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Verfaellie M, Patt V, Lafleche G, Strang C, Vasterling JJ. Future thinking in PTSD: Preliminary evidence for altered event construction. Psychiatry Res 2024; 333:115768. [PMID: 38325161 PMCID: PMC10901291 DOI: 10.1016/j.psychres.2024.115768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 01/04/2024] [Accepted: 01/30/2024] [Indexed: 02/09/2024]
Abstract
Using a future event fluency task, the current study sought to examine future event construction in PTSD and to identify clinical profiles associated with altered event construction. Thirty-eight trauma exposed war-zone veterans with (n=25) and without (n=13) PTSD generated within one minute as many positive and negative future events as possible in the near and distant future. The PTSD group generated fewer specific, but not generic, events than the no-PTSD group, a difference that was amplified for positive events as a result of comorbid depression. Clinical correlates of event construction varied as a function of event valence.
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Affiliation(s)
- Mieke Verfaellie
- Memory Disorders Research Center, VA Boston Healthcare System, Boston MA, USA; Department of Psychiatry, Boston University Chobanian and Avedisian School of Medicine, Boston MA, USA.
| | - Virginie Patt
- Memory Disorders Research Center, VA Boston Healthcare System, Boston MA, USA
| | - Ginette Lafleche
- Memory Disorders Research Center, VA Boston Healthcare System, Boston MA, USA
| | - Caroline Strang
- Memory Disorders Research Center, VA Boston Healthcare System, Boston MA, USA
| | - Jennifer J Vasterling
- National Center for PTSD, VA Boston Healthcare System, Boston MA, USA; Department of Psychiatry, Boston University Chobanian and Avedisian School of Medicine, Boston MA, USA
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2
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Verfaellie M, Patt V, Lafleche G, Hunsberger R, Vasterling JJ. Correction to: Imagining emotional future events in PTSD: clinical and neurocognitive correlates. Cogn Affect Behav Neurosci 2024; 24:184-185. [PMID: 38040864 DOI: 10.3758/s13415-023-01141-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/03/2023]
Affiliation(s)
- Mieke Verfaellie
- Memory Disorders Research Center, VA Boston Healthcare System (182 MDRC), 150 S Huntington Avenue, Boston, MA, 02130, USA.
- Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA.
| | - Virginie Patt
- Memory Disorders Research Center, VA Boston Healthcare System (182 MDRC), 150 S Huntington Avenue, Boston, MA, 02130, USA
| | - Ginette Lafleche
- Memory Disorders Research Center, VA Boston Healthcare System (182 MDRC), 150 S Huntington Avenue, Boston, MA, 02130, USA
| | - Renee Hunsberger
- Memory Disorders Research Center, VA Boston Healthcare System (182 MDRC), 150 S Huntington Avenue, Boston, MA, 02130, USA
| | - Jennifer J Vasterling
- Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA
- National Center for PTSD, VA Boston Healthcare System, Boston, MA, USA
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3
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Verfaellie M, Patt V, Lafleche G, Hunsberger R, Vasterling JJ. Imagining emotional future events in PTSD: clinical and neurocognitive correlates. Cogn Affect Behav Neurosci 2023; 23:1428-1444. [PMID: 37700143 PMCID: PMC10592365 DOI: 10.3758/s13415-023-01121-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/10/2023] [Indexed: 09/14/2023]
Abstract
Emotional future thinking serves important functions related to goal pursuit and emotion regulation but has been scantly studied in posttraumatic stress disorder (PTSD). The current study sought to characterize emotional future thinking in PTSD and to identify clinical and neurocognitive profiles associated with potential alterations in the level of detail in narratives of imagined future events. Fifty-eight, trauma-exposed, war-zone veterans, who were classified into current PTSD, past PTSD, and no-PTSD groups, were asked to vividly imagine future events in response to positive and negative cue words occurring in the near and distant future. These narratives were scored for internal (i.e., pertaining to the main event) and external (i.e., tangential to the main event) details. Participants also performed neurocognitive tasks of generative ability, working memory, and relational verbal memory. Linear mixed modeling revealed that the current and past PTSD groups generated fewer internal details than the no-PTSD group across positive and negative cue words and across temporal proximity. Partial least squares analysis revealed that symptom severity for all PTSD clusters was inversely associated with production of internal details, albeit with the association relatively weaker for intrusion symptoms. Among the neurocognitive tasks, only relational verbal memory was associated with production of internal details. These findings suggest, as predicted, that functional avoidance may underlie reduced detail generation but also point to potential additional mechanisms to be further investigated. That future event simulation remains overgeneral even when PTSD symptoms abate highlights the importance of addressing alterations in future thinking in this population.
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Affiliation(s)
- Mieke Verfaellie
- Memory Disorders Research Center, VA Boston Healthcare System (182 MDRC), 150 S Huntington Avenue, Boston, MA, 02130, USA.
- Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA.
| | - Virginie Patt
- Memory Disorders Research Center, VA Boston Healthcare System (182 MDRC), 150 S Huntington Avenue, Boston, MA, 02130, USA
| | - Ginette Lafleche
- Memory Disorders Research Center, VA Boston Healthcare System (182 MDRC), 150 S Huntington Avenue, Boston, MA, 02130, USA
| | - Renee Hunsberger
- Memory Disorders Research Center, VA Boston Healthcare System (182 MDRC), 150 S Huntington Avenue, Boston, MA, 02130, USA
| | - Jennifer J Vasterling
- Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA
- National Center for PTSD, VA Boston Healthcare System, Boston, MA, USA
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Vasterling JJ, Franz MR, Lee LO, Kaiser AP, Proctor SP, Marx BP, Schnurr PP, Ko J, Concato J, Aslan M. Early predictors of chronic posttraumatic stress disorder symptom trajectories in U.S. Army soldiers deployed to the Iraq war zone. J Trauma Stress 2023; 36:955-967. [PMID: 37608526 DOI: 10.1002/jts.22964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 05/09/2023] [Accepted: 06/12/2023] [Indexed: 08/24/2023]
Abstract
The course of posttraumatic stress disorder (PTSD) symptoms varies among veterans of war zones, but sources of variation in long-term symptom course remain poorly understood. Modeling of symptom growth trajectories facilitates the understanding of predictors of individual outcomes over time. Although growth mixture modeling (GMM) has been applied to military populations, few studies have incorporated both predeployment and follow-up measurements over an extended time. In this prospective study, 1,087 U.S. Army soldiers with varying military occupational specialties and geographic locations were assessed before and after deployment to the Iraq war zone, with long-term follow-up assessment occurring at least 5 years after return from deployment. The primary outcome variable was the PTSD Checklist-Civilian Version summary score. GMM yielded four latent profiles, characterized as primarily asymptomatic (n = 194, 17.8%); postdeployment worsening symptoms (n = 84, 7.7%); mild symptoms (n = 320, 29.4%); and preexisting, with a chronic postdeployment elevation of symptoms (n = 489, 45.0%). Regression models comparing the primarily asymptomatic class to the symptomatic classes revealed that chronic symptom classes were associated with higher degrees of stress exposure, less predeployment social support, military reservist or veteran status at the most recent assessment, and poorer predeployment visual memory, ORs = 0.98-2.90. PTSD symptom course varies considerably over time after military deployment and is associated with potentially modifiable biopsychosocial factors that occur early in its course in addition to exposures and military status.
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Affiliation(s)
- Jennifer J Vasterling
- National Center for PTSD, VA Boston Healthcare System, Boston, Massachusetts, USA
- Department of Psychiatry, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
| | - Molly R Franz
- Department of Psychology, University of Maryland, Baltimore County, Baltimore, Maryland, USA
| | - Lewina O Lee
- National Center for PTSD, VA Boston Healthcare System, Boston, Massachusetts, USA
- Department of Psychiatry, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
| | - Anica Pless Kaiser
- National Center for PTSD, VA Boston Healthcare System, Boston, Massachusetts, USA
- Department of Psychiatry, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
| | - Susan P Proctor
- US Army Research Institute of Environmental Medicine, Natick, Massachusetts, USA
- Research Service, VA Boston Healthcare System, Boston, Massachusetts, USA
| | - Brian P Marx
- National Center for PTSD, VA Boston Healthcare System, Boston, Massachusetts, USA
- Department of Psychiatry, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
| | - Paula P Schnurr
- National Center for PTSD, White River Junction, Vermont, USA
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
| | - John Ko
- Clinical Epidemiology Research Center, VA Cooperative Studies Program, West Haven, Connecticut, USA
| | - John Concato
- Department of Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
- Center for Drug Evaluation and Research, Food and Drug Administration, Silver Spring, Maryland, USA
| | - Mihaela Aslan
- Clinical Epidemiology Research Center, VA Cooperative Studies Program, West Haven, Connecticut, USA
- Department of Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
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Chiu C, Gnall K, Kaiser AP, Taft CT, Franz MR, Lee LO, Vasterling JJ. Neurocognitive Performance Predicts Future Partner Violence Among U.S. Iraq-and Afghanistan-deployed Army Soldiers and Veterans. Psychol Violence 2022; 12:160-169. [PMID: 38463935 PMCID: PMC10923519 DOI: 10.1037/vio0000408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/12/2024]
Abstract
Objective Intimate partner violence (IPV) constitutes a major U.S. national health concern and disproportionately affects military families. Prior research, which has been conducted primarily in civilian populations, suggests that relative neurocognitive weaknesses may increase risk for IPV. This prospective study examined the associations between post-deployment neurocognitive performance and subsequent IPV (5-13 years later) among warzone veterans in the context of psychological health and TBI. Method Participants were 217 warzone veterans from a nationally-dispersed sample of service members and veterans who had previously deployed to the Iraq war zone and their intimate partners. Warzone veterans had previously completed performance-based neurocognitive assessments at a post-deployment assessment. An average of eight years later, participants completed structured psychiatric interviews and psychometric surveys assessing TBI history, posttraumatic stress disorder (PTSD), depression, alcohol use, and IPV perpetration. Results Regression analyses revealed that relatively greater psychopathology and history of TBI were significantly associated with more frequent warzone veteran IPV psychological perpetration. Further, relatively poorer post-deployment neurocognitive performance predicted higher subsequent psychological and physical IPV perpetration, adjusting for demographics, psychological health, and TBI. Conclusions Our findings highlight the importance of identifying both psychological/behavioral and neurocognitive correlates of IPV among warzone veterans. An integrative understanding of IPV risk can help inform both IPV prevention and treatment efforts for warzone veterans.
