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The presence of naturally occurring and man-made public health threats necessitate the design and implementation of mitigation strategies, such that adequate response is provided in a timely manner. Since multiple variables, such as geographic properties, resource constraints, and government mandated time-frames must be accounted for, computational methods provide the necessary tools to develop contingency response plans while respecting underlying data and assumptions. A typical response scenario involves the placement of points of dispensing (PODs) in the affected geographic region to supply vaccines or medications to the general public. Computational tools aid in the analysis of such response plans, as well as in the strategic placement of PODs, such that feasible response scenarios can be developed. Due to the sensitivity of bio-emergency response plans, geographic information, such as POD locations, must be kept confidential. The generation of synthetic geographic regions allows for the development of emergency response plans on non-sensitive data, as well as for the study of the effects of single geographic parameters. Further, synthetic representations of geographic regions allow for results to be published and evaluated by the scientific community. This dissertation presents methodology for the analysis of bio-emergency response plans, methods for plan optimization, as well as methodology for the generation of synthetic geographic regions.

This quasi-experimental study investigates neuropsychological functioning differences between 63 active duty soldiers who were placed into three groups (MTBI, PTSD, control) to provide better information for differentiating PTSD and MTBI. The ANAM and MicroCog were utilized to measure psychomotor speed, memory, and attention. Participants with PTSD performed worse on most measures of psychomotor speed and attention, and endorsed more symptoms of depression and anxiety when compared to MTBI and control participants. Further, attention appears to be the best cognitive domain for differentiating PTSD from MTBI, whereas memory variables did not differentiate these groups. Clinical and research implications of these findings are discussed.

Today’s military encompasses a wide variety of families who are affected by deployments in multiple and complex ways. Following deployments, families must reconnect in their relationships and reestablish their way of life. Appropriate and effective communication during this time is critical, yet many military couples struggle with this process. Moreover, student service members/veterans and their families are in a unique position. In addition to coping with changes in their marital relationship, student veterans may feel isolated or unsupported on college campuses, often experiencing anxiety, depression, posttraumatic stress, or suicidality. The current study seeks to bridge the gap between the military family literature and the student service member/veteran literature by examining how deployment experiences, mental health issues, and communication patterns influence post-deployment relationship adjustment among student veterans. Analyses tested whether communication style and/or current mental health concerns mediate associations between combat experiences and couples’ relationship adjustment, as well as between experiences in the aftermath of battle and relationship adjustment. Results suggest that although posttraumatic stress is significantly related to deployment experiences among student veterans, participants report no significant negative effects of deployment on relationship adjustment. Communication style, however, was significantly associated with relationship adjustment, and a lack of positive communication was found to correlate with PTSD diagnosis. Research and clinical implications are discussed.

With the current military mental health crisis, it is important to understand the role of the leader in military mental health. First, the impact of military leader behaviors on the well-being of military personnel is reviewed. Next, the role of leader attitudes as a precursor to leader behaviors is discussed. The relation of leader behaviors to leader personality using the NEO Five Factor Model (FFM) is reviewed, as well as the relation of prejudicial attitudes to the NEO FFM personality factors. A research project is described that attempted to draw these concepts together, assessing the NEO FFM personality dimensions and mental health attitudes of US Army ROTC cadets, the future leaders of the US Army. No significant relations were observed between NEO FFM personality traits and mental health attitudes, even after controlling for Impression Management. Also, the predicted positive correlation between positive mental health attitudes and Impression Management was not found. These results suggest that more research and more refined measures are needed in the area of leader attitudes toward soldier mental health problems, and how those attitudes might impact the soldiers.

Human beings have two apparently conflicting fundamental rights. On the one hand, individuals have a right to health care as the United Nations declared in 1948. On the other hand, individuals have a right to liberty; that is, the freedom to make one's own health related choices, even poor ones. One goal of this essay is to show how to reconcile these two apparently conflicting core American values. This reconciliation is important, because a universal health care system that is fair and just must account for individual rights in tandem with attempts to address matters of social justice. In order for this reconciliation to occur, matters of individual responsibility, social responsibility, and social justice must be central to health care reform. / by Jennifer Lynn Mantoni. / Vita. / Thesis (M.A.)--Florida Atlantic University, 2011. / Includes bibliography. / Electronic reproduction. Boca Raton, Fla., 2011. Mode of access: World Wide Web.

