Pathways to the All-Volunteer Military

Prison Adjustment Among Military Veterans: The Impact of Traumatic Events, Service History, and PTSD

Military veterans have been shown to differ demographically from non-veterans in the criminal justice system. However, relatively little is known about their psychological adjustment, institutional misbehavior, and the efficacy of programing received while incarcerated. Using data taken from a national sample of prison inmates, this study investigates how traumatic events experienced during military service can impact the intensity of negative affect among veterans. Additionally, we examine whether prison misconduct is influenced by military service history and the receipt of substance abuse treatment. Controlling for a host of relevant variables, our results indicate that traumatic events show a significant effect on psychological adjustment only indirectly through veterans who developed post-traumatic stress disorder and that misconduct is lower among those who received an honorable discharge. Overall, these findings suggest that the ability of veterans to resist adverse outcomes may depend on a variety of factors both within and outside the prison environment.

Do early responders and treatment non-responders offer guidance to make CPT group a more effective treatment?

BACKGROUND

Treatment dropout has been problematic with evidence-based treatments for posttraumatic stress disorder (PTSD), including cognitive processing therapy (CPT). This study sought to evaluate whether CPT group contributed to symptom improvement among treatment completers and non-completers.

METHODS

Sixty-one Iraq and Afghanistan combat Veterans self-selected CPT group or treatment as usual (TAU) forming a convenience sample. Defining treatment completion as attending at least nine sessions: 18 completed treatment, 20 dropped-out (DOs); 20 completed TAU, 3 lost to TAU follow-up.

RESULTS

Multiple Regression revealed significant pre-post-treatment improvement, the Clinician-Administered PTSD Scale (CAPS-IV, F(5, 40.1) = 2.53, p = 0.0436). Reviewing DOs' last available PTSD Checklist-Military Version scores before leaving treatment, six achieved clinically significant improvement of >10 points; seven a clinically reliable change of 5-10 points.

CONCLUSION

These findings highlight that CPT group may be effective at reducing trauma-related symptoms among treatment completers and dropouts and point to the utility of a clinical definition of good treatment end-state.

Geographically based risk assessment of sleep disorders and disease states impacting medical readiness across active duty army installations from military medical databases in fiscal year 2017

BACKGROUND

The impact of sleep disorders on active duty Soldiers' medical readiness is clinically significant. Sleep disorders often present high comorbidity with disease states impacting readiness ranging from obesity and drug dependence. Patient data generated from military health databases can be accessed to examine such relationships. The current study performed a risk assessment of sleep disorders, obesity, tobacco use, and substance abuse based on geographical distribution of active duty Army installations through a comprehensive analysis of the Office of the Army Surgeon General Health of the Force report, specifically for Fiscal Year 2017, which summarizes data collected during 2016.

METHODS

Health incidences (percent active duty per installation) were queried from the Health of the Force Fiscal Year 2017 (n = 471,000; 85.5% male, >70% between 18 and 34). Nonparametric ranked tests identified active duty Army installations at low risk (green; <25% percentile relative to mean rank), moderate risk (amber; 25%-50% percentile relative to mean rank), and high risk (red; >75% percentile relative to mean rank). Pearson's correlations determined extent of generalized comorbidity of sleep disorders with obesity, tobacco use, and substance abuse across all installations.

RESULTS

Large combat arms and training installations of the Southern U.S. were at highest risk for sleep disorder. Mean rank comparisons for sleep disorders versus obesity (P = .306), tobacco use (P = .378), and substance abuse (P = .591) did not differ for each installation. There was a high degree of generalized comorbidity of diagnosed sleep disorder with obesity (P < .001; r² = 0.963), tobacco use (P < .001; r² = 0.928), and substance abuse (P < .001; r² = 0.968).

CONCLUSIONS

These risk assessments mirror geographical risk data from civilian populations which is surprising because there is a large degree of inter-individual variability in geographical origin, race/ethnicity, and socioeconomic statuses within a single Army installation. Nevertheless, these data demonstrate strong geographical influences on medical readiness in active duty Soldiers comparable to civilian sectors.

Psychological Problems among 12th-Grade Students Predicting Military Enlistment: Findings from the Monitoring the Future Survey