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Affiliation(s)
- Christopher Chiu
- National Center for PTSD and Psychology Service, VA Boston Healthcare System, Boston, MA
- Department of Psychology, University of Massachusetts Boston, Boston, MA
| | - Katherine Gnall
- Department of Psychological Sciences, University of Connecticut, Storrs, CT
| | - Anica Pless Kaiser
- National Center for PTSD and Psychology Service, VA Boston Healthcare System, Boston, MA
- Department of Psychiatry, Boston University School of Medicine, Boston, MA
| | - Casey T. Taft
- National Center for PTSD and Psychology Service, VA Boston Healthcare System, Boston, MA
- Department of Psychiatry, Boston University School of Medicine, Boston, MA
| | - Molly R. Franz
- National Center for PTSD and Psychology Service, VA Boston Healthcare System, Boston, MA
- Department of Psychiatry, Boston University School of Medicine, Boston, MA
- Department of Psychology, University of Maryland, Baltimore County, Baltimore, MD
| | - Lewina O. Lee
- National Center for PTSD and Psychology Service, VA Boston Healthcare System, Boston, MA
- Department of Psychiatry, Boston University School of Medicine, Boston, MA
| | - Jennifer J. Vasterling
- National Center for PTSD and Psychology Service, VA Boston Healthcare System, Boston, MA
- Department of Psychiatry, Boston University School of Medicine, Boston, MA
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Vasterling JJ, Lafleche GC, Patt V, Verfaellie M. Episodic Future Thinking and COVID-19 Vaccination Intent in Trauma-Exposed Military Veterans: A Pilot Study. Behav Ther (N Y N Y) 2022; 45:96-99. [PMID: 38584963 PMCID: PMC10996582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Subscribe] [Scholar Register] [Indexed: 04/09/2024]
Affiliation(s)
- Jennifer J Vasterling
- Psychology Service and National Center for PTSD, Veterans Affairs Boston Healthcare System and Boston University School of Medicine
| | - Ginette C Lafleche
- Memory Disorders Research Center, Veterans Affairs Boston Healthcare System
| | - Virginie Patt
- Memory Disorders Research Center, Veterans Affairs Boston Healthcare System
| | - Mieke Verfaellie
- Memory Disorders Research Center, Veterans Affairs Boston Healthcare System and Boston University School of Medicine
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Toomey R, Alpern RE, Reda DJ, Baker DG, Vasterling JJ, Blanchard MS, Eisen SA. A cohort study of neuropsychological functioning in spouses of U.S. Gulf War veterans. Life Sci 2021; 284:119894. [PMID: 34450171 DOI: 10.1016/j.lfs.2021.119894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 08/01/2021] [Accepted: 08/10/2021] [Indexed: 11/17/2022]
Abstract
AIMS Veterans of the 1991 Gulf War reported symptoms in their spouses that mirrored veterans' symptoms following their return from the war, including problems with attention and memory. Neuropsychological functioning in these spouses has not been examined with objective tests. This study sought to determine if these spouses exhibited deficits in neuropsychological functioning. MAIN METHODS Spouses of a national cohort of 1991 Gulf War deployed (n = 470) and non-deployed veterans (n = 524) were examined with neuropsychological tests in 1999-2001. KEY FINDINGS Neuropsychological tests were factor analyzed yielding five factors: verbal memory, visual memory, attention/working memory, visual organization, and motor speed. Spouses of deployed and nondeployed veterans did not differ on mean factor scores, percentage of impaired factors, or individual test scores. Spouse attention/working memory was related to their having diagnoses of PTSD or anxiety disorders, or self-reported symptoms of current anxiety. Spouse visual memory was related to a diagnosis of current depression. Spouse motor speed was related to their own status of having chronic multisymptom illness (CMI). SIGNIFICANCE Spouses of Gulf War deployed and nondeployed veterans demonstrated similar neuropsychological functioning, although spouses with psychiatric diagnoses and symptoms, or CMI demonstrated neuropsychological impairments characteristic of those conditions, suggesting that monitoring spouses for these conditions and impairments may be warranted. This pattern of relative weaknesses mirrors some of the previously reported findings for Gulf War veterans, although the veterans displayed neuropsychological impairments beyond what was accounted for by these conditions.
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Affiliation(s)
- Rosemary Toomey
- Department of Psychological and Brain Sciences, Boston University, Boston, MA, USA.
| | - Renee E Alpern
- Cooperative Study Program Coordinating Center, Edward Hines Jr. VA Hospital, Hines, IL, USA
| | - Domenic J Reda
- Cooperative Study Program Coordinating Center, Edward Hines Jr. VA Hospital, Hines, IL, USA
| | - Dewleen G Baker
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA; VA Center of Excellence for Stress and Mental Health and VA San Diego Healthcare System, San Diego, CA, USA
| | - Jennifer J Vasterling
- Department of Psychiatry, School of Medicine, Boston University, Boston, MA, USA; National Center for PTSD and Psychology Service, VA Boston Healthcare System, Boston, MA, USA
| | | | - Seth A Eisen
- School of Medicine, Washington University, St. Louis, MO, USA
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Jackson CE, Ciarleglio MM, Aslan M, Marx BP, Ko J, Concato J, Proctor SP, Vasterling JJ. Associations Among Increases in Posttraumatic Stress Symptoms, Neurocognitive Performance, and Long-Term Functional Outcomes in U.S. Iraq War Veterans. J Trauma Stress 2021; 34:628-640. [PMID: 33650202 DOI: 10.1002/jts.22663] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 12/04/2020] [Accepted: 01/09/2021] [Indexed: 11/12/2022]
Abstract
Cross-sectional research suggests that posttraumatic stress symptoms (PTSS) among war zone veterans are associated with functional impairment and poor quality of life. Less is known about the long-term functional repercussions of PTSS. This study of Iraq War veterans examined the associations between increases in PTSS and long-term functional outcomes, including the potential contributions of neurocognitive decrements. Service members and veterans (N = 594) completed self-report measures of functioning and PTSS severity before Iraq War deployment and again after their return (M = 9.3 years postdeployment). Some participants (n = 278) also completed neurocognitive testing at both times. Multiple regression analyses with the full sample-adjusted for TBI, demographic characteristics, military variables, and predeployment PTSS and functioning-revealed that increased PTSS severity over time was significantly associated with unemployment, aOR = 1.04, 95% CI [1.03, 1.06]; poorer work performance; and poorer physical, emotional, and cognitive health-related functioning at long-term follow-up, f2 s = 0.37-1.79. Among participants who completed neurocognitive testing, a decline in select neurocognitive measures was associated with poorer functioning; however, neurocognitive decrements did not account for associations between increased PTSS and unemployment, aOR = 1.04, 95% CI [1.02, 1.07], with the size and direction upheld after adding neurocognitive variables, or poorer functional outcomes, with small increases after adding neurocognitive measures to the models, f2 s = 0.03-0.10. War zone veterans experiencing long-term increased PTSS and/or neurocognitive decrements may be at elevated risk for higher-level functional impairment over time, suggesting that early PTSS management may enhance long-term functioning.
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Affiliation(s)
- Colleen E Jackson
- Psychology Service, VA Boston Healthcare System, Boston, Massachusetts, USA.,Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Maria M Ciarleglio
- Clinical Epidemiology Research Center, VA Cooperative Studies Program, West Haven, Connecticut, USA.,Department of Biostatistics, School of Public Health, Yale University, New Haven, Connecticut, USA
| | - Mihaela Aslan
- Clinical Epidemiology Research Center, VA Cooperative Studies Program, West Haven, Connecticut, USA.,Department of Medicine, School of Medicine, Yale University, New Haven, Connecticut, USA
| | - Brian P Marx
- Psychology Service, VA Boston Healthcare System, Boston, Massachusetts, USA.,Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts, USA.,National Center for PTSD, VA Boston Healthcare System, Boston, Massachusetts, USA
| | - John Ko
- Clinical Epidemiology Research Center, VA Cooperative Studies Program, West Haven, Connecticut, USA
| | - John Concato
- Department of Medicine, School of Medicine, Yale University, New Haven, Connecticut, USA.,Center for Drug Evaluation and Research, Food and Drug Administration, Silver Spring, Maryland, USA
| | - Susan P Proctor
- U.S. Army Research Institute of Environmental Medicine, Natick, Massachusetts, USA.,Research Service, VA Boston Healthcare System, Boston, Massachusetts, USA
| | - Jennifer J Vasterling
- Psychology Service, VA Boston Healthcare System, Boston, Massachusetts, USA.,Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts, USA.,National Center for PTSD, VA Boston Healthcare System, Boston, Massachusetts, USA
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Denckla CA, Lee SY, Kim R, Spies G, Vasterling JJ, Subramanian SV, Seedat S. Patterning of individual variability in neurocognitive health among South African women exposed to childhood maltreatment. Sci Rep 2021; 11:6669. [PMID: 33758246 PMCID: PMC7988062 DOI: 10.1038/s41598-021-85979-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 03/09/2021] [Indexed: 11/08/2022] Open
Abstract
There are individual differences in health outcomes following exposure to childhood maltreatment, yet constant individual variance is often assumed in analyses. Among 286 Black, South African women, the association between childhood maltreatment and neurocognitive health, defined here as neurocognitive performance (NP), was first estimated assuming constant variance. Then, without assuming constant variance, we applied Goldstein's method (Encyclopedia of statistics in behavioral science, Wiley, 2005) to model "complex level-1 variation" in NP as a function of childhood maltreatment. Mean performance in some tests of information processing speed (Digit-symbol, Stroop Word, and Stroop Color) lowered with increasing severity of childhood maltreatment, without evidence of significant individual variation. Conversely, we found significant individual variation by severity of childhood maltreatment in tests of information processing speed (Trail Making Test) and executive function (Color Trails 2 and Stroop Color-Word), in the absence of mean differences. Exploratory results suggest that the presence of individual-level heterogeneity in neurocognitive performance among women exposed to childhood maltreatment warrants further exploration. The methods presented here may be used in a person-centered framework to better understand vulnerability to the toxic neurocognitive effects of childhood maltreatment at the individual level, ultimately informing personalized prevention and treatment.
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Affiliation(s)
- Christy A Denckla
- Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA, 02115, USA.
| | - Sun Yeop Lee
- Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA, 02115, USA
| | - Rockli Kim
- Interdisciplinary Program in Precision Public Health, Department of Public Health Sciences, Graduate School of Korea University, Seoul, Republic of Korea
- Division of Health Policy and Management, College of Health Science, Korea University, Seoul, Republic of Korea
| | - Georgina Spies
- NRF/DST South African Research Chairs Initiative, PTSD Program, Stellenbosch University, Cape Town, South Africa
| | | | - S V Subramanian
- Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA, 02115, USA
- Harvard Center for Population and Development Studies, Cambridge, MA, 02138, USA
| | - Soraya Seedat
- NRF/DST South African Research Chairs Initiative, PTSD Program, Stellenbosch University, Cape Town, South Africa
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10
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Franz MR, Kaiser AP, Phillips RJ, Lee LO, Lawrence AE, Taft CT, Vasterling JJ. Associations of warzone veteran mental health with partner mental health and family functioning: Family Foundations Study. Depress Anxiety 2020; 37:1068-1078. [PMID: 32805764 PMCID: PMC8252135 DOI: 10.1002/da.23083] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2020] [Revised: 07/01/2020] [Accepted: 07/06/2020] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION Warzone participation is associated with increased risk of stress-related psychopathology, including posttraumatic stress disorder (PTSD) and depression. Prior research suggests that the mental health of spouses of warzone veterans (WZVs) is linked to that of their partners. Additionally, PTSD among WZVs has been associated with marital dysfunction. Less is known about the effects of depression among WZVs on partner mental health and family relationships. We sought in this study to examine associations between WZV PTSD and depression and partner mental health and relationship outcomes. METHODS Using a nationally dispersed sample of Iraq and Afghanistan veterans and their married and unmarried intimate partners, 245 dyads completed structured psychiatric interviews and psychometric surveys assessing family functioning and relationship aggression. RESULTS Adjusted regression analyses indicated that depression among WZVs was associated with partner depression and anxiety disorders. WZV PTSD and depression were also associated with partner-reported relationship dysfunction, dissatisfaction, and communication issues, and higher rates of intimate partner aggression victimization and perpetration. CONCLUSIONS Mental health consequences of war extend beyond WZVs to the mental health of their intimate partners and their relationships with intimate partners.
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Affiliation(s)
- Molly R. Franz
- National Center for PTSD, VA Boston Healthcare System, Boston, Massachusetts,Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts
| | - Anica Pless Kaiser
- National Center for PTSD, VA Boston Healthcare System, Boston, Massachusetts,Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts,Psychology Service, VA Boston Healthcare System, Boston, Massachusetts
| | | | - Lewina O. Lee
- National Center for PTSD, VA Boston Healthcare System, Boston, Massachusetts,Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts,Psychology Service, VA Boston Healthcare System, Boston, Massachusetts
| | - Amy E. Lawrence
- Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts,Psychology Service, VA Boston Healthcare System, Boston, Massachusetts
| | - Casey T. Taft
- National Center for PTSD, VA Boston Healthcare System, Boston, Massachusetts,Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts,Psychology Service, VA Boston Healthcare System, Boston, Massachusetts
| | - Jennifer J. Vasterling
- National Center for PTSD, VA Boston Healthcare System, Boston, Massachusetts,Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts,Psychology Service, VA Boston Healthcare System, Boston, Massachusetts
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11
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LaMotte AD, Pless Kaiser A, Lee LO, Supelana C, Taft CT, Vasterling JJ. Factors Influencing Family Environment Reporting Concordance Among U.S. War Zone Veterans and Their Partners. Assessment 2020; 28:1459-1470. [PMID: 32486907 DOI: 10.1177/1073191120922619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
A key challenge in the assessment of family variables is the discrepancies that arise between reports. Although prior research has observed levels of interpartner agreement on the family environment, no studies have investigated factors that may influence agreement. In this study, war zone veterans (WZVs) and their partners (N = 207 couples) completed assessments of the family environment. We examined interpartner agreement in relation to WZV and partner posttraumatic stress disorder (PTSD) symptoms, WZV time away from home, and family size. More severe WZV PTSD symptoms were associated with greater interpartner agreement on family environment, whereas more severe partner PTSD symptoms were associated with reporting more negative perceptions of the family environment relative to WZV reports. Family size was associated with greater interpartner agreement. Factors associated with concordance in this study should be considered by clinicians and researchers seeking to understand and address reporting discrepancies on the family.
