Suchergebnisse

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

Suicide and violence are significant problems in a subset of Iraq/Afghanistan-era veterans. This study investigates how posttraumatic stress disorder (PTSD) and resilience in veterans are associated with suicidal ideation and violent impulses while controlling for known covariates of both adverse outcomes. Structured clinical interviews were conducted of N=2,543 Iraq/Afghanistan-era US veterans. Compared to veterans denying suicidal ideation or violent impulses (n=1927), veterans endorsing both (n=171) were more likely to meet diagnostic criteria for PTSD, report childhood abuse, combat exposure, physical pain symptoms, and drug misuse, and less likely to endorse self-direction/life purpose. Veterans reporting concurrent suicidal ideation and violent impulses had higher odds of misusing drugs and reporting pain symptoms relative to veterans reporting suicidal ideation only (n=186) and had lower odds of endorsing self-direction/life purpose compared to Veterans reporting violent impulses only (n=259). The findings underscore the importance of examining drug abuse, physical pain symptoms, and self-direction/life purpose, as well as PTSD and history of trauma, in the context of clinical assessment and empirical research aimed at optimizing risk management of suicide and violence in military veterans.

Death by suicide and suicidal behavior are major concerns among U.S. military veterans; however, no genome-wide association studies (GWAS) studies of suicidal behavior have been conducted among U.S. military veterans to date, despite the elevated rate of suicidal behavior observed within this population. Accordingly, the primary objective of the present research was to conduct the first GWAS of suicide attempts and suicidal ideation in a large and well-characterized sample of U.S. military veterans. The gene most significantly associated (p=9.28×10(−7)) with suicide attempts was the Potassium Calcium-Activated Channel Subfamily M Regulatory Beta Subunit 2 (KCNMB2) gene, which plays a key role in neuronal excitability. In addition, replication analyses provided additional support for the potential role of the ABI Family Member 3 Binding Protein (ABI3BP) gene in the pathogenesis of suicidal behavior, as numerous nominal associations were found between this gene and both suicide attempts and suicidal ideation. Additional work aimed at replicating and extending these findings is needed.

The polytrauma clinical triad refers to the co-occurrence of chronic pain, traumatic brain injury (TBI), and posttraumatic stress disorder (PTSD). Despite research implicating dyadic relationships between these conditions and adverse outcomes, scant research has examined the polytrauma clinical triad's relation to suicide or violence. The present cross-sectional study was designed to examine whether this complex clinical presentation increases risk of suicidal ideation and violent impulses after accounting for other established risk factors. Veterans who served in the military since 9/11/01 (N = 667) who reported chronic pain completed an interview and self-report battery. Bivariate analyses showed that suicidal ideation and violent impulses both correlated with PTSD, TBI+PTSD, pain intensity and interference, drug abuse, and major depressive disorder (MDD). Multiple regression analyses showed that (a) race, chronic pain with PTSD, alcohol abuse, and MDD significantly predicted suicidal ideation, (b) pain interference, chronic pain with TBI, chronic pain with PTSD, chronic pain with TBI+PTSD, drug abuse, and MDD significantly predicted violent impulses, and (c) pain interference was a more critical predictor of suicidal and violent ideation than pain intensity. Implications for risk assessment and treatment are discussed.

Distress tolerance (i.e., perceived or actual capacity to tolerate aversive internal states) has received considerable research attention as a transdiagnostic risk-factor underlying the development and maintenance of psychopathology. Lower levels of emotional distress tolerance have been linked to psychopathology (e.g. Posttraumatic Stress Disorder) within Military populations; however, the association of physical distress tolerance to psychopathology in this population has been under-researched. This research gap may be due in part to a paucity of comprehensive, temporally stable and brief measures of distress tolerance that have been validated within Military populations, which may hinder further examination and refinement of the construct. Addressing this problem, the current study evaluates the psychometric properties of a novel and brief measure of emotional and physical distress tolerance in a sample of United States post-9/11 Veterans. Participants were 307 Veterans (M(age)= 38.9, 67.7% male) who completed the 10-item Distress Tolerance Inventory at baseline and annual follow-up. Exploratory structural equation modeling was used to examine the optimal latent factor structure and longitudinal invariance of the DTI measurement model, along with correlational analyses to examine the convergent properties of the DTI subscales. The DTI reflected a longitudinally invariant two-factor structure (emotional and physical distress tolerance), with excellent internal consistency and preliminary evidence of convergent validity. Thus, the DTI represents a brief, reliable and temporally stable measure of physical and emotional distress tolerance.