Objective: Rates of some psychological disorders are higher among enlisted U.S. military personnel than socio-demographically matched civilians. Indirect evidence suggests some internalizing and externalizing psychological problems among enlistees onset prior to enlistment. However, the consistency and strength of the associations between pre-enlistment psychological problems and enlistment over time is unknown. We address this uncertainty by examining whether internalizing and externalizing problems in high school predicted subsequent military enlistment using a large cohort-sequential panel study. Method: The Monitoring the Future study administered baseline surveys from 1989-2014 and biennial follow-up surveys two and four years later to national samples of high-school seniors (N = 20,823). Validated self-report scales assessed internalizing (depression, low self-esteem) and externalizing (risk-taking, school misbehavior, conduct disorder, interpersonal violence, alcohol, and drug use) problems in each survey. Follow-up surveys assessed military enlistment. Logistic regression models were used to estimate associations of problems scales with subsequent enlistment. Results: School misbehavior in 12th grade, and risk-taking in 12th grade and two years after graduation were associated with significantly elevated odds of enlistment at follow-up. Although modest, these associations were linear and invariant across respondent sex and baseline survey year. Conclusions: School misbehavior and risk-taking predicted subsequent enlistment and there was no evidence of historical changes in these associations over the course of 25 years; these pre-enlistment psychological problems do not fully explain the high rates of psychological disorders among enlisted military personnel. Further research is needed to determine whether these predictors are associated with negative outcomes during or after military service.

The Predictive Value of Early-Life Trauma, Psychopathy, and the Testosterone-Cortisol Ratio for Impulsive Aggression Problems in Veterans

Background

In this study, we examined whether early-life trauma, psychopathy, and the testosterone/cortisol ratio predicted impulsive aggression problems in veterans.

Method

A sample of 49 male veterans with impulsive aggression problems and 51 nonaggressive veterans were included in the study. Logistic regression analysis was performed with early-life trauma, primary and secondary psychopathy, and testosterone/cortisol ratio as continuous predictor variables; impulsive aggression status was entered as a binary outcome measure. Correlation analyses were conducted to examine pairwise relations among the predictors.

Results

Results indicated that early-life trauma and secondary psychopathy, but not the testosterone/cortisol ratio or primary psychopathy, were significant predictors of impulsive aggression status.

Conclusions

The current results indicate that early-life trauma and secondary psychopathy are risk factors for impulsive aggression problems among veterans. Future studies are needed to determine the exact causal relations among the variables examined here.

Reasons Why Post–9/11 Era Veterans Continue to Volunteer After Their Military Service

A myriad reasons exist as to why individuals volunteer to serve in the U.S. military. However, less is known about why these same veterans who have returned home choose to serve again in their communities. We aim to describe the lived experience of post–9/11 era veterans who shared their reasons for joining a civic service program after the completion of their military service. Narrative data from an observationally designed study of veterans ( N = 346) who completed a leadership and civic service program administered by a national nonprofit, was qualitatively analyzed. Findings reveal 15 distinct personal and professional reasons why veterans engage in civic service following the completion of their military service, with 84% of the veteran sample reporting wanting to continue to serve while 41% reporting that participating would aid in their employment transition from military to civilian life. Other personal reasons include wanting a sense of purpose (20%) and wanting to integrate and participate in a community (20%). The motivation to continue to serve is strong among those who have served in the military and offers implications for conducting research with community-based and federal programs for veterans, military service members, and their communities.

The Role of Maternal Relationship in the Persisting Effect of Combat Exposure

Background and Objectives

The veteran population is aging. Combat exposure is associated with negative health and psychological outcomes in some, but not all veterans; others even appear to experience gains. One mechanism driving these varied responses might be early life relationships. This study investigated the extent to which the quality of early maternal relationships influences the association between combat exposures and life satisfaction (LS) among older male veterans.

Research Design and Methods

Data were drawn from a pooled sample of male veterans in the Health and Retirement Study who completed the 2013 Veteran Mail Survey (N = 1,160). We used ordinary least squares regression to examine the association between combat exposures (with and without exposure to death) and LS, and the moderating effect of maternal relationship quality on this association.

Results

We found a significant positive association between maternal relationship quality and LS, and a significant association of combat that was dependent on maternal relationship quality. Specifically, combat-exposed veterans with poor maternal relationship quality reported lower LS, whereas combat-exposed veterans with high relationship quality reported higher LS—relative to their noncombat-exposed counterparts. The effects of exposure to death of hazardous toxins did not mediate or moderate this relationship.

Discussion and Implications

Findings indicate that maternal relationships had a lasting influence on whether combat contributed to a positive, negative, or neutral long-term effect on wellbeing. Findings support previous studies that suggest early life factors may play an important role in the fostering of resilient health outcomes over the life course. Implications for preventative strategies in soldiers are discussed.

The Influence of Men's Military Service on Smoking Across the Life Course

The military is described as a social context that contributes to the (re-)initiation or intensification of cigarette smoking. We draw on data from the 1985-2014 National Survey of Drug Use and Health (NSDUH) and the Wisconsin Longitudinal Study (WLS) to conduct complementary sub-studies of the influence of military service on men's smoking outcomes across the life course. Descriptive findings from an age-period-cohort analysis of NSDUH data document higher probabilities of current smoking and heavy smoking among veteran men across a broad range of cohorts and at all observed ages. Findings from sibling fixed-effects Poisson models estimated on the WLS data document longer durations of smoking among men who served in the military and no evidence that selection explains the observed relationship. Together, these results provide novel and potentially generalizable evidence that participation in the military in early adulthood exerts a causal influence on smoking across the life course.