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Affiliation(s)
- Adam D LaMotte
- University of Maryland, Baltimore County, Baltimore MD, USA
| | - Anica Pless Kaiser
- National Center for PTSD, VA Boston Healthcare System, Boston, MA, USA.,Boston University School of Medicine, Boston, MA, USA.,Psychology Service, VA Boston Healthcare System, Boston, MA, USA
| | - Lewina O Lee
- Boston University School of Medicine, Boston, MA, USA.,Research Service, VA Boston Healthcare System, Boston, MA, USA.,Psychology Service, VA Boston Healthcare System, Boston, MA, USA
| | - Christina Supelana
- Boston University School of Medicine, Boston, MA, USA.,Psychology Service, VA Boston Healthcare System, Boston, MA, USA
| | - Casey T Taft
- National Center for PTSD, VA Boston Healthcare System, Boston, MA, USA.,Boston University School of Medicine, Boston, MA, USA.,Psychology Service, VA Boston Healthcare System, Boston, MA, USA
| | - Jennifer J Vasterling
- National Center for PTSD, VA Boston Healthcare System, Boston, MA, USA.,Boston University School of Medicine, Boston, MA, USA.,Psychology Service, VA Boston Healthcare System, Boston, MA, USA
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12
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Lee DJ, Lee LO, Bovin MJ, Moshier SJ, Dutra SJ, Kleiman SE, Rosen RC, Vasterling JJ, Keane TM, Marx BP. The 20-year course of posttraumatic stress disorder symptoms among veterans. J Abnorm Psychol 2020; 129:658-669. [PMID: 32478530 DOI: 10.1037/abn0000571] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Although numerous longitudinal studies have examined heterogeneity in posttraumatic stress disorder (PTSD) symptom course, the long-term course of the disorder remains poorly understood. This study sought to understand and predict long-term PTSD symptom course among a nationwide sample of Operations Enduring Freedom and Iraqi Freedom veterans enrolled in Veterans Health Administration services. We assessed PTSD symptoms at 4 time points over approximately 4.5 years (M = 55.11 months, SD = 6.89). Participants (N = 1,353) with and without probable PTSD were sampled at a 3:1 ratio, and male and female veterans were sampled at a 1:1 ratio to fully explore the heterogeneity of PTSD symptom course and the effect of sex on symptom course. By coding time as years since index trauma, we estimated the course of PTSD symptoms over 20 years. Results indicate symptom course is most appropriately characterized by substantial heterogeneity. On average, veterans experienced initial PTSD symptom severity above the diagnostic threshold following trauma exposure, which was initially stable over time and later began to gradually improve. Although results indicate symptoms eventually began to decline, this effect was gradual; most participants continued to meet or exceed the PTSD provisional diagnostic threshold long after trauma exposure. We identified several predictors and correlates of symptom course, including Hispanic ethnicity, postdeployment social support, and co-occurring psychopathology. Results highlight the heterogeneous nature of PTSD symptom course following trauma exposure and the urgency of the need to ensure access to evidence-based care and to improve available treatments. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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Affiliation(s)
- Daniel J Lee
- National Center for PTSD at VA Boston Healthcare System
| | - Lewina O Lee
- National Center for PTSD at VA Boston Healthcare System
| | | | | | - Sunny J Dutra
- National Center for PTSD at VA Boston Healthcare System
| | | | | | | | | | - Brian P Marx
- National Center for PTSD at VA Boston Healthcare System
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13
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Abstract
OBJECTIVE Many veterans of the Iraq and Afghanistan Wars have experienced traumatic brain injury (TBI). Although prior work has examined associations between TBI and development of psychiatric syndromes, less is known about associations between TBI and component emotions constituting these syndromes, especially in the long term. The purpose of this study was to examine the long-term emotional consequences of deployment-related TBI. METHODS As part of VA Cooperative Studies Program #566, we assessed a sample of n = 456 US Army soldiers prior to an index deployment to Iraq, and again an average of 8.3 years (SD = 2.4 years) after their deployment for a long-term follow-up assessment. In this report, we used adjusted regression analyses to examine the relationship of deployment TBI to depression, anxiety, and stress symptom severity measured at the long-term follow-up assessment. A structured interview was used to determine TBI history; the Depression, Anxiety, and Stress Scale, 21-item version (DASS-21) was used to determine emotional status at the follow-up evaluation. RESULTS Warzone TBI events, particularly when greater than mild in severity, were independently associated with depression, anxiety, and stress severity at long-term follow-up, even after taking into account variance attributable to pre-deployment emotional distress and war-zone stress. Post-hoc analyses did not detect independent associations of either number of events or injury mechanism with outcomes. CONCLUSIONS These findings highlight the potentially enduring and multi-faceted emotional effects of deployment TBI, underscoring the need for early assessment of negative affectivity in warzone veterans reporting TBI.
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Affiliation(s)
- Jennifer J Vasterling
- Psychology Service, VA Boston Healthcare System, Boston, MA, USA.,Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA.,National Center for PTSD, VA Boston Healthcare System, Boston, MA, USA
| | - Mihaela Aslan
- Clinical Epidemiology Research Center, VA Cooperative Studies Program, West Haven, CT, USA.,Department of Medicine, School of Medicine, Yale University, New Haven, CT, USA
| | - Susan P Proctor
- U.S. Army Research Institute of Environmental Medicine, Natick, MA, USA.,Research Service, VA Boston Healthcare System, Boston, MA, USA
| | - John Ko
- Clinical Epidemiology Research Center, VA Cooperative Studies Program, West Haven, CT, USA
| | - Xenia Leviyah
- National Center for PTSD, VA Boston Healthcare System, Boston, MA, USA
| | - John Concato
- Department of Medicine, School of Medicine, Yale University, New Haven, CT, USA.,Center for Drug Evaluation and Research, Food and Drug Administration, Silver Spring, MD, USA
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14
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Jacob SN, Dodge CP, Vasterling JJ. Posttraumatic stress disorder and neurocognition: A bidirectional relationship? Clin Psychol Rev 2019; 72:101747. [DOI: 10.1016/j.cpr.2019.101747] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Revised: 04/25/2019] [Accepted: 06/11/2019] [Indexed: 12/20/2022]
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15
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Toomey R, Alpern R, Reda DJ, Baker DG, Vasterling JJ, Blanchard M, Eisen SA. Mental health in spouses of U.S. Gulf War veterans. Psychiatry Res 2019; 275:287-295. [PMID: 30953873 DOI: 10.1016/j.psychres.2019.03.043] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Revised: 03/25/2019] [Accepted: 03/25/2019] [Indexed: 11/27/2022]
Abstract
Veterans' spouses are at risk for mental distress and substance use. We examined long term psychological functioning in spouses from a national cohort of 1991 Gulf War era veterans. From clinical interviews, spouses of deployed veterans (n = 488) did not have a greater prevalence of post-war mental disorders compared to spouses of non-deployed veterans (n = 536); however, in couples that were living together since the war, there was an increased risk of anxiety disorders or any one disorder. On questionnaires, the impact varied but was most consistently observed in more severe depression and greater functional impairment in spouses of deployed compared to non-deployed veterans. If a veteran developed post-war anxious/depressive disorders or any one mental disorder, the matched spouse was more likely to develop post-war anxious/depressive disorders or any one mental disorder, respectively. Veteran combat exposure did not similarly increase the risk of spouse post-war mental disorders. Greater spouse self-reported symptomatology was observed in spouses of veterans with anxious/depressive disorders even when controlling for deployment. In summary, the war conferred greater risk for spouse mental disorders and distress for spouses of veterans with mental health disorders, with some increased risk for spouses of deployed veterans, especially in couples together since the war.
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Affiliation(s)
- Rosemary Toomey
- Department of Psychological and Brain Sciences, College of Arts and Sciences, Boston University, 900 Commonwealth Ave., Boston, MA, USA.
| | - Renee Alpern
- Cooperative Study Program Coordinating Center, Edward Hines Jr. VA Hospital, Hines, IL, USA
| | - Domenic J Reda
- Cooperative Study Program Coordinating Center, Edward Hines Jr. VA Hospital, Hines, IL, USA
| | - Dewleen G Baker
- VA Center of Excellence for Stress and Mental Health and VA San Diego Healthcare System, San Diego, CA, USA; Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
| | - Jennifer J Vasterling
- National Center for PTSD and Psychology Service, VA Boston Healthcare System, Boston, MA, USA; Department of Psychiatry, School of Medicine, Boston University, Boston, Massachusetts, USA
| | | | - Seth A Eisen
- School of Medicine, Washington University, St. Louis, MO, USA
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16
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Arditte Hall KA, Davison EH, Galovski TE, Vasterling JJ, Pineles SL. Associations Between Trauma-Related Rumination and Symptoms of Posttraumatic Stress and Depression in Treatment-Seeking Female Veterans. J Trauma Stress 2019; 32:260-268. [PMID: 31009555 DOI: 10.1002/jts.22385] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Revised: 11/07/2018] [Accepted: 11/15/2018] [Indexed: 12/12/2022]
Abstract
Trauma-related rumination is a cognitive style characterized by repetitive negative thinking about the causes, consequences, and implications of a traumatic experience. Frequent trauma-related rumination has been linked to posttraumatic stress disorder (PTSD) and depression in civilian samples but has yet to be examined among military veterans. This study extended previous research by examining trauma-related rumination in female veterans who presented to a Veterans Affairs women's trauma recovery clinic (N = 91). The study had two main aims: (a) to examine associations between trauma-related rumination and specific PTSD symptoms, adjusting for the overlap between trauma-related rumination and other relevant cognitive factors, such as intrusive trauma memories and self-blame cognitions; and (b) to assess associations between trauma-related rumination, PTSD, and depression, adjusting for symptom comorbidity. At intake, patients completed a semistructured interview and self-report questionnaires. Primary diagnoses were confirmed via medical record review. Trauma-related rumination was common, with more than 80% of patients reporting at least sometimes engaging in this cognitive style in the past week. After adjusting for other relevant cognitive factors, trauma-related rumination was significantly associated with several specific PTSD symptoms, rp s = .33-.48. Additionally, the severity of trauma-related rumination was associated with overall PTSD symptom severity, even after adjusting for comorbid depression symptoms, rp 2 = .35. In contrast, the association between trauma-related rumination and depressive symptom severity was not significant after adjusting for comorbid PTSD symptoms, rp 2 = .008. These results highlight trauma-related rumination as a unique contributing factor to the complex clinical presentation for a subset of trauma-exposed veterans.
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Affiliation(s)
- Kimberly A Arditte Hall
- VA National Center for PTSD, Boston, Massachusetts, USA.,Boston University School of Medicine, Boston, Massachusetts, USA.,VA Boston Healthcare System, Boston, Massachusetts, USA
| | - Eve H Davison
- VA National Center for PTSD, Boston, Massachusetts, USA.,Boston University School of Medicine, Boston, Massachusetts, USA.,VA Boston Healthcare System, Boston, Massachusetts, USA
| | - Tara E Galovski
- VA National Center for PTSD, Boston, Massachusetts, USA.,Boston University School of Medicine, Boston, Massachusetts, USA.,VA Boston Healthcare System, Boston, Massachusetts, USA
| | - Jennifer J Vasterling
- VA National Center for PTSD, Boston, Massachusetts, USA.,Boston University School of Medicine, Boston, Massachusetts, USA.,VA Boston Healthcare System, Boston, Massachusetts, USA
| | - Suzanne L Pineles
- VA National Center for PTSD, Boston, Massachusetts, USA.,Boston University School of Medicine, Boston, Massachusetts, USA.,VA Boston Healthcare System, Boston, Massachusetts, USA
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17
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Abstract
PURPOSE OF REVIEW We review recent research addressing neurocognitive and information processing abnormalities in posttraumatic stress disorder (PTSD), including studies informing direction of causality. We additionally consider neurocognition in the context of co-morbid mild traumatic brain injury (TBI) and psychosocial treatments for PTSD. RECENT FINDINGS Learning, memory, attention, inhibitory functions, and information processing biases frequently accompany PTSD, reflecting potential bi-directional relationships with PTSD. Although mild TBI is associated with increased risk of PTSD development and maintenance, TBI does not typically contribute significantly to sustained neurocognitive deficits in individuals with PTSD. Whereas better learning and memory is associated with mildly enhanced response to psychosocial interventions, such interventions may also improve neurocognitive performance and can be effectively provided to patients with TBI history. PTSD is associated with cognitive abnormalities in processing both emotionally relevant and emotionally neutral information and, although mild, may underlie some PTSD symptom expression.
