Nietert
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC USA
| | - Steven Lauzon
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC USA
| | - Mark Hamner
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA; Mental Health Services, Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC, USA
| | - Zhewu Wang
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA; Mental Health Services, Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC, USA.
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9
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Judkins JL, Moore BA, Collette TL, Hale WJ, Peterson AL, Morissette SB. Incidence Rates of Posttraumatic Stress Disorder Over a 17-Year Period in Active Duty Military Service Members. J Trauma Stress 2020; 33:994-1006. [PMID: 32598575 DOI: 10.1002/jts.22558] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 04/16/2020] [Accepted: 04/20/2020] [Indexed: 12/17/2022]
Abstract
Posttraumatic stress disorder (PTSD) affects approximately 8% of the general population. The prevalence of PTSD is twice as high in active duty service members and military veterans. Few studies have investigated the incidence rates of PTSD in active duty military personnel. The present study evaluated the incidence of PTSD diagnoses and the differences between demographic factors for service members between 2001 and 2017. Data on 182,400 active duty service members between 2001 and 2017 were drawn from the Defense Medical Epidemiological Database and examined by sex, age, service branch, military pay grade, marital status, and race. From 2001 to 2017, the incidence rates of PTSD in the active force (per 1,000 service members) steadily climbed, with a low of 1.24 in 2002 to a high of 12.94 in 2016. Service members most often diagnosed with PTSD were in the U.S. Army, with the enlisted pay grades of E-5-E-9, White, married, male, and between 20 and 24 years old. Statistically significant differences, ps < .001, were found between observed and expected counts across all examined demographic variables. The present study is the first to our knowledge to provide a comprehensive examination of PTSD incidence rates in an active duty military population.
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Affiliation(s)
- Jason L Judkins
- Department of Psychology, The University of Texas at San Antonio, San Antonio, Texas, USA.,United States Army, 187th Medical Battalion, Medical Professional Brigade, Joint Base San Antonio Fort Sam Houston, San Antonio, Texas, USA
| | - Brian A Moore
- Department of Psychology, The University of Texas at San Antonio, San Antonio, Texas, USA.,Department of Psychiatry, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Tyler L Collette
- Department of Psychology, The University of Texas at San Antonio, San Antonio, Texas, USA
| | - Willie J Hale
- Department of Psychology, The University of Texas at San Antonio, San Antonio, Texas, USA
| | - Alan L Peterson
- Department of Psychology, The University of Texas at San Antonio, San Antonio, Texas, USA.,Department of Psychiatry, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA.,Office of Research and Development, South Texas Veterans Health Care System, San Antonio, Texas, USA
| | - Sandra B Morissette
- Department of Psychology, The University of Texas at San Antonio, San Antonio, Texas, USA
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10
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Tam CC, Zeng C, Li X. Prescription opioid misuse and its correlates among veterans and military in the United States: A systematic literature review. Drug Alcohol Depend 2020; 216:108311. [PMID: 33010713 DOI: 10.1016/j.drugalcdep.2020.108311] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Revised: 08/20/2020] [Accepted: 09/15/2020] [Indexed: 12/25/2022]
Abstract
BACKGROUND Prescription opioid misuse (POM) has become a critical public health issue in the United States (US), with veteran and military population being especially vulnerable to POM. However, limited behavioral interventions have been developed for veterans and military to reduce POM risk due to the lack of an adequate understanding of POM andrelated factors among veterans and military. The current study aims to review and synthesize empirical findings regarding POM and its correlates among US veterans and military. METHODS We conducted a systematic review of 17 empirical studies (16 quantitative studies and one qualitative study) from 1980 to 2019 that reported POM statistics (e.g., prevalence) and examined correlates of POM in veterans and military. RESULTS The prevalence of POM in veterans and military ranged from 6.9%-77.9% varying by study samples, individual POM behaviors, and recalled time periods. Several factors were identified to be associated with POM in veterans and military. These factors included socio-demographic factors (age, race/ethnicity, education, relationship status, and military status), pain-related factors (pain symptoms, severity, interference, and cognitions), other physical factors (e.g., common illness), opioid-medication-related factors (receipt of opioid medications and quantity of opioid medications), behavioral factors (substance use disorder, alcohol use, cigarette use, and other prescription drug use), and psychological factors (psychiatric symptoms and cognitive factors). CONCLUSIONS POM was prevalent in veterans and military and could be potentially influenced by multiple psycho-behavioral factors. Future research guided by a theoretical framework is warranted to examine psycho-behavioral influences on POM and their mechanisms and to inform effective psychosocial POM interventions in veterans and military.
