Posttraumatic stress disorder (PTSD) is a serious condition with debilitating symptoms which affects military veterans and has been understudied in the older population. Aside from treating the veterans of the Vietnam War and World War II, as service members from more recent conflicts age, the mental healthcare system needs to be able to treat them with empathy and effective therapies. As there is a need for future research focusing on this population, this paper reviews the current literature and utilizes Grounded theory to further the research related to PTSD in aging veterans. A selection of mental health clinicians with experience treating this population were interviewed and the results discussed. Those therapists who work for the Department of Veterans Affairs (VA) most often use Cognitive Behavioral Therapy to treat their clients, with Prolonged Exposure Therapy being the next most popular therapeutic modality. Those clinicians who are separate from the VA are able to employ therapies such as Cognitive Restructuring or blend theories to meet the precise needs of individual veterans. Also addressed are the differences and commonalities in PTSD symptoms between veterans of different conflict eras. Based upon these interviews, suggestions were made for changes to the treatment of military-related PTSD.

While there is considerable research linking trauma to psychological distress, such as posttraumatic stress disorder (PTSD), among military populations, some service members may develop other variants of psychological difficulties following exposure to traumatic life events. For example, moral injury, a more recently studied outcome within the field of trauma, is conceptualized to occur when a person perceives their response to a morally challenging situation as a transgression that may lead to an incongruence with their morals producing moral emotions (i.e., shame, guilt, and anxiety; Litz et al., 2009). The current study investigated the role of self-compassion in the relationship between moral injury and psychological distress (i.e., PTSD and depression) among a sample of 216 military veterans recruited from TurkPrime online panels. Among these military veterans, a conditional process analysis of our moderated mediation model suggests an indirect effect of moral injury predicting depression symptoms through guilt, Index = 1.469, SE = .460, 95% CI [.602, 2.409] and shame, Index = -.803, SE = .346, 95% CI [-1.552, -.161] was conditioned on different levels of self-compassion. Findings are expected to have important implications for treatment conceptualization for military populations.

The purpose of this study was to examine potential predictors of PTG across time in Veterans with acquired physical disabilities. Specifically, this study aimed to understand how various demographic and injury characteristics, coping styles, appraisals of injury, and social support might predict trajectories of PTG from discharge from inpatient rehabilitation through 12 months after baseline. Initial curvature analyses suggested that a cubic polynomial trend best fit the movement of PTG over time, generally conforming to an initial increase, decrease, and then plateau or slight increase. Four HLMs were run to examine whether demographic and injury characteristics, coping styles, appraisals of injury, and social support predicted the height of this cubic architecture of PTG across baseline, 1, 3, 6, and 12-month follow ups, and a final HLM examined whether any statistically significant fixed effects in the first four HLMs interacted with time in the prediction of participants’ PTG trajectories. Estimated premorbid IQ was negatively associated, while age was positively associated with the height of PTG over time. Reframing and religious coping were positively associated with PTG over time, as were challenge appraisals. Three types of social support did not independently predict PTG trajectories, although bivariate correlations suggested the presence of isolated relationships between different types of social support and PTG at certain time points. None of the significant predictors interacted with time in predicting participants’ PTG trajectories.

The transformative process of personal growth following suffering and challenges, or posttraumatic growth (PTG), is limited in persons with acquired disability. The dimensions of acquired disability, as outlined by the World Health Organization, include impairments in body functions, body structures, and growth restrictions in activities and participation. The 5 domains of PTG include personal strength, new possibilities, relating to other people, appreciation of life, and spiritual change. Using discriminant function analysis, the purpose of this quantitative study was to identify a discriminant analysis of the dimensions of acquired disability on the domains of posttraumatic growth. The first research question focused on investigating the number of statistically significant uncorrelated linear combinations. The second research question reviewed the multivariate profile (or profiles if there is more than one statistically significant function) of the Posttraumatic Growth Inventory domains that discriminant the dimensions of acquired disability. A cross-sectional survey design was used to gather data from 161 individuals with acquired disability who were over 18 years of age and were at least 1 year postdiagnosis. Participants were invited to participate using a Facebook page and targeted advertising, as well as personal invitations to online support groups advocating for persons with acquired disability. This study and analysis only found 1 significant pairwise connection between impairment in body structure and growth, activity, and participation with the PTG domain of personal strength. Results may be used to guide the planning and implementation of aftercare programs for individuals diagnosed with an acquired disability to help promote PTG.