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Affiliation(s)
- Jennifer J Vasterling
- Psychology (116B), National Center for PTSD at VA Boston Healthcare System, 150 S. Huntington Ave., Boston, MA, 02130, USA.
- Boston University School of Medicine, Boston, MA, USA.
| | - Kimberly A Arditte Hall
- Psychology (116B), National Center for PTSD at VA Boston Healthcare System, 150 S. Huntington Ave., Boston, MA, 02130, USA
- Boston University School of Medicine, Boston, MA, USA
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18
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Vasterling JJ, Jacob SN, Rasmusson A. Traumatic Brain Injury and Posttraumatic Stress Disorder: Conceptual, Diagnostic, and Therapeutic Considerations in the Context of Co-Occurrence. J Neuropsychiatry Clin Neurosci 2018; 30:91-100. [PMID: 29132272 DOI: 10.1176/appi.neuropsych.17090180] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
The events leading to traumatic brain injury (TBI) are often psychologically traumatic (e.g., motor vehicle accidents) or occur within a broader context of psychological trauma, such as military combat or recurrent interpersonal violence. In such cases, posttraumatic stress disorder (PTSD) may develop and serve to complicate TBI recovery. Likewise, brain trauma may impede emotional resolution following psychological trauma exposure. This article addresses comorbid PTSD and TBI, including the epidemiology of PTSD following TBI; the clinical presentation of the comorbidity; potential mechanisms that complicate recovery from psychological trauma and TBI when they co-occur; and considerations for the clinical management of PTSD in the context of TBI, including implications for both psychosocial and psychopharmacological PTSD treatments. Although the authors address the full spectrum of TBI severity, because PTSD more commonly co-occurs with mild TBI, compared with moderate and severe TBI, the authors focus in particular on mild TBI.
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Affiliation(s)
- Jennifer J Vasterling
- From the Psychology Service, VA Boston Healthcare System, Boston (JJV, SNJ); the National Center for PTSD at VA Boston Healthcare System, Boston (JJV, AR); the Department of Psychiatry, Boston University School of Medicine, Boston (JJV, SNJ, AR); and the Psychiatry Service, VA Boston Healthcare System, Boston (AR)
| | - Shawna N Jacob
- From the Psychology Service, VA Boston Healthcare System, Boston (JJV, SNJ); the National Center for PTSD at VA Boston Healthcare System, Boston (JJV, AR); the Department of Psychiatry, Boston University School of Medicine, Boston (JJV, SNJ, AR); and the Psychiatry Service, VA Boston Healthcare System, Boston (AR)
| | - Ann Rasmusson
- From the Psychology Service, VA Boston Healthcare System, Boston (JJV, SNJ); the National Center for PTSD at VA Boston Healthcare System, Boston (JJV, AR); the Department of Psychiatry, Boston University School of Medicine, Boston (JJV, SNJ, AR); and the Psychiatry Service, VA Boston Healthcare System, Boston (AR)
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19
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Ciarleglio MM, Aslan M, Proctor SP, Concato J, Ko J, Kaiser AP, Vasterling JJ. Associations of Stress Exposures and Social Support With Long-Term Mental Health Outcomes Among U.S. Iraq War Veterans. Behav Ther 2018; 49:653-667. [PMID: 30146134 DOI: 10.1016/j.beth.2018.01.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Revised: 12/31/2017] [Accepted: 01/06/2018] [Indexed: 11/30/2022]
Abstract
The long-term mental health effects of war-zone deployment in the Iraq and Afghanistan wars on military personnel are a significant public health concern. Using data collected prospectively at three distinct assessments during 2003-2014 as part of the Neurocognition Deployment Health Study and VA Cooperative Studies Program Study #566, we explored how stress exposures prior, during, and after return from deployment influence the long-term mental health outcomes of posttraumatic stress disorder (PTSD), depression, anxiety disorders, and problem drinking. Longer-term mental health outcomes were assessed in 375 service members and military veterans an average of 7.5 years (standard deviation = 1.0 year) after the initial (i.e., "index") Iraq deployment following their predeployment assessment. Anxiety disorder was the most commonly observed long-term mental health outcome (36.0%), followed by depression (24.5%), PTSD (24.3%), and problem drinking (21.0%). Multivariable regression models showed that greater postdeployment stressors, as measured by the Post-Deployment Life Events scale, were associated with greater risk of depression, anxiety disorders, and problem drinking. Anxiety disorder was the only outcome affected by predeployment stress concerns. In addition, greater postdeployment social support was associated with lower risk of all outcomes except problem drinking. These findings highlight the importance of assessing postdeployment stress exposures, such as stressful or traumatic life events, given the potential impact of these stressors on long-term mental health outcomes. This study also highlights the importance of postdeployment social support as a modifiable protective factor that can be used to help mitigate risk of long-term adverse mental health outcomes following war-zone exposure.
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Affiliation(s)
- Maria M Ciarleglio
- Clinical Epidemiology Research Center, VA Cooperative Studies Program, West Haven, Connecticut, USA; Department of Biostatistics, School of Public Health, Yale University, New Haven, Connecticut, USA
| | - Mihaela Aslan
- Clinical Epidemiology Research Center, VA Cooperative Studies Program, West Haven, Connecticut, USA; Department of Medicine, School of Medicine, Yale University, New Haven, Connecticut, USA
| | - Susan P Proctor
- US Army Research Institute of Environmental Medicine, Natick, Massachusetts, USA; Research Service, VA Boston Healthcare System, Boston, Massachusetts, USA; Department of Environmental Health, School of Public Health, Boston University, Boston, Massachusetts, USA
| | - John Concato
- Clinical Epidemiology Research Center, VA Cooperative Studies Program, West Haven, Connecticut, USA; Department of Medicine, School of Medicine, Yale University, New Haven, Connecticut, USA
| | - John Ko
- Clinical Epidemiology Research Center, VA Cooperative Studies Program, West Haven, Connecticut, USA
| | - Anica Pless Kaiser
- National Center for PTSD at VA Boston Healthcare System, Boston, Massachusetts, USA; Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Jennifer J Vasterling
- National Center for PTSD at VA Boston Healthcare System, Boston, Massachusetts, USA; Psychology Service, VA Boston Healthcare System, Boston, Massachusetts, USA; Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts, USA.
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20
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Abstract
OBJECTIVE Understanding the relationship between chronic pain and neurocognition has important implications for the assessment and treatment of patient experiencing pain. This paper provides an overview of the current literature examining the neurocognition-chronic pain relationship and suggests future avenues of research, along with a discussion of clinical implications of the literature findings. Consideration of potential moderators and mediators of this relationship, as well as a brief discussion of the importance of future research in special populations at particular risk for these problems, are also a focus of this paper. METHODS This systematic review summarizes the findings of clinical studies in which neurocognitive performance was measured in chronic pain samples. A literature search led to the inclusion of 53 articles in the review. RESULTS Studies of neurocognitive performance in clinical chronic pain samples support a relationship between chronic pain and neurocognitive abnormalities, particularly on tests of memory, attention, and processing speed, with mixed data regarding executive functioning. DISCUSSION Several factors may moderate or mediate the relationship between chronic pain and neurocognitive functioning, including mood symptoms, medication side effects, and intensity and/or chronicity of pain. Limitations in the literature include a paucity of methodologically rigorous studies controlling for confounding variables (eg, opioid analgesia) and a limited number of studies examining the relationship between chronic pain and traumatic brain injury (a potential precipitant of both pain and neurocognitive impairment). Nonetheless, findings from the existing literature have significant clinical implications, including for populations with heightened risk of both pain and neurocognitive disorders.
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Affiliation(s)
- Diana M. Higgins
- VA Boston Healthcare System, Boston, MA
- Boston University School of Medicine, Boston, MA
| | | | - Dewleen G. Baker
- University of California San Diego, San Diego, CA
- VA Center of Excellence for Stress and Mental Health and San Diego Healthcare System, San Diego, CA
| | | | - Victoria Risbrough
- University of California San Diego, San Diego, CA
- VA Center of Excellence for Stress and Mental Health and San Diego Healthcare System, San Diego, CA
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21
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Brailey K, Mills MA, Marx BP, Proctor SP, Seal KH, Spiro A, Ulloa EW, Vasterling JJ. Prospective Examination of Early Associations of Iraq War Zone Deployment, Combat Severity, and Posttraumatic Stress Disorder with New Incident Medical Diagnoses. J Trauma Stress 2018. [PMID: 29513919 DOI: 10.1002/jts.22264] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
War zone deployment and posttraumatic stress disorder (PTSD) have been associated with morbidity and mortality decades later. Less is known about the associations between these variables and the early emergence of medical disorders in war zone veterans. This prospective study of 862 U.S. Army soldiers (n = 569 deployed; n = 293 nondeployed) examined: (a) associations between Iraq War deployment status (deployed vs. nondeployed) and new medical diagnoses that emerged within six months after return from Iraq among all participants; and (b) associations between combat severity and PTSD symptoms, and new postdeployment medical diagnoses that emerged within 12 months after return from Iraq within deployed participants. New medical diagnoses were abstracted from diagnostic codes associated with clinical outpatient visits recorded within the Department of Defense Standard Ambulatory Data Record database. Combat severity was measured with the Combat Experiences module of the Deployment Risk and Resilience Inventory, and postdeployment posttraumatic stress disorder symptom severity was measured using the PTSD Checklist-Civilian. Neither deployment nor combat severity was associated with new medical diagnoses. However, among deployed soldiers, more severe PTSD symptoms were associated with increased risk for a new medical disorder diagnosis; every 10-point increase in PTSD symptoms increased odds of a new diagnosis by nearly 20% (odds ratio = 1.20). Results suggest that PTSD symptoms are associated with early morbidity in Iraq War veterans.