BACKGROUND: This study investigates the empirical association between psychosocial protective factors and subsequent suicidal ideation in veterans. METHODS: We conducted a national longitudinal survey in which participants were randomly drawn from over one million U. S. military service members who served after September 11, 2001. Data were provided by a total of 1090 veterans representative of all 50 states and all military branches in two waves of data collection one year apart (79% retention rate). RESULTS: In chi-square analyses, psychosocial protective factors at wave 1 (employment, meeting basic needs, self-care, living stability, social support, spirituality, resilience, and self-determination) were significantly related to lower suicidal ideation at wave 2 (p<.01). In multivariable analyses controlling for covariates at wave 1 including suicidal ideation, the total number of protective factors endorsed at wave 1 significantly predicted reduced odds of suicidal ideation at wave 2. In multivariable analysis examining individual risk and protective factors, again controlling for covariates, results showed that money to cover basic needs and higher psychological resilience at wave 1 were associated with significantly lower odds of suicidal ideation at wave 2. LIMITATIONS: The study measured the link between psychosocial protective factors and suicidal ideation but not suicide attempts, which would be an important next step for this research. CONCLUSIONS: The results indicate that psychosocial rehabilitation and holistic approaches targeting these protective factors may offer a promising avenue in both veteran and non-veteran populations for treatment safety planning as well as suicide risk management and prevention.

OBJECTIVE/BACKGROUND: Despite a well-established role of guilt cognitions in the maintenance and treatment of posttraumatic stress disorder (PTSD), relationships of guilt cognitions to nightmares are not well understood. This study investigated the ways in which guilt cognitions related to traumatic events influenced the relationship between combat exposure and trauma-related sleep disturbance in military Veterans with PTSD. PARTICIPANTS: We recruited a sample of 50 Veterans with PTSD who completed study measures at a screening session. METHODS: Participants completed self-report measures of exposure to potentially traumatic events, trauma-related guilt (hindsight bias, wrongdoing, and lack of justification) and trauma-related sleep disturbance as measured by a self-report scale and clinician ratings of nightmare severity. RESULTS: Bivariate regression analyses established a relationship of combat exposure to wrongdoing (β = .31, p = .031), and a relationship of wrongdoing with self-reported trauma-related sleep disturbance (β = .27, p = .049) and clinician-rated nightmare severity (β = .36, p = .009). Bootstrapping analysis that included years of education as a covariate found a significant overall indirect effect of combat exposure on clinician-rated nightmare severity exerted through wrongdoing (β = .10, 95% CI [.004, .246]). CONCLUSIONS: Results suggest the association of combat exposure with trauma-related sleep disturbance is significantly influenced by perceived wrongdoing related to a traumatic event. Targeting cognitions related to wrongdoing and moral injury during a traumatic event in PTSD treatment may help ameliorate trauma-related sleep disturbance.

Military sexual trauma (MST) has been linked with increased rates of mental health disorders among veterans. Few studies have addressed how military sexual trauma is related to use of VA and non-VA health care. The purpose of the current study was to (1) examine the association between MST, combat experiences and mental health outcomes (i.e., PTSD and depression) and (2) examine the association of MST and use of VA and non-VA health care services among female veterans who served in Iraq and Afghanistan. Female respondents to a survey assessing OEF/OIF veterans' needs and health (N=185) completed measures of demographic variables, military history, combat exposure, MST, PTSD and depression symptoms, and use of VA and non-VA healthcare. Overall, 70% of the sample experienced one or more combat-related experiences and 15.7% endorsed MST during deployment to Iraq or Afghanistan. MST and combat exposure were both positively associated with PTSD and depression symptoms even after controlling for the effects of demographic and military history variables; the interaction between MST and combat exposure was not a significant predictor of PTSD or depression symptoms. MST was associated with increased use of VA mental health services in bivariate results but was not independently related to VA service utilization after accounting for PTSD and depression symptoms. MST and combat exposure are significantly related to PTSD and depression symptoms among female OEF/OIF veterans, but there was not a synergistic effect of these two types of trauma in the current study. Approximately half of women who report MST have not used VA healthcare. Continued outreach and education initiatives may be needed to ensure veterans understand the resources available to address MST related mental and physical health problems through the VA.

The present research sought to replicate the finding that military sexual trauma (MST) moderates the effect of critical warzone experiences on mental health outcomes in a sample of male veterans. One-hundred eighty-one male veterans completed measures of MST, critical warzone experiences, and mental health symptoms. The hypothesized interaction was not significant, nor was a significant main effect observed for MST. In contrast, both critical warzone experiences and childhood maltreatment had significant main effects.

OBJECTIVE: Previous studies of military veterans have produced mixed findings regarding whether combat exposure is directly related to suicidal ideation or is indirectly related to suicidal ideation via its influence on other factors. The present study used a longitudinal design to test the hypothesis that posttraumatic stress disorder (PTSD) symptom severity mediates the effect of combat exposure on suicidal ideation in veterans METHOD: Participants included 319 post-9/11 Veterans (83.4% male; 42.1% White/52.1% Black; M(age) = 39.7) assessed at baseline, 6 months, and 12 months. Structural equation modeling and bootstrapped confidence intervals were employed to examine the direct and indirect relationships between combat exposure, suicidal ideation, and PTSD symptom severity. RESULTS: Results from the mediation model, in which demographic variables and non-combat trauma were included as covariates, revealed that the indirect effect of combat exposure on suicidal ideation via PTSD symptom severity was statistically significant, accounting for 64.1% of the covariance between combat exposure and suicidal ideation. CONCLUSIONS: This study provides longitudinal evidence that the effects of combat exposure on suicidal ideation are mediated by PTSD symptom severity, suggesting the importance of targeting such symptoms in treatment to mitigate suicide risk among veterans with combat exposure.