Posttraumatic stress disorder (PTSD) affects more than 60% of Cambodian immigrants in the United States. However, researchers do not yet know why less than 5% of Cambodian immigrants are accessing mental health services. This qualitative study involved investigation of participants' perceptions of how PTSD is manifested in the Cambodian immigrant community to understand barriers to mental health services access. The social ecological theory provided a frame for understanding how traditions, values, culture, and beliefs affect Cambodian immigrants' perceptions of PTSD and the mental health system. Data was collected from semi structured interviews of 13 participants, 18 to 70 years of age, residing in Stockton, California, who shared their perceptions of PTSD. NVIVO was used to organize each data category for thematic analysis. The themes included: (a) hearing of PTSD, (b) meaning of PTSD, (c) contributing factors, (d) healing practices, (e) recognition of PTSD, (f) reactions, (g) reasons most often given, (h) encouraging family members, (i) healing practices, (j) ways of helping, (k) counseling, (l) medications, (m) mental health support, (n) mental health resources, and (o) want more information. The findings indicated that stigma continues to be one of the barriers in accessing mental health services, and that Cambodian immigrants have a strong desire to learn more about mental health and mental health services in San Joaquin County. Results from this study contribute to an area of mental health research that is limited, and they may be used by researchers and mental health practitioners to improve cultural understanding and awareness among diverse communities and help reduce the stigma regarding mental health issues.

Since the establishment of the individual augmentee role within the U.S. Navy, little research has examined this nontraditional role associated with combat units. The majority of combat-related posttraumatic stress disorder (PTSD) research has been dedicated to Army and Marine Corps personnel with little research conducted on the Navy population. The purpose of this nonexperimental study was to identify the prevalence of combat-related PTSD symptomology for Navy personnel returning from an augmentee tour. The link between component and tour length and the presence of individual resilience factors on PTSD were examined. The theoretical foundation of this research included the cognitive link between the single and multiple exposures to traumatic events and the automatic conditioned responses related to the combat-related trauma using a retrospective view of archival datasets. Data analysis included a chi square test of independence and factoral analysis of variance to identify the combat-related PTSD symptoms and its associated variables. The sample size was a stratified random sampling of 570 cases. The results of this analysis support an association between location of tours and PTSD symptomology as well as a small effect between number of deployments and PTSD symptomology irrespective of status. These results will benefit the U.S. Navy enlisted personnel by increasing the awareness of a trend in combat-related PTSD, identify protective factors in resilience, and showcase the need for greater focus of these issues within Navy policy and leadership.

Trauma literature demonstrates that sexually abused youth are at risk for psychopathology and adjustment problems, including Posttraumatic Stress Disorder (PTSD; e.g. Yancey, & Hansen, 2010). Dissociation is a response to a traumatic event that may be adaptive within the traumatic experience; however, persistent trauma-specific dissociation can impair affect regulation and cognitive skills and increase risk for PTSD (e.g. Kaplow, Dodge, Amaya-Jackson, & Saxe, 2005). The current study aimed to confirm the relationship between dissociation and posttraumatic stress symptoms (PTSS) and examine the potential moderating effect of abuse-related support from the non-offending caregiver, the single best predictor of resilience after sexual abuse. The study sample included 52 sexually abused youth ages 8-16 years (M = 12.94, SD = 2.18) who were predominantly female (85%) and African American (62%). It was hypothesized that (1) dissociation during a forensic interview would predict PTSS and (2) low levels of caregiver support would strengthen the magnitude of the association between dissociation and PTSS compared to high levels of caregiver support. Findings confirmed the first hypothesis such that participants who reported more symptoms of dissociation in response to a forensic interview were at higher risk for PTSS. However, caregiver support did not moderate this relationship. Exploratory analyses examining the differential impact of caregiver support and caregiver blame also revealed no moderating effects. However, youth of caregivers reporting more blame of the child and/or less blame of the perpetrator were at higher risk of PTSS. These results provide support for guidelines recommending forensic interviewers include screening for dissociation and PTSS, as well as caregiver responses to disclosure. Importantly, the caregiver’s attributions of blame may be relevant points of intervention when targeting resilience among sexually abused youth. / acase@tulane.edu