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Affiliation(s)
- Cheuk Chi Tam
- South Carolina SmartState Center for Healthcare Quality, Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Discovery I, 915 Greene Street, Columbia, SC, 29208, USA.
| | - Chengbo Zeng
- South Carolina SmartState Center for Healthcare Quality, Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Discovery I, 915 Greene Street, Columbia, SC, 29208, USA
| | - Xiaoming Li
- South Carolina SmartState Center for Healthcare Quality, Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Discovery I, 915 Greene Street, Columbia, SC, 29208, USA
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11
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Herbert MS, Hernandez J, Dochat C, Pittman JOE, Afari N. Ethnic Differences in the Association Between Pain and Social Support in Iraq and Afghanistan Veterans. PAIN MEDICINE 2020; 21:3066-3072. [PMID: 32022888 DOI: 10.1093/pm/pnz374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Although past research has identified differences in pain between non-Latino white (NLW) and Latino persons, few studies have focused on the influence of social support. The purpose of the present study was to determine if the association between the number of social support sources and ratings of pain intensity and pain interference differed as a function of ethnicity. DESIGN Cross-sectional. SETTING Veterans Affairs San Diego Healthcare System. SUBJECTS Participants were NLW (N = 389) and Latino (N = 207) Iraq and Afghanistan veterans. METHODS Linear regression analyses were used to examine the interaction between ethnicity and number of social support sources on pain intensity and pain interference as measured by the Patient-Reported Outcomes Measurement Information System pain inventory. RESULTS The association between number of social support sources and pain intensity and interference significantly differed by ethnicity (P < 0.01 and P = 0.01, respectively). Among NLW veterans, there was a significant negative association between number of social support sources and pain intensity. Among Latino veterans, there was a significant positive association between number of social support sources and pain intensity and interference. CONCLUSIONS These findings suggest important differences between NLW and Latino Iraq and Afghanistan veterans in the association between social support and pain. Future research should examine ethnic differences in pain-specific support received from the social environment.
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Affiliation(s)
- Matthew S Herbert
- VA San Diego Healthcare System, San Diego, California.,Center of Excellence for Stress and Mental Health (CESAMH), San Diego, California.,Department of Psychiatry, University of California, San Diego, California
| | | | - Cara Dochat
- San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology, San Diego, California, USA
| | - James O E Pittman
- VA San Diego Healthcare System, San Diego, California.,Center of Excellence for Stress and Mental Health (CESAMH), San Diego, California.,Department of Psychiatry, University of California, San Diego, California
| | - Niloofar Afari
- VA San Diego Healthcare System, San Diego, California.,Center of Excellence for Stress and Mental Health (CESAMH), San Diego, California.,Department of Psychiatry, University of California, San Diego, California
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12
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Gaffey AE, Aranda F, Burns JW, Purim-Shem-Tov YA, Burgess HJ, Beckham JC, Bruehl S, Hobfoll SE. Race, psychosocial vulnerability and social support differences in inner-city women's symptoms of posttraumatic stress disorder. ANXIETY, STRESS, AND COPING 2019; 32:18-31. [PMID: 30306795 PMCID: PMC6269211 DOI: 10.1080/10615806.2018.1532078] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
BACKGROUND/OBJECTIVES Inner-city Black women may be more susceptible to posttraumatic stress disorder (PTSD) than White women, although mechanisms underlying this association are unclear. Living in urban neighborhoods distinguished by higher chronic stress may contribute to racial differences in women's cognitive, affective, and social vulnerabilities, leading to greater trauma-related distress including PTSD. Yet social support could buffer the negative effects of psychosocial vulnerabilities on women's health. METHODS/DESIGN Mediation and moderated mediation models were tested with 371 inner-city women, including psychosocial vulnerability (i.e., catastrophizing, anger, social undermining) mediating the pathway between race and PTSD, and social support moderating psychosocial vulnerability and PTSD. RESULTS Despite comparable rates of trauma, Black women reported higher vulnerability and PTSD symptoms, and lower support compared to White Hispanic and non-Hispanic women. Psychosocial vulnerability mediated the pathway between race and PTSD, and social support moderated vulnerability, reducing negative effects on PTSD. When examining associations by race, the moderation effect remained significant for Black women only. CONCLUSIONS Altogether these psychosocial vulnerabilities represent one potential mechanism explaining Black women's greater risk of PTSD, although cumulative psychosocial vulnerability may be buffered by social support. Despite higher support, inner-city White women's psychosocial vulnerability may actually outweigh support's benefits for reducing trauma-related distress.