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Affiliation(s)
- Kevin Brailey
- Psychology Service, VA Boston Healthcare System, Boston, Massachusetts, USA.,Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Mary Alice Mills
- Psychology Service, VA Boston Healthcare System, Boston, Massachusetts, USA.,Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Brian P Marx
- Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts, USA.,National Center for PTSD, VA Boston Healthcare System, Boston, Massachusetts, USA
| | - Susan P Proctor
- Military Performance Division, U.S. Army Research Institute of Environmental Medicine, Natick, Massachusetts, USA.,Research Service, VA Boston Healthcare System, Boston, Massachusetts, USA.,Department of Environmental Health, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Karen H Seal
- San Francisco VA Health Care System, San Francisco, California, USA.,Departments of Medicine and Psychiatry, University of California San Francisco, San Francisco, California, USA
| | - Avron Spiro
- Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts, USA.,Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston, Massachusetts, USA.,Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Erin W Ulloa
- Behavioral Health Service, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania, USA.,Department of Psychiatry, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA
| | - Jennifer J Vasterling
- Psychology Service, VA Boston Healthcare System, Boston, Massachusetts, USA.,Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts, USA
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22
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McFarland CP, Vasterling JJ. Prospective Memory in Depression: Review of an Emerging Field†. Arch Clin Neuropsychol 2017; 33:912-930. [DOI: 10.1093/arclin/acx118] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Accepted: 11/07/2017] [Indexed: 11/12/2022] Open
Affiliation(s)
| | - Jennifer J Vasterling
- Psychology Service, VA Boston Healthcare System, Boston, MA, USA
- Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, VA Boston Healthcare System, Boston, MA, USA
- Boston University School of Medicine, Boston, MA, USA
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23
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Scholten J, Vasterling JJ, Grimes JB. Traumatic brain injury clinical practice guidelines and best practices from the VA state of the art conference. Brain Inj 2017; 31:1246-1251. [DOI: 10.1080/02699052.2016.1274780] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Joel Scholten
- US Department of Veterans Affairs, Physical Medicine and Rehabilitation, Veterans Health Administration, Washington, DC, USA
| | - Jennifer J. Vasterling
- Department of Veterans Affairs, National Center for Posttraumatic Stress Disorder and Psychology Service, VA Boston Healthcare System and Boston University School of Medicine, Boston, MA, USA
| | - Jamie B. Grimes
- Neurology Department and Uniformed Services University of the Health Sciences, Bethesda, MD, USA
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Abstract
INTRODUCTION Preparation and training for long-duration spaceflight bring with them psychosocial stressors potentially affecting the well-being and performance of astronauts, before and during spaceflight. Social support from within the workplace may mitigate behavioral health concerns arising during the preflight period and enhance resiliency before and during extended missions. The purpose of this review was to evaluate evidence addressing the viability of workplace social support as a pre-mission countermeasure, specifically addressing: 1) the observed relationships between workplace social support and behavioral health; 2) perceived need, acceptability, and format preference for workplace social support among high-achievers; 3) potential barriers to delivery/receipt of workplace social support; 4) workplace social support interventions; and 5) delivery timeframe and anticipated duration of workplace social support countermeasure benefits. METHODS We conducted an evidence review examining workplace social support in professional contexts sharing one or more characteristics with astronauts and spaceflight. Terms included populations of interest, social support constructs, and behavioral health outcomes. Abstracts of matches were subsequently reviewed for relevance and quality. RESULTS Research findings demonstrate clear associations between workplace social support and behavioral health, especially following exposure to stress. Further, studies indicate strong need for support and acceptability of support countermeasures, despite barriers. Our review revealed two general formats for providing support (i.e., direct provision of support and training to optimize skills in provision and receipt of support) with potential differentiation of expected duration of benefits, according to format. DISCUSSION Workplace social support countermeasures hold promise for effective application during pre-mission phases of long-duration spaceflight. Specific recommendations are provided.Deming CA, Vasterling JJ. Workplace social support and behavioral health prior to long-duration spaceflight. Aerosp Med Hum Perform. 2017; 88(6):565-573.
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25
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Vasterling JJ, Proctor SP, Aslan M, Ko J, Jakupcak M, Harte CB, Marx BP, Concato J. Military, demographic, and psychosocial predictors of military retention in enlisted army soldiers 12 months after deployment to Iraq. Mil Med 2016; 180:524-32. [PMID: 25939106 DOI: 10.7205/milmed-d-14-00468] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVE To examine military, demographic, and psychosocial predictors of military retention following operational deployment. METHODS Military status 12 months following return from Iraq deployment was assessed via service records in 740 regular active duty Army Soldiers. Potential predictors of military retention were derived from prospectively administered in-person interviews and questionnaires conducted within 3 months following return from Iraq. RESULTS At 12 months following return from deployment, 18.1% (n = 134) of the sample had separated from military service. Cox proportional hazards analyses, adjusting for demographic, military, and psychosocial predictors, identified several factors that were independently associated with military attrition: less than (vs. equal to or more than) 6 years military experience (hazards ratio [HR], 3.98; 95% CI, 2.12-7.45); unmarried (vs. married) status (HR, 1.51; 95% CI, 1.06-2.16); and lower (vs. higher) levels of self-reported unit support during deployment (HR, 2.22; 95% CI, 1.42-3.47). CONCLUSIONS Service members early in their career may be especially prone to military attrition. With regard to military retention, our findings suggest that it may be particularly important to develop initiatives that target organizational cohesion and support.
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Affiliation(s)
- Jennifer J Vasterling
- National Center for PTSD and Psychology, VA Boston Healthcare System, 150 South Huntington Avenue, Boston, MA 02130
| | - Susan P Proctor
- US Army Research Institute for Environmental Medicine, Kansas Street, Building 42, Natick, MA 01760
| | - Mihaela Aslan
- Clinical Epidemiology Research Center, VA Connecticut Healthcare System, 950 Campbell Avenue, West Haven, CT 06516
| | - John Ko
- Clinical Epidemiology Research Center, VA Connecticut Healthcare System, 950 Campbell Avenue, West Haven, CT 06516
| | - Matthew Jakupcak
- VA Puget Sound Healthcare System, 1660 South Columbian Way, Seattle, WA 98108
| | - Christopher B Harte
- National Center for PTSD and Psychology, VA Boston Healthcare System, 150 South Huntington Avenue, Boston, MA 02130
| | - Brian P Marx
- National Center for PTSD and Psychology, VA Boston Healthcare System, 150 South Huntington Avenue, Boston, MA 02130
| | - John Concato
- Clinical Epidemiology Research Center, VA Connecticut Healthcare System, 950 Campbell Avenue, West Haven, CT 06516
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26
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Vasterling JJ, Aslan M, Proctor SP, Ko J, Marx BP, Jakupcak M, Schnurr PP, Gleason T, Huang GD, Concato J. Longitudinal Examination of Posttraumatic Stress Disorder as a Long-Term Outcome of Iraq War Deployment. Am J Epidemiol 2016; 184:796-805. [PMID: 27852604 DOI: 10.1093/aje/kww151] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Accepted: 10/18/2016] [Indexed: 11/12/2022] Open
Abstract
The mental health toll of the Iraq and Afghanistan Wars on military veterans has been considerable, yet little is known about the persistence of these adverse outcomes, especially relative to predeployment status. We prospectively examined posttraumatic stress disorder (PTSD) as a long-term consequence of warzone deployment, integrating data collected from 2003-2014. In the Neurocognition Deployment Health Study, we measured PTSD symptoms in US Army soldiers before and shortly after Iraq War deployment. We used the PTSD Checklist-Civilian Version and a structured clinical interview (i.e., Clinician-Administered PTSD Scale) to reassess PTSD in 598 service members and military veterans a median of 7.9 years (interquartile range, 7.2-8.5 years) after an index Iraq deployment. At long-term follow-up, 24.7% (95% confidence interval (CI): 21.5, 28.4) of participants met the case definition for PTSD, which was an absolute increase of 14.2% from the percentage assessed postdeployment (10.5%; 95% CI: 7.8, 13.7) and of 17.3% from the percentage assessed predeployment (7.4%; 95% CI: 5.5, 9.8). These findings highlight that PTSD is an enduring consequence of warzone participation among contemporary military personnel and veterans. The largest increase in PTSD cases occurred between the postdeployment and long-term follow-up assessments, which suggests that adverse stress reactions cannot necessarily be expected to dissipate over time and actually may increase.
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Jackson CE, Green JD, Bovin MJ, Vasterling JJ, Holowka DW, Ranganathan G, Rosen RC, Keane TM, Marx BP. Mild Traumatic Brain Injury, PTSD, and Psychosocial Functioning Among Male and Female U.S. OEF/OIF Veterans. J Trauma Stress 2016; 29:309-16. [PMID: 27405050 DOI: 10.1002/jts.22110] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2015] [Revised: 03/30/2016] [Accepted: 04/03/2016] [Indexed: 11/07/2022]
Abstract
This study examined the unique and combined relationship between mild traumatic brain injury (mTBI) and posttraumatic stress disorder (PTSD) with psychosocial functioning in a cohort of 1,312 U.S. male and female veterans of Operations Enduring Freedom (OEF) and Iraqi Freedom (OIF) enrolled in the Veterans After-Discharge Longitudinal Registry (Project VALOR). We assessed mTBI with structured screening questions reflective of current TBI classification standards and PTSD via the SCID-IV PTSD module; all other variables were assessed by self-report questionnaires. We identified significant diagnostic group differences in psychosocial functioning for both sexes. Individuals with PTSD, with or without a history of mTBI, reported significantly worse psychosocial functioning than individuals with mTBI alone or neither mTBI nor PTSD (males, η(2) p = .11, p < .001; females, η(2) p = .14, p < .001), even after adjusting for demographics and severity of chronic pain. The results suggested that veterans experiencing PTSD, regardless of whether they had a history of mTBI, were at increased risk for long-term psychosocial impairment. Further research examining possible benefits from improved access to resources and treatment to address these needs would be valuable.
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Affiliation(s)
- Colleen E Jackson
- Geriatric Research, Education and Clinical Center (GRECC), VA Boston Healthcare System, Boston, Massachusetts, USA.,Translational Research Center for TBI and Stress Disorders (TRACTS), VA Boston Healthcare System, Boston, Massachusetts, USA.,Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Jonathan D Green
- Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts, USA.,Research Service, VA Boston Healthcare System, Boston, Massachusetts, USA
| | - Michelle J Bovin
- Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts, USA.,National Center for PTSD-Behavioral Sciences Division, VA Boston Healthcare System, Boston, Massachusetts, USA
| | - Jennifer J Vasterling
- Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts, USA.,National Center for PTSD-Behavioral Sciences Division, VA Boston Healthcare System, Boston, Massachusetts, USA
| | - Darren W Holowka
- Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts, USA.,National Center for PTSD-Behavioral Sciences Division, VA Boston Healthcare System, Boston, Massachusetts, USA
| | | | - Raymond C Rosen
- New England Research Institutes, Watertown, Massachusetts, USA
| | - Terence M Keane
- Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts, USA.,National Center for PTSD-Behavioral Sciences Division, VA Boston Healthcare System, Boston, Massachusetts, USA
| | - Brian P Marx
- Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts, USA.,National Center for PTSD-Behavioral Sciences Division, VA Boston Healthcare System, Boston, Massachusetts, USA
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Abstract
War stress frequently leads to the subsequent development of psychopathology including posttraumatic stress disorder (PTSD), but recent research has indicated that individual difference factors may alter vulnerability to trauma-related distress. In an effort to examine the potential buffering effects of intellectual resources on PTSD development, this study assessed intellectual functioning in subsets of Persian Gulf War zone veterans with and without PTSD diagnoses. The two subsets, comprised of 18 PTSD-diagnosed and 23 psychopathology-free Persian Gulf War veterans, were compared on a multi-faceted test of intellectual functioning, the Wechsler Adult Intelligence Scale-Revised. As compared to psychopathology-free veterans, PTSD-diagnosed veterans performed significantly more poorly on tasks of verbal intellectual functioning including those tasks thought to reflect premorbid functioning. The two groups did not differ on visuospatial tasks or on a task of attention. Findings suggest that intellectual resources, particularly verbal skills, may buffer development of stress-related psychopathology following trauma exposure.
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Affiliation(s)
| | - Kevin Brailey
- Veterans Affairs Medical Center, New Orleans, Louisiana
| | | | - Alicia Borges
- Veterans Affairs Medical Center, New Orleans, Louisiana
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Abstract
OBJECTIVES Measurement of stress exposure is central to understanding military mental health outcomes. Although temporal stability of combat event reporting has been examined, less is known about the stability of reporting for noncombat events in military samples. Objectives are to examine consistency in reporting stressful life events in nondeployed U.S. Army soldiers and its association with posttraumatic stress disorder (PTSD) symptomatology. METHOD Examined reporting consistency over approximately 8 months among 466 soldiers. Regression models examined factors associated with decreased, increased, and stable reporting. RESULTS Stability of the number of events endorsed over time was high. However, item-level agreement was slight to moderate (kappas: .13-.54), with inconsistencies due primarily to decreased reporting. After adjusting for covariates and initial PTSD, second assessment PTSD was associated with increased and stable reporting. CONCLUSIONS Inconsistent reporting extends beyond combat events to other stressful life events in military personnel and is associated with PTSD.