Altering the life course: Military service and contact with the criminal justice system

Using data taken from the 1997 National Longitudinal Survey of Youth, we examine the relationship between military service and contact with the criminal justice system. Drawing on the life course concept of a turning point, we show that military service does little to affect the risk of being arrested or being convicted of crimes involving violence or destructive behavior, while at the same time significantly reducing the risk of being arrested or being convicted of non-violent crimes. We find no evidence that service in a combat zone alters these relationships. Our results demonstrate how participation in a large-scale institution can serve as a turning point, altering the life course trajectories of young persons.

The role of public health in the prevention of war: rationale and competencies

In 2009 the American Public Health Association approved the policy statement, "The Role of Public Health Practitioners, Academics, and Advocates in Relation to Armed Conflict and War." Despite the known health effects of war, the development of competencies to prevent war has received little attention. Public health's ethical principles of practice prioritize addressing the fundamental causes of disease and adverse health outcomes. A working group grew out of the American Public Health Association's Peace Caucus to build upon the 2009 policy by proposing competencies to understand and prevent the political, economic, social, and cultural determinants of war, particularly militarism. The working group recommends that schools of public health and public health organizations incorporate these competencies into professional preparation programs, research, and advocacy.

Delinquent behavior, the transition to adulthood, and the likelihood of military enlistment

Using data taken from the 1997 National Longitudinal Survey of Youth we examine the relationship between delinquency and enlistment in the military. We argue that delinquent behavior is positively related to enlistment because military service is an attractive alternative for delinquents to mark their transition to adulthood and their desistance from delinquent behavior. We also argue, however, that this relationship is not linear, with higher levels of delinquent behavior actually acting to reduce the likelihood of enlistment. We further suggest that the relationship between delinquency and enlistment is similar for men and women. We test and find support for our hypotheses using data taken from the 1997 National Longitudinal Survey of Youth.

Does Adolescent Family Structure Predict Military Enlistment? A Comparison of Post-High School Activities

This paper investigates the link between adolescent family structure and the likelihood of military enlistment in young adulthood, as compared to alternative post-high school activities. We use data from the National Longitudinal Study of Adolescent Health and multinomial logistic regression analyses to compare the odds of military enlistment with college attendance or labor force involvement. We find that alternative family structures predict enlistment relative to college attendance. Living in a single-parent household during adolescence increased odds of military enlistment, but the effect is accounted for by socioeconomic status and early feelings of social isolation. Living with a stepparent or with neither biological parent more than doubles the odds of enlistment, independent of socioeconomic status, characteristics of parent-child relationships, or feelings of social isolation. Although college attendance is widely promoted as a valued post-high school activity, military service may offer a route to independence and a greater sense of belonging.

The psychological costs of war: military combat and mental health

We exploit plausibly exogenous variation in overseas deployment assignment to estimate the effect of combat exposure on psychological well-being. Controlling for pre-deployment mental health, we find that active-duty soldiers deployed to combat zones are more likely to suffer from post-traumatic stress disorder (PTSD) than their counterparts deployed outside the United States in non-combat zones. Among those deployed to combat zones, those deployed to locales where they engage in enemy firefight or witness allied or civilian deaths are at an increased risk for suicidal ideation and PTSD relative to their active-duty counterparts deployed to combat zones without enemy firefight.

Status Configurations, Military Service and Higher Education

The U.S. Armed Forces offer educational and training benefits as incentives for service. This study investigates the influence of status configurations on military enlistment and their link to greater educational opportunity. Three statuses (socioeconomic status of origin, cognitive ability and academic performance) have particular relevance for life course options. We hypothesize that young men with inconsistent statuses are more likely to enlist than men with consistent status profiles, and that military service improves access to college for certain configurations. Analyses of the National Longitudinal Study of Adolescent Health (Add Health) show (1. that several status configurations markedly increased the likelihood of military enlistment and (2. within status configurations, recruits were generally more likely to enroll in higher education than nonveterans, with associate degrees being more likely.

Military Training and Personality Trait Development

Military experience is an important turning point in a person’s life and, consequently, is associated with important life outcomes. Using a large longitudinal sample of German males, we examined whether personality traits played a role during this period. Results indicated that personality traits prospectively predicted the decision to enter the military. People lower in agreeableness, neuroticism, and openness to experience during high school were more likely to enter the military after graduation. In addition, military training was associated with changes in personality. Compared with a control group, military recruits had lower levels of agreeableness after training. These levels persisted 5 years after training, even after participants entered college or the labor market. This study is one of the first to identify life experiences associated with changes in personality traits. Moreover, our results suggest that military experiences may have a long-lasting influence on individual-level characteristics.