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Affiliation(s)
- Allison E. Gaffey
- Yale School of Medicine, Department of Internal Medicine 330 Cedar Street, New Haven, CT 06520
| | - Frances Aranda
- Rush University Medical Center, Dept. of Behavioral Sciences, 1645 W. Jackson Blvd., Ste. 400, Chicago, IL 60612
| | - John W. Burns
- Rush University Medical Center, Dept. of Behavioral Sciences, 1645 W. Jackson Blvd., Ste. 400, Chicago, IL 60612
| | - Yanina A. Purim-Shem-Tov
- Rush University Medical Center, Dept. of Emergency Medicine, 1653 W. Congress Parkway, Chicago, IL 60612
| | - Helen J. Burgess
- Rush University Medical Center, Dept. of Behavioral Sciences, 1645 W. Jackson Blvd., Ste. 400, Chicago, IL 60612
| | - Jean C. Beckham
- Department of Psychiatry, Duke University School of Medicine, 40 Duke Medicine Circle, Durham, NC 27710
- Durham Veterans Affairs Health System, 508 Fulton St, Durham, NC 27705
| | - Stephen Bruehl
- Department of Anesthesiology, Vanderbilt University Medical Center, 1211 Medical Center Drive, Nashville, TN 37232
| | - Stevan E. Hobfoll
- Rush University Medical Center, Dept. of Behavioral Sciences, 1645 W. Jackson Blvd., Ste. 400, Chicago, IL 60612
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13
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Zang Y, Gay NG, Kaczkurkin AN, McLean CP, Wachen JS, Yarvis JS, Litz BT, Yadin E, Mintz J, Roache JD, Young-McCaughan S, Peterson AL, Foa EB, Resick PA. Factor Structure and Psychometric Properties of the Peritraumatic and Posttraumatic Emotions Questionnaires Among Active Duty Military Personnel With Posttraumatic Stress Disorder. J Trauma Stress 2018; 31:826-836. [PMID: 30548330 DOI: 10.1002/jts.22350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Revised: 07/18/2018] [Accepted: 08/10/2018] [Indexed: 11/11/2022]
Abstract
The Peritraumatic Emotions Questionnaire (Peri-TEQ) and Posttraumatic Emotions Questionnaire (Post-TEQ) are self-report measures of emotions experienced during and after a traumatic event, respectively. The factor structure and psychometric properties of the Peri- and Post-TEQ were investigated among 474 military personnel with posttraumatic stress disorder (PTSD) following deployment. Exploratory factor analysis and confirmatory factor analysis were conducted to test the factor structure of the scales. Internal consistency, composite reliability, convergent validity, and discriminant validity were also assessed. Four factors were identified for the Peri-TEQ (Fear, Humiliation, Anger, and Sadness), and three factors were identified for the Post-TEQ (Fear, Anger-Hurt, and Humiliation). The full scales and all subscales demonstrated adequate-to-good internal consistency, Cronbach's αs = .722-.893. The subscales demonstrated adequate-to-good composite reliability, Cronbach's αs = .763-.861. The Peri- and Post-TEQ demonstrated good convergent validity with measures of PTSD symptoms, rs = .229-.601, ps < .001, and depressive symptoms, rs = .284-.470, ps < .001, and good discriminate validity with measures of resilience, ps = .116-.940, and unit cohesion, Peri-TEQ, p = .304 and Post-TEQ, r = -.123, p = .008. The Humiliation subscales demonstrated good convergent validity with guilt cognitions, rs = .315-.341, ps < .001, and the Anger subscales demonstrated good convergent validity with state anger, rs = .260-.347, ps < .001. The Peri- and Post-TEQ are reliable, valid self-report measures of emotions during and in response to remembering a trauma. The results support the use of these measures in research investigating trauma-related emotions.