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Affiliation(s)
- Anica Pless Kaiser
- VA National Center for PTSD, Behavioral Science Division, VA Boston Healthcare System. .,Boston University School of Medicine.
| | - Susan P Proctor
- Military Performance Division, U.S. Army Research Institute of Environmental Medicine.,VA Boston Healthcare System.,Boston University School of Public Health
| | - Jennifer J Vasterling
- VA National Center for PTSD, Behavioral Science Division, VA Boston Healthcare System.,Boston University School of Medicine
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30
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Seal KH, Bertenthal D, Samuelson K, Maguen S, Kumar S, Vasterling JJ. Association between mild traumatic brain injury and mental health problems and self-reported cognitive dysfunction in Iraq and Afghanistan Veterans. ACTA ACUST UNITED AC 2016; 53:185-98. [DOI: 10.1682/jrrd.2014.12.0301] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Revised: 06/25/2015] [Indexed: 11/05/2022]
Affiliation(s)
- Karen H. Seal
- San Francisco Department of Veterans Affairs (VA) Health Care System, San Francisco, CA
| | - Daniel Bertenthal
- San Francisco Department of Veterans Affairs (VA) Health Care System, San Francisco, CA
| | - Kristin Samuelson
- San Francisco Department of Veterans Affairs (VA) Health Care System, San Francisco, CA;California School of Professional Psychology, Alliant International University, San Francisco, CA
| | - Shira Maguen
- San Francisco Department of Veterans Affairs (VA) Health Care System, San Francisco, CA
| | - Sant Kumar
- San Francisco Department of Veterans Affairs (VA) Health Care System, San Francisco, CA
| | - Jennifer J. Vasterling
- VA Boston Healthcare System, Boston, MA; and Boston University School of Medicine, Boston, MA
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McFarland CP, Clark JB, Lee LO, Grande LJ, Marx BP, Vasterling JJ. Event-based prospective memory among veterans: The role of posttraumatic stress disorder symptom severity in executing intentions. J Clin Exp Neuropsychol 2015; 38:251-60. [DOI: 10.1080/13803395.2015.1102203] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Aslan M, Concato J, Peduzzi PN, Proctor SP, Schnurr PP, Marx BP, McFall M, Gleason T, Huang GD, Vasterling JJ. Design of “Neuropsychological and Mental Health Outcomes of Operation Iraqi Freedom. J Investig Med 2015; 61:569-77. [DOI: 10.2310/jim.0b013e31828407ff] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Palombo DJ, Kapson HS, Lafleche G, Vasterling JJ, Marx BP, Franz M, Verfaellie M. Alterations in autobiographical memory for a blast event in Operation Enduring Freedom and Operation Iraqi Freedom veterans with mild traumatic brain injury. Neuropsychology 2015; 29:543-549. [PMID: 25893970 PMCID: PMC4748832 DOI: 10.1037/neu0000198] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVE Although loss of consciousness associated with moderate or severe traumatic brain injury (TBI) is thought to interfere with encoding of the TBI event, little is known about the effects of mild TBI (mTBI), which typically involves only transient disruption in consciousness. METHOD Blast-exposed Afghanistan and Iraq War veterans were asked to recall the blast event. Participants were stratified based on whether the blast was associated with probable mTBI (n = 50) or not (n = 25). Narratives were scored for organizational structure (i.e., coherence) using the Narrative Coherence Coding Scheme (Reese et al., 2011) and episodic recollection using the Autobiographical Interview Coding Procedures (Levine et al., 2002). RESULTS The mTBI group produced narratives that were less coherent but contained more episodic details than those of the no-TBI group. CONCLUSION These results suggest that mTBI interferes with the organizational quality of memory in a manner that is independent of episodic detail generation.
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Affiliation(s)
| | | | | | | | - Brian P Marx
- National Center for PTSD, Veterans Affairs Boston Healthcare System
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34
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Vasterling JJ, Taft CT, Proctor SP, Macdonald HZ, Lawrence A, Kalill K, Kaiser AP, Lee LO, King DW, King LA, Fairbank JA. Establishing a methodology to examine the effects of war-zone PTSD on the family: the family foundations study. Int J Methods Psychiatr Res 2015; 24:143-55. [PMID: 26077194 PMCID: PMC4470319 DOI: 10.1002/mpr.1464] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2014] [Revised: 12/09/2014] [Accepted: 02/20/2015] [Indexed: 11/07/2022] Open
Abstract
Military deployment may adversely affect not only returning veterans, but their families, as well. As a result, researchers have increasingly focused on identifying risk and protective factors for successful family adaptation to war-zone deployment, re-integration of the returning veteran, and the longer-term psychosocial consequences of deployment experienced by some veterans and families. Post-traumatic stress disorder (PTSD) among returning veterans may pose particular challenges to military and military veteran families; however, questions remain regarding the impact of the course of veteran PTSD and other potential moderating factors on family adaptation to military deployment. The Family Foundations Study builds upon an established longitudinal cohort of Army soldiers (i.e. the Neurocognition Deployment Health Study) to help address remaining knowledge gaps. This report describes the conceptual framework and key gaps in knowledge that guided the study design, methodological challenges and special considerations in conducting military family research, and how these gaps, challenges, and special considerations are addressed by the study.
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Affiliation(s)
- Jennifer J. Vasterling
- VA National Center for PTSD at VA Boston Healthcare System and Boston UniversitySchool of MedicineBostonMAUSA
| | - Casey T. Taft
- VA National Center for PTSD at VA Boston Healthcare System and Boston UniversitySchool of MedicineBostonMAUSA
| | - Susan P. Proctor
- US Army Research Institute of Environmental Medicine and Boston UniversitySchool of Public HealthBostonMAUSA
| | | | - Amy Lawrence
- VA Boston Healthcare System and Boston UniversitySchool of MedicineBostonMAUSA
| | - Kathleen Kalill
- VA Boston Healthcare System and Boston UniversitySchool of MedicineBostonMAUSA
| | - Anica P. Kaiser
- VA National Center for PTSD at VA Boston Healthcare System and Boston UniversitySchool of MedicineBostonMAUSA
| | - Lewina O. Lee
- VA National Center for PTSD at VA Boston Healthcare System and Boston UniversitySchool of MedicineBostonMAUSA
| | - Daniel W. King
- VA National Center for PTSD at VA Boston Healthcare System and Boston UniversitySchool of MedicineBostonMAUSA
| | - Lynda A. King
- VA National Center for PTSD at VA Boston Healthcare System and Boston UniversitySchool of MedicineBostonMAUSA
| | - John A. Fairbank
- VA Mid‐Atlantic (VISN 6) Mental Illness Research, Education and Clinical Center (MIRECC) at Durham VA Medical CenterDuke UniversityDurhamNCUSA
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Han SC, Castro F, Lee LO, Charney ME, Marx BP, Brailey K, Proctor SP, Vasterling JJ. Military unit support, postdeployment social support, and PTSD symptoms among active duty and National Guard soldiers deployed to Iraq. J Anxiety Disord 2014; 28:446-53. [PMID: 24846492 DOI: 10.1016/j.janxdis.2014.04.004] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2013] [Revised: 04/16/2014] [Accepted: 04/16/2014] [Indexed: 11/26/2022]
Abstract
Research suggests that military unit support and community postdeployment social support are associated with fewer PTSD symptoms following military deployment. This study extended prior research by examining the associations among predeployment unit support and PTSD symptoms before Iraq deployment as well as unit support, PTSD symptoms, and postdeployment social support after deployment among 835 U.S. Army and 173 National Guard soldiers. Multiple regression analyses indicated that predeployment unit support was not significantly associated with postdeployment PTSD severity in either group of soldiers, whereas higher unit support during deployment was significantly associated with lower postdeployment PTSD severity among active duty soldiers only. Among both groups, higher levels of postdeployment social support were associated with lower levels of postdeployment PTSD symptom severity. These findings suggest that postdeployment social support is a particularly strong buffer against postdeployment PTSD symptoms among both groups of soldiers whereas the effects of unit support may be limited.
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Affiliation(s)
- Sohyun C Han
- National Center for PTSD at VA Boston Healthcare System, 150 South Huntington Avenue, Boston, MA 02130, United States
| | - Frank Castro
- National Center for PTSD at VA Boston Healthcare System, 150 South Huntington Avenue, Boston, MA 02130, United States
| | - Lewina O Lee
- National Center for PTSD at VA Boston Healthcare System, 150 South Huntington Avenue, Boston, MA 02130, United States; Boston University School of Medicine, 72 East Concord Street, Boston, MA 02118, United States; Boston University School of Public Health, 715 Albany Street, Boston, MA 02118, United States
| | - Meredith E Charney
- VA Boston Healthcare System, 150 South Huntington Avenue, Boston, MA 02130, United States
| | - Brian P Marx
- National Center for PTSD at VA Boston Healthcare System, 150 South Huntington Avenue, Boston, MA 02130, United States; Boston University School of Medicine, 72 East Concord Street, Boston, MA 02118, United States
| | - Kevin Brailey
- VA Boston Healthcare System, 150 South Huntington Avenue, Boston, MA 02130, United States; Boston University School of Medicine, 72 East Concord Street, Boston, MA 02118, United States
| | - Susan P Proctor
- National Center for PTSD at VA Boston Healthcare System, 150 South Huntington Avenue, Boston, MA 02130, United States; U.S. Army Research Institute of Environmental Medicine, Natick, MA, United States; Boston University School of Public Health, 715 Albany Street, Boston, MA 02118, United States
| | - Jennifer J Vasterling
- National Center for PTSD at VA Boston Healthcare System, 150 South Huntington Avenue, Boston, MA 02130, United States; Boston University School of Medicine, 72 East Concord Street, Boston, MA 02118, United States.
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36
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Wisco BE, Marx BP, Holowka DW, Vasterling JJ, Han SC, Chen MS, Gradus JL, Nock MK, Rosen RC, Keane TM. Traumatic brain injury, PTSD, and current suicidal ideation among Iraq and Afghanistan U.S. veterans. J Trauma Stress 2014; 27:244-8. [PMID: 24639101 PMCID: PMC9040387 DOI: 10.1002/jts.21900] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Suicide is a prevalent problem among veterans deployed to Iraq and Afghanistan. Traumatic brain injury (TBI) and psychiatric conditions, such as posttraumatic stress disorder (PTSD), are potentially important risk factors for suicide in this population, but the literature is limited by a dearth of research on female veterans and imprecise assessment of TBI and suicidal behavior. This study examined 824 male and 825 female U.S. veterans who were enrolled in the baseline assessment of the Veterans After-Discharge Longitudinal Registry (Project VALOR), an observational registry of veterans with and without PTSD who deployed in support of the wars in Iraq and Afghanistan and were enrolled in the Veterans Affairs healthcare system. Results indicated that current depressive symptoms, PTSD, and history of prior TBI were all significantly associated with current suicidal ideation (Cohen's d = 0.91, Cramers' Vs = .19 and .08, respectively). After adding a number of variables to the model, including psychiatric comorbidity, TBI history was associated with increased risk of current suicidal ideation among male veterans only (RR = 1.55). TBI is an important variable to consider in future research on suicide among veterans of the wars in Iraq and Afghanistan, particularly among male veterans.
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Affiliation(s)
- Blair E. Wisco
- National Center for PTSD at VA Boston Healthcare System, Boston, MA, USA,Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA
| | - Brian P. Marx
- National Center for PTSD at VA Boston Healthcare System, Boston, MA, USA,Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA
| | - Darren W. Holowka
- National Center for PTSD at VA Boston Healthcare System, Boston, MA, USA,Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA
| | - Jennifer J. Vasterling
- National Center for PTSD at VA Boston Healthcare System, Boston, MA, USA,Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA
| | - Sohyun C. Han
- National Center for PTSD at VA Boston Healthcare System, Boston, MA, USA
| | - May S. Chen
- National Center for PTSD at VA Boston Healthcare System, Boston, MA, USA
| | - Jaimie L. Gradus
- National Center for PTSD at VA Boston Healthcare System, Boston, MA, USA,Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA,Department of Epidemiology, Boston University School of Public Health, Boston MA, USA
| | - Matthew K. Nock
- Department of Psychology, Harvard University, Cambridge, MA, USA
| | | | - Terence M. Keane
- National Center for PTSD at VA Boston Healthcare System, Boston, MA, USA,Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA
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Elbogen EB, Johnson SC, Newton VM, Timko C, Vasterling JJ, Van Male LM, Wagner HR, Beckham JC. Protective mechanisms and prevention of violence and aggression in veterans. Psychol Serv 2014; 11:220-8. [PMID: 24512537 DOI: 10.1037/a0035088] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Although a subset of Iraq and Afghanistan Veterans show aggression toward others after they return home from military service, little is known about protective mechanisms that could be bolstered to prevent violence. A national longitudinal survey was conducted between 2009 and 2011 using a random sample of veterans who served in Operation Iraqi Freedom or Operation Enduring Freedom. One thousand and ninety veterans, from 50 states representing all military branches, completed 2 waves of data collection, 1 year apart (retention rate = 79%). The final sample resembled the U.S. military post 9/11 in terms of age, sex, ethnicity, geography, and service branch. Protective mechanisms in socioeconomic (money to cover basic needs, stable employment), psychosocial (resilience, perceiving control over one's life, social support), and physical (healthy sleep, no physical pain) domains were examined. We found these protective mechanisms predicted decreased aggression and violence at follow-up, particularly among higher risk veterans. Multivariable analyses confirmed that protective mechanisms lowered violence through their interaction with risk factors. This study identifies protective mechanisms related to decreased community violence in veterans and indicates that rehabilitation aimed at improving socioeconomic, psychosocial, and physical well-being has potential promise to reduce aggression and violence among veterans after returning home from military service.