This study examined a mediational model of mental illness stigma, parent-child communication about mental health concerns, and help seeking attitudes/behaviors among young adults with at least one immigrant parent while considering the possible moderating effect of acculturation gap. The primary goal of this study was to examine whether the acculturation gap changed the relation between mental illness stigma and communication about personal mental health concerns with immigrant parents, which in turn could become a significant predictor of their help-seeking attitudes, as well as a barrier to seeking professional mental health services. Findings provided support to the direct and indirect effects of mental illness stigma through communication about mental health concerns on attitudes about help-seeking. The acculturation gap hypothesized to be a possible moderator for the stigma-communication about mental health concerns relationship among young adult ABCI was found to be significant for ABCI with a low mainstream culture acculturation gap. Discussion on the findings, limitations of the study, future research directions, and counseling implications are addressed.

Indiana University-Purdue University Indianapolis (IUPUI) / Symptoms of post-traumatic stress disorder (PTSD) are a common comorbidity in veterans seeking treatment of chronic musculoskeletal pain (CMP). However, little is known regarding the mutual influence of PTSD and CMP in this population. Using cross-sectional and longitudinal data from a randomized clinical trial evaluating a stepped care intervention for CMP in Iraq/Afghanistan veterans (ESCAPE), this dissertation examined the relationships between PTSD and CMP along with other factors including depression, anxiety, catastrophizing and health-related quality of life. The Classification and Regression Tree (CART) analysis was conducted to identify key factors associated with baseline PTSD besides CMP severity. A series of statistical analyses including logistical regression analysis, mixed model repeated measure analysis, confirmatory factor analysis and cross-lagged panel analysis via structural equation modeling were conducted to test five competing models of PTSD symptom clusters, and to examine the mutual influences of PTSD symptom clusters and CMP outcomes. Results showed baseline pain intensity and pain disability predicted PTSD at 9 months. And baseline PTSD predicted improvement of pain disability at 9 months. Moreover, direct relationships were found between PTSD and the disability component of CMP, and indirect relationships were found between PTSD, CMP and CMP components (intensity and disability) mediated by depression, anxiety and pain catastrophizing. Finally, the coexistence of PTSD and more severe pain was associated with worse SF-36 Physical Component Summary (PCS) and Mental Component Summary (MCS) scores. Together these findings provided empirical support for the mutual maintenance theory.

Indiana University-Purdue University Indianapolis (IUPUI) / This study investigates differences between Veterans and non-Veterans with severe mental illness (SMI) regarding perceptions of their illness, themselves, and treatment. I compare patient interviews (using the Indiana Psychiatric Illness Interview, IPII) of Veterans (N=20) and non-Veterans (N=26). Modified grounded theory and qualitative coding software Atlas-TI were used to develop codebooks for each group, and these were compared for differences. I examined differences in both code frequency and meaning. Statistically, more Veterans were male, employed, married, had higher income, and had higher education. Statistical differences in code frequency included: more Veterans discussing boredom, regret/guilt/loss, and wanting to be “normal.” More non-Veterans had codes of pessimism and religion/spirituality, wanting a different future, bringing up mental health, family, future: no change, life goals, and relapse. Key differences in narrative themes included: (1) Veterans’ “military mindset”/discussion of anger as part of mental illness, (2) non-Veterans’ focus on mental-illness, (3) differing attitudes regarding stigma, (4) active versus passive attitudes toward treatment, and (5) degree of optimism regarding the future. Differences are described and then potential relationships and interactions are proposed. Veterans appear to have several protective factors (i.e., finances, employment, marriage). Additionally, Veterans’ military-mindset seems to encourage greater stigma-resistance, and thereby also facilitate Veterans being more active and optimistic toward treatment and recovery. By contrast, non-Veteran focus on mental illness may be related to increased self-stigma, passive and pessimistic attitudes. I propose that Veteran identity can serve as an additional protective factor against stigma, pessimism, and passivity. Veteran-identity may also be a useful framework clinically, to help promote active approaches to treatment (e.g., “fighting symptoms”). Further, Veterans emphasized issues relating to anger as important and part of their mental health. It may be that Veterans are more comfortable discussing mental health in the language of “anger,” given stigma. Finally, findings suggest that helping individuals in both groups engage in meaningful, non-mental illness-related life activities may help shape self-perception, and thereby responses to stigma, attitudes toward treatment, and hope for the future.