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Affiliation(s)
- Yinying Zang
- Department of Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Natalie G Gay
- Department of Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Antonia N Kaczkurkin
- Department of Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Carmen P McLean
- Department of Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jennifer Schuster Wachen
- National Center for PTSD, VA Boston Healthcare System, Boston, Massachusetts, USA.,Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Jeffrey S Yarvis
- Department of Behavioral Health, Carl R. Darnall Army Medical Center, Fort Hood, Texas, USA
| | - Brett T Litz
- Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts, USA.,Massachusetts Veterans Epidemiological Research Center, VA Boston Healthcare System, Boston, Massachusetts
| | - Elna Yadin
- Department of Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jim Mintz
- Department of Epidemiology and Biostatistics, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA.,Department of Psychiatry, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - John D Roache
- Department of Psychiatry, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Stacey Young-McCaughan
- Department of Psychiatry, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Alan L Peterson
- Department of Psychiatry, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA.,Research and Development Service, South Texas Veterans Health Care System, San Antonio, Texas, USA
| | - Edna B Foa
- Department of Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Patricia A Resick
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina, USA
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14
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Herbert MS, Leung DW, Pittman JOE, Floto E, Afari N. Race/ethnicity, psychological resilience, and social support among OEF/OIF combat veterans. Psychiatry Res 2018; 265:265-270. [PMID: 29763847 DOI: 10.1016/j.psychres.2018.04.052] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Revised: 03/12/2018] [Accepted: 04/28/2018] [Indexed: 11/19/2022]
Abstract
This study examined the relationship between race/ethnicity and psychological resilience, and the moderating role of social support in this relationship among non-Hispanic White (n = 605), Hispanic (n = 107), African American (n = 141), and Asian American (n = 97) Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF) combat veterans. Veterans were primarily male (88%) with a mean age of 31.4 years (SD = 8.35). An analysis of covariance showed that Asian American veterans reported significantly lower psychological resilience than non-Hispanic White veterans. The interaction of race/ethnicity and social support with psychological resilience was examined via linear regression. We found that the relationship between psychological resilience and social support significantly differed by race/ethnicity such that social support was positively associated with psychological resilience among non-Hispanic White veterans, but not among other racial/ethnic groups. Our findings are consistent with previous studies that show Asian American veterans report lower psychological resilience than non-Hispanic White veterans. Cultural differences in how and why individuals use social support may underlie racial/ethnic differences in the relationship between social support and psychological resilience. Future qualitative and quantitative research is encouraged to better understand how social support relates to psychological resilience among minority OEF/OIF combat veterans.
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Affiliation(s)
- Matthew S Herbert
- Center of Excellence for Stress and Mental Health (CESAMH) San Diego, CA USA; VA San Diego Healthcare System, University of California, San Diego, CA, USA; Department of Psychiatry, University of California, San Diego, CA USA
| | - Desmond W Leung
- Baruch College & The Graduate Center, City University of New York, NY USA
| | - James O E Pittman
- Center of Excellence for Stress and Mental Health (CESAMH) San Diego, CA USA; VA San Diego Healthcare System, University of California, San Diego, CA, USA; Department of Psychiatry, University of California, San Diego, CA USA
| | - Elizabeth Floto
- Center of Excellence for Stress and Mental Health (CESAMH) San Diego, CA USA; VA San Diego Healthcare System, University of California, San Diego, CA, USA; Department of Psychiatry, University of California, San Diego, CA USA
| | - Niloofar Afari
- Center of Excellence for Stress and Mental Health (CESAMH) San Diego, CA USA; VA San Diego Healthcare System, University of California, San Diego, CA, USA; Department of Psychiatry, University of California, San Diego, CA USA.
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