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Affiliation(s)
- Eric B Elbogen
- Department of Psychiatry, University of North Carolina-Chapel Hill
| | - Sally C Johnson
- Department of Psychiatry, University of North Carolina-Chapel Hill
| | | | - Christine Timko
- Center for Health Care Evaluation, Health Services Research and Development Service, VA Palo Alto Healthcare System
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Yurgil KA, Barkauskas DA, Vasterling JJ, Nievergelt CM, Larson GE, Schork NJ, Litz BT, Nash WP, Baker DG. Association between traumatic brain injury and risk of posttraumatic stress disorder in active-duty Marines. JAMA Psychiatry 2014; 71:149-57. [PMID: 24337530 DOI: 10.1001/jamapsychiatry.2013.3080] [Citation(s) in RCA: 150] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Whether traumatic brain injury (TBI) is a risk factor for posttraumatic stress disorder (PTSD) has been difficult to determine because of the prevalence of comorbid conditions, overlapping symptoms, and cross-sectional samples. OBJECTIVE To examine the extent to which self-reported predeployment and deployment-related TBI confers increased risk of PTSD when accounting for combat intensity and predeployment mental health symptoms. DESIGN, SETTING, AND PARTICIPANTS As part of the prospective, longitudinal Marine Resiliency Study (June 2008 to May 2012), structured clinical interviews and self-report assessments were administered approximately 1 month before a 7-month deployment to Iraq or Afghanistan and again 3 to 6 months after deployment. The study was conducted at training areas on a Marine Corps base in southern California or at Veterans Affairs San Diego Medical Center. Participants for the final analytic sample were 1648 active-duty Marine and Navy servicemen who completed predeployment and postdeployment assessments. Reasons for exclusions were nondeployment (n = 34), missing data (n = 181), and rank of noncommissioned and commissioned officers (n = 66). MAIN OUTCOMES AND MEASURES The primary outcome was the total score on the Clinician-Administered PTSD Scale (CAPS) 3 months after deployment. RESULTS At the predeployment assessment, 56.8% of the participants reported prior TBI; at postdeployment assessment, 19.8% reported sustaining TBI between predeployment and postdeployment assessments (ie, deployment-related TBI). Approximately 87.2% of deployment-related TBIs were mild; 250 of 287 participants (87.1%) who reported posttraumatic amnesia reported less than 24 hours of posttraumatic amnesia (37 reported ≥ 24 hours), and 111 of 117 of those who lost consciousness (94.9%) reported less than 30 minutes of unconsciousness. Predeployment CAPS score and combat intensity score raised predicted 3-month postdeployment CAPS scores by factors of 1.02 (P < .001; 95% CI, 1.02-1.02) and 1.02 (P < .001; 95% CI, 1.01-1.02) per unit increase, respectively. Deployment-related mild TBI raised predicted CAPS scores by a factor of 1.23 (P < .001; 95% CI, 1.11-1.36), and moderate/severe TBI raised predicted scores by a factor of 1.71 (P < .001; 95% CI, 1.37-2.12). Probability of PTSD was highest for participants with severe predeployment symptoms, high combat intensity, and deployment-related TBI. Traumatic brain injury doubled or nearly doubled the PTSD rates for participants with less severe predeployment PTSD symptoms. CONCLUSIONS AND RELEVANCE Even when accounting for predeployment symptoms, prior TBI, and combat intensity, TBI during the most recent deployment is the strongest predictor of postdeployment PTSD symptoms.
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Affiliation(s)
- Kate A Yurgil
- Department of Psychiatry, Veterans Affairs San Diego Healthcare System, San Diego, California2Veterans Affairs Center of Excellence for Stress and Mental Health, San Diego, California
| | - Donald A Barkauskas
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles
| | - Jennifer J Vasterling
- Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts 5Division of Behavioral Sciences, Veterans Affairs National Center for Posttraumatic Stress Syndrome, Boston, Massachusetts 6Department of Psychology, Veterans Affairs B
| | - Caroline M Nievergelt
- Department of Psychiatry, Veterans Affairs San Diego Healthcare System, San Diego, California2Veterans Affairs Center of Excellence for Stress and Mental Health, San Diego, California7Department of Psychiatry, School of Medicine, University of California
| | - Gerald E Larson
- Department of Behavioral Science and Epidemiology, Naval Health Research Center, San Diego, California
| | - Nicholas J Schork
- Department of Molecular and Experimental Medicine, Scripps Translational Research Institute, San Diego, California
| | - Brett T Litz
- Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts 5Division of Behavioral Sciences, Veterans Affairs National Center for Posttraumatic Stress Syndrome, Boston, Massachusetts 6Department of Psychology, Veterans Affairs B
| | - William P Nash
- Boston Veterans Affairs Research Institute, Boston, Massachusetts
| | - Dewleen G Baker
- Department of Psychiatry, Veterans Affairs San Diego Healthcare System, San Diego, California2Veterans Affairs Center of Excellence for Stress and Mental Health, San Diego, California7Department of Psychiatry, School of Medicine, University of California
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Vogt D, Smith BN, King LA, King DW, Knight J, Vasterling JJ. Deployment risk and resilience inventory-2 (DRRI-2): an updated tool for assessing psychosocial risk and resilience factors among service members and veterans. J Trauma Stress 2013; 26:710-7. [PMID: 24490250 DOI: 10.1002/jts.21868] [Citation(s) in RCA: 188] [Impact Index Per Article: 17.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
The Deployment Risk and Resilience Inventory (DRRI) is a widely used instrument for assessing deployment-related risk and resilience factors among war veterans. A revision of this instrument was recently undertaken to enhance the DRRI’s applicability across a variety of deployment-related circumstances and military subgroups. The resulting suite of 17 distinct DRRI-2 scales is the product of a multiyear psychometric endeavor that involved (a) focus groups with Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF) veterans to inform an assessment of the content validity of original DRRI measures, (b) examination of item and scale characteristics of revised scales in a national sample of 469 OEF/OIF veterans, and (c) administration of refined scales to a second national sample of 1,046 OEF/OIF veterans to confirm their psychometric quality. Both classical test theory and item response theory analytical strategies were applied to inform major revisions, which included updating the coverage of warfare-related stressors, expanding the assessment of family factors throughout the deployment cycle, and shortening scales. Finalized DRRI-2 scales demonstrated strong internal consistency reliability and criterion-related validity. The DRRI-2 can be applied to examine the role that psychosocial factors play in post deployment health and inform interventions aimed at reducing risk and enhancing resilience among war veterans.
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Affiliation(s)
- Dawne Vogt
- Women's Health Sciences Division, National Center for PTSD; VA Boston Healthcare System; Boston Massachusetts USA
- Department of Psychiatry; Boston University School of Medicine; Boston Massachusetts USA
| | - Brian N. Smith
- Women's Health Sciences Division, National Center for PTSD; VA Boston Healthcare System; Boston Massachusetts USA
- Department of Psychiatry; Boston University School of Medicine; Boston Massachusetts USA
| | - Lynda A. King
- Women's Health Sciences Division, National Center for PTSD; VA Boston Healthcare System; Boston Massachusetts USA
- Department of Psychiatry; Boston University School of Medicine; Boston Massachusetts USA
- Department of Psychology; Boston University School of Medicine; Boston Massachusetts USA
| | - Daniel W. King
- Department of Psychiatry; Boston University School of Medicine; Boston Massachusetts USA
- Department of Psychology; Boston University School of Medicine; Boston Massachusetts USA
- Behavioral Sciences Division; National Center for PTSD, VA Boston Healthcare System; Boston Massachusetts USA
| | - Jeffrey Knight
- Department of Psychiatry; Boston University School of Medicine; Boston Massachusetts USA
- Behavioral Sciences Division; National Center for PTSD, VA Boston Healthcare System; Boston Massachusetts USA
| | - Jennifer J. Vasterling
- Department of Psychiatry; Boston University School of Medicine; Boston Massachusetts USA
- Behavioral Sciences Division; National Center for PTSD, VA Boston Healthcare System; Boston Massachusetts USA
- Psychology Service; VA Boston Healthcare System; Boston Massachusetts USA
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Franz MR, Wolf EJ, MacDonald HZ, Marx BP, Proctor SP, Vasterling JJ. Relationships among predeployment risk factors, warzone-threat appraisal, and postdeployment PTSD symptoms. J Trauma Stress 2013; 26:498-506. [PMID: 23893499 DOI: 10.1002/jts.21827] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Previous research indicates a relationship between perceived fear for one's safety (i.e., threat appraisal) and posttraumatic stress disorder (PTSD). This prospective study examined relationships among deployment- and predeployment-related variables, threat appraisal, and postdeployment PTSD symptom severity. Prior to Iraq deployment, 774 U.S. Army soldiers completed self-report measures assessing previous life stressors, deployment history, current (predeployment) PTSD symptoms, deployment preparedness, and unit cohesion. Following deployment, participants completed self-report measures assessing combat intensity, deployment threat appraisal, and current (postdeployment) PTSD symptoms. Structural equation modeling revealed that predeployment PTSD symptom severity, prior warzone deployment, unit cohesion, and preparedness were each independently associated with deployment threat appraisal, even after taking into account combat intensity. Deployment threat appraisal was associated with postdeployment PTSD severity. Results indicated that predeployment PTSD symptom severity, history of warzone deployment, and preparedness-risk factors previously thought to influence PTSD outcomes directly-were either partially or fully mediated by threat appraisal. The model explained 15% of the variance in deployment threat appraisal and 50% of the variance in postdeployment PTSD severity. Helping service members cope with exposure to extreme stress during deployment by modifying certain prewar risk factors may facilitate reduction of PTSD symptoms following deployment.
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Affiliation(s)
- Molly R Franz
- Research Service, VA Boston Healthcare System, Boston, Massachusetts 02130, USA
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Elbogen EB, Wagner HR, Johnson SC, Kinneer P, Kang H, Vasterling JJ, Timko C, Beckham JC. Are Iraq and Afghanistan veterans using mental health services? New data from a national random-sample survey. Psychiatr Serv 2013; 64:134-41. [PMID: 23475498 PMCID: PMC3622866 DOI: 10.1176/appi.ps.004792011] [Citation(s) in RCA: 116] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE This study analyzed data from a national survey of Iraq and Afghanistan veterans to improve understanding of mental health services use and perceived barriers. METHODS The National Post-Deployment Adjustment Survey randomly sampled post-9/11 veterans separated from active duty or in the Reserves or National Guard. The corrected response rate was 56% (N=1,388). RESULTS Forty-three percent screened positive for posttraumatic stress disorder (PTSD), major depression, or alcohol misuse. Past-year psychiatric treatment was reported by 69% of the PTSD group, 67% of the depression group, and 45% of those with alcohol misuse. Most received care at Veterans Affairs (VA) facilities, although women were more likely than men to seek non-VA services. Veterans with more severe symptoms reported greater treatment utilization. Eighteen percent saw a pastoral counselor (chaplain) in the past year. Veterans with mental health needs who did not access treatment were more likely to believe that they had to solve problems themselves and that medications would not help. Those who had accessed treatment were more likely to express concern about being seen as weak by others. CONCLUSIONS Veterans in greatest need were more likely to access services. More than two-thirds with probable PTSD obtained past-year treatment, mostly at VA facilities. Treatment for veterans may be improved by increasing awareness of gender differences, integrating mental health and pastoral services, and recognizing that alcohol misuse may reduce utilization. Veterans who had and had not used services endorsed different perceptions about treatment, indicating that barriers to accessing care may be distinct from barriers to engaging in care.