acase@tulane.edu

BACKGROUND: Female veterans are at risk for stress-related physical disorders given unique environmental stress factors, high rates of trauma exposure and a heightened physiologic stress response. There is a need to identify modifiable risk factors which may help minimize the emergence and impact of veteran illness. RESEARCH QUESTION: The present study investigated the contributions of posttraumatic stress symptoms, maladaptive repetitive thought (MRT), depression, childhood trauma and health behaviors (sleep, alcohol use and smoking) to physical disease as operationalized by immune-mediated inflammatory disease occurrence and related functional disability. METHOD: Female Reserve or National Guard veterans (N = 643) enrolled in a parent study conducted through the Iowa City Veteran's Affairs Hospital completed a one-time computer-assisted telephone interview. The current study examined self-report measures of posttraumatic stress symptoms, MRT, depression, childhood trauma, smoking, alcohol use, sleep, inflammatory disease incidence and physical functioning. RESULTS: Proposed models of primary hypotheses were tested using structural equation modeling. Results indicated that both physical disease and functional decline were greater in veterans reporting a history of trauma. Physical disease was associated with greater depression and childhood trauma but lower levels of alcohol use after accounting for covariates. Unexpectedly, greater MRT was associated with less physical disease, although it was only related to disease when depression was included as a covariate. Reduced sleep was linked with greater disease but only when depression was not included in the model, and depression was found to fully mediate the relationship between sleep and physical disease. Smoking and the interaction between posttraumatic stress symptoms and MRT were generally unrelated to physical disease in this sample. CONCLUSIONS: Results of this study are consistent with the hypothesis that physical disorders and related functional decline are greater in trauma-exposed individuals and that depression, childhood trauma, repetitive thought and alcohol use have independent associations with physical disease. This study offers support for further research and interventions which address these relationships to protect female veteran health.

The first year postpartum is often a challenging time for romantic partners. During this time, couples tend to experience less relationship intimacy and sexual satisfaction, which may be further exacerbated by individual stressors and vulnerabilities. Little is known about whether a maternal history of adverse life events and mental health prior to the infant’s birth negatively interfere with postpartum relationship and sexual well-being. Accordingly, the current study examined whether maternal trauma history, prenatal posttraumatic stress, and prenatal depressed mood were risk factors for poor postpartum couple adjustment. It also investigated whether perceiving a partner as motivated to meet one’s interest and disinterest in sexual activity, referred to as sexual communal strength for having sex (SCS for having sex) and sexual communal strength not having sex (SCS for not having sex), were buffers to relationship deterioration among mothers with this history of adversity. One hundred and sixty women (N = 160) who had completed an earlier study during pregnancy participated in a subsequent online survey between six and twelve months postpartum. Using path analysis to investigate the prospective relationships between maternal trauma history, prenatal mental health difficulties, and postpartum relationship and sexual well-being, trauma history was found to significantly predict sexual satisfaction and desire. Specifically, childhood maltreatment predicted poorer sexual well-being following childbirth, whereas adult sexual victimization predicted improved sexual well-being. No other pathways in the model were significant. Additionally, contrary to predictions, sexual communal strength did not moderate associations between maternal prenatal adversity and postpartum relationship outcomes in the primary analyses. However, follow-up analyses including only mothers who reported some symptoms of PTSD revealed that SCS for having sex moderated the association between these symptoms and relationship satisfaction. Results from this research highlight that childhood maltreatment likely has enduring detrimental implications for women’s sexual well-being as they transition- either again or for the first time - to motherhood. Further implications and directions for future research in this area are discussed. / Graduate