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Affiliation(s)
- Eric B Elbogen
- Department of Psychiatry, University of North Carolina at Chapel Hill, CB 7167, Durham, NC 27599, USA.
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MacDonald HZ, Proctor SP, Heeren T, Vasterling JJ. Associations of postdeployment PTSD symptoms with predeployment symptoms in Iraq-deployed Army soldiers. Psychological Trauma: Theory, Research, Practice, and Policy 2013. [DOI: 10.1037/a0029010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Elbogen EB, Johnson SC, Newton VM, Straits-Troster K, Vasterling JJ, Wagner HR, Beckham JC. Criminal justice involvement, trauma, and negative affect in Iraq and Afghanistan war era veterans. J Consult Clin Psychol 2012; 80:1097-102. [PMID: 23025247 PMCID: PMC3514623 DOI: 10.1037/a0029967] [Citation(s) in RCA: 85] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Although criminal behavior in veterans has been cited as a growing problem, little is known about why some veterans are at increased risk for arrest. Theories of criminal behavior postulate that people who have been exposed to stressful environments or traumatic events and who report negative affect such as anger and irritability are at increased risk of antisocial conduct. METHOD We hypothesized veterans with posttraumatic stress disorder (PTSD) or traumatic brain injury (TBI) who report anger/irritability would show higher rates of criminal arrests. To test this, we examined data in a national survey of N = 1,388 Iraq and Afghanistan war era veterans. RESULTS We found that 9% of respondents reported arrests since returning home from military service. Most arrests were associated with nonviolent criminal behavior resulting in incarceration for less than 2 weeks. Unadjusted bivariate analyses revealed that veterans with probable PTSD or TBI who reported anger/irritability were more likely to be arrested than were other veterans. In multivariate analyses, arrests were found to be significantly related to younger age, male gender, having witnessed family violence, prior history of arrest, alcohol/drug misuse, and PTSD with high anger/irritability but were not significantly related to combat exposure or TBI. CONCLUSIONS Findings show that a subset of veterans with PTSD and negative affect may be at increased risk of criminal arrest. Because arrests were more strongly linked to substance abuse and criminal history, clinicians should also consider non-PTSD factors when evaluating and treating veterans with criminal justice involvement.
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Affiliation(s)
- Eric B Elbogen
- University of North Carolina–Chapel Hill School of Medicine and Veterans, Durham, NC, USA.
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Tharp AT, Constans JI, Yin R, Sullivan G, Vasterling JJ, Rouse J, Schreiber MD, King M. Service provision in disaster preparation, response, and recovery for individuals with predisaster mental illness. Am J Disaster Med 2012; 7:171-4. [PMID: 23140060 DOI: 10.5055/ajdm.2012.0092] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Individuals with preexisting mental disorders are at increased risk for negative outcomes following a disaster and are one type of vulnerable subpopulation that requires special consideration in disaster preparedness, response, and recovery. We describe evidence of the increased risk for individuals with predisaster mental illness as well as tools for field triage, the critical role of partnerships in preparedness and response, and integration of mental health as a priority in emergency management systems. Considering individuals with predisaster mental disorders at each phase of a disaster may ameliorate some negative postdisaster outcomes, such as suicide.
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Constans JI, Vasterling JJ, Deitch E, Han X, Tharp ALT, Davis TD, Sullivan G. Pre-Katrina mental illness, postdisaster negative cognitions, and PTSD symptoms in male veterans following Hurricane Katrina. ACTA ACUST UNITED AC 2012. [DOI: 10.1037/a0027487] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Gates MA, Holowka DW, Vasterling JJ, Keane TM, Marx BP, Rosen RC. Posttraumatic stress disorder in veterans and military personnel: epidemiology, screening, and case recognition. Psychol Serv 2012; 9:361-382. [PMID: 23148803 DOI: 10.1037/a0027649] [Citation(s) in RCA: 133] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Posttraumatic stress disorder (PTSD) is a psychiatric disorder that affects 7-8% of the general U.S. population at some point during their lifetime; however, the prevalence is much higher among certain subgroups, including active duty military personnel and veterans. In this article, we review the empirical literature on the epidemiology and screening of PTSD in military and veteran populations, including the availability of sensitive and reliable screening tools. Although estimates vary across studies, evidence suggests that the prevalence of PTSD in deployed U.S. military personnel may be as high as 14-16%. Prior studies have identified trauma characteristics and pre- and posttrauma factors that increase risk of PTSD among veterans and military personnel. This information may help to inform prevention and screening efforts, as screening programs could be targeted to high-risk populations. Large-scale screening efforts have recently been implemented by the U.S. Departments of Defense and Veterans Affairs. Given the prevalence and potential consequences of PTSD among veterans and active duty military personnel, development and continued evaluation of effective screening methods is an important public health need.
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Affiliation(s)
| | | | | | | | - Brian P Marx
- National Center for PTSD, VA Boston Healthcare System
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Davis TD, Sullivan G, Vasterling JJ, Tharp ALT, Han X, Deitch EA, Constans JI. Racial variations in postdisaster PTSD among veteran survivors of Hurricane Katrina. ACTA ACUST UNITED AC 2012. [DOI: 10.1037/a0025501] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Vasterling JJ, Brailey K, Proctor SP, Kane R, Heeren T, Franz M. Neuropsychological outcomes of mild traumatic brain injury, post-traumatic stress disorder and depression in Iraq-deployed US Army soldiers. Br J Psychiatry 2012; 201:186-92. [PMID: 22743844 DOI: 10.1192/bjp.bp.111.096461] [Citation(s) in RCA: 132] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Traumatic brain injury (TBI) is a concern of contemporary military deployments. Whether milder TBI leads to enduring impairment remains controversial. AIMS To determine the influence of deployment TBI, and post-traumatic stress disorder (PTSD) and depression symptoms on neuropsychological and functional outcomes. METHOD A sample of 760 US Army soldiers were assessed pre- and post-deployment. Outcomes included neuropsychological performances and subjective functional impairment. RESULTS In total, 9% of the participants reported (predominantly mild) TBI with loss of consciousness between pre- and post-deployment. At post-deployment, 17.6% of individuals with TBI screened positive for PTSD and 31.3% screened positive for depression. Before and after adjustment for psychiatric symptoms, TBI was significantly associated only with functional impairment. Both PTSD and depression symptoms adjusted for TBI were significantly associated with several neuropsychological performance deficits and functional impairment. CONCLUSIONS Milder TBI reported by deployed service members typically has limited lasting neuropsychological consequences; PTSD and depression are associated with more enduring cognitive compromise.
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Affiliation(s)
- Jennifer J Vasterling
- VA Boston Healthcare System and Boston University School of Medicine, Boston, MA 02130, USA.
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Tharp AT, Vasterling JJ, Sullivan G, Han X, Davis T, Deitch EA, Constans J. Effects of pre- and post-Katrina nonviolent and violent experiences on male veterans' psychological functioning. Disaster Med Public Health Prep 2012; 5 Suppl 2:S227-34. [PMID: 21908700 DOI: 10.1001/dmp.2011.47] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND Identifying individuals at risk for mental health problems after a disaster often involves assessing potentially traumatic exposures inherent to the disaster. Survivors of disasters also may have been exposed, both before and during the event, to trauma not directly related to the disaster. A substantial literature suggests exposure to interpersonal violence may have more severe negative outcomes than exposure to non-violent events; however, it is unclear whether violent vs nonviolent exposures before and during a disaster have differential effects on postdisaster psychological functioning. METHODS We examined the associations of violent and nonviolent exposures before and during Hurricane Katrina with postdisaster psychological functioning in a sample of male military veterans. RESULTS Violent and nonviolent exposures post-Hurricane Katrina as well as pre-Katrina violent exposures were significantly associated with symptoms of posttraumatic stress disorder, panic, and generalized anxiety disorder more than 2 years after the storm. Moreover, veterans who reported violent exposures pre-Katrina were more than 4 times more likely to have reexperienced interpersonal violence during Katrina than those who did not report such exposures. CONCLUSIONS Results suggest assessing disaster-specific experiences in addition to predisaster interpersonal violence may be important for identifying and triaging individuals at risk for postdisaster mental health problems.
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Elbogen EB, Johnson SC, Wagner HR, Newton VM, Timko C, Vasterling JJ, Beckham JC. Protective factors and risk modification of violence in Iraq and Afghanistan War veterans. J Clin Psychiatry 2012; 73:e767-73. [PMID: 22795217 PMCID: PMC3399731 DOI: 10.4088/jcp.11m07593] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2011] [Accepted: 04/18/2012] [Indexed: 10/28/2022]
Abstract
OBJECTIVE After returning home, a subset of Iraq and Afghanistan War veterans report engaging in aggression toward others. This study is the first to identify variables empirically related to decreased risk of community violence among veterans. METHOD The authors conducted a national survey from July 2009 to April 2010 in which participants were randomly drawn from over 1 million US military service members who served after September 11, 2001. Data were collected from a total of 1,388 Iraq and Afghanistan War era and theater veterans. The final sample included veterans from all 50 states and all military branches. RESULTS One-third of survey respondents self-identified committing an act of aggression toward others during the past year, mostly involving minor aggressive behavior. Younger age, criminal arrest record, combat exposure, probable posttraumatic stress disorder, and alcohol misuse were positively related to violence toward others. Controlling for these covariates, multivariate analyses showed that stable living situation and the perception of having control over one's life were associated with reduced odds of severe violence (R2 = 0.24, χ27 = 145.03, P < .0001). Greater resilience, perceiving positive social support, and having money to cover basic needs were linked to reduced odds of other physical aggression (R2 = 0.20, χ28 = 188.27, P < .0001). CONCLUSIONS The study identifies aggression as a problem for a subset of Iraq and Afghanistan War veterans who endorsed few protective factors. Analyses revealed that protective factors added incremental value to statistical modeling of violence, even when controlling for robust risk factors. The data indicate that, in addition to clinical interventions directed at treating mental health and substance abuse problems, psychosocial rehabilitation approaches aimed at improving domains of basic functioning and psychological well-being may also be effective in modifying risk and reducing violence among veterans.
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Affiliation(s)
- Eric B. Elbogen
- Department of Psychiatry, Forensic Psychiatry Program and Clinic, University of North Carolina-Chapel Hill School of Medicine, Chapel Hill, NC,VISN 6 Mental Illness Research, Education, and Clinical Center (MIRECC), Durham VA Medical Center, Durham, NC
| | - Sally C. Johnson
- Department of Psychiatry, Forensic Psychiatry Program and Clinic, University of North Carolina-Chapel Hill School of Medicine, Chapel Hill, NC
| | - H. Ryan Wagner
- VISN 6 Mental Illness Research, Education, and Clinical Center (MIRECC), Durham VA Medical Center, Durham, NC,Department of Psychiatry, Duke University Medical Center, Durham, NC
| | - Virginia M. Newton
- Department of Psychiatry, Forensic Psychiatry Program and Clinic, University of North Carolina-Chapel Hill School of Medicine, Chapel Hill, NC,VISN 6 Mental Illness Research, Education, and Clinical Center (MIRECC), Durham VA Medical Center, Durham, NC
| | - Christine Timko
- Center for Health Care Evaluation, Health Services Research & Development Service, VA Palo Health Care System,Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, CA
| | - Jennifer J. Vasterling
- Psychology Service, VA National Center for PTSD, VA Boston Healthcare System, Boston, MA,Department of Psychiatry, Boston University School of Medicine, Boston, MA
| | - Jean C. Beckham
- VISN 6 Mental Illness Research, Education, and Clinical Center (MIRECC), Durham VA Medical Center, Durham, NC,Department of Psychiatry, Duke University Medical Center, Durham, NC
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