While previous research has explored the relationship between combat exposure and mental health disorders, the effects of mental health disorders on attrition rates of Service members, the discrepancy between mental health counseling services available and utilized by Service members, and barriers to seeking mental health counseling services, the majority of studies thus far have only been conducted with Service members and have been quantitative in nature. While researchers have begun to explore the experience of deployment on Service member spouses, little research has focused specifically on their service seeking behavior regarding accessing mental health services. This is unfortunate given that multiple studies have indicated the importance of including Service member's spouses in future research. This qualitative study included both Service members and spouses of Service member's in an attempt to capture their mental health counseling service seeking behaviors. Thematic analysis was employed to develop a model of mental health seeking behavior among Service members and their spouses. The resulting model is unique in that it attempts to account for the influence of multiple contextual and ecological factors. Limitations of the study, future research and clinical implications are also discussed. / Master of Science

Service members and veterans of the current era, Operation Enduring Freedom (OEF), Operation Iraqi Freedom (OIF), and Operation New Dawn (OND) are at a high risk for a variety of psychological disorders and physical health impairments. Common disorders among male service members and veterans include posttraumatic stress disorder (PTSD), substance use, and hypersexuality. Each of these disorders affect all aspects of an individual’s life and can deteriorate important interpersonal relationships or impair functioning in a variety of contexts. All these variables can affect sexual health and functioning in these service members. Sexual functioning is an important aspect of overall well-being, relationship satisfaction, and marriage satisfaction. Conversely, sexual dysfunction can create interpersonal distress in important relationships and decrease overall well-being. One of the most common forms of sexual dysfunction in males is erectile dysfunction, and rates of sexual dysfunction are higher among male service members. These rates increase for combat veterans with a posttraumatic stress disorder (PTSD) diagnosis compared to those who do not have the same diagnosis. To date sexual dysfunction has been associated with PTSD, substance use, and hypersexuality. The current study examines how each of these disorders together are associated with erectile dysfunction in a sample of OEF/OIF/OND service members and veterans (N = 213). Exploratory analysis breaks down PTS symptoms into seven separate symptom clusters in an effort to determine what types of symptoms are most strongly associated with erectile dysfunction. The study recruited a sample of service members and veterans via Facebook and asked them to complete a survey battery that covered sexual health and assessed for PTSD, substance use, and hypersexuality. PTS symptoms were significantly associated with erectile dysfunction, in particular anhedonia and dysphoric arousal symptoms accounted for the most variance in this sample. Further research with clinical samples may strengthen these results or indicate additional symptom clusters that should be targeted in treatment and screening.

An Evaluation of Military Education Assistance Programs From ParticipantsF Perspectives by Ella Bolling-Harris MS, Capella University, 2008 MS, Capella University, 2004 BS, Park University, 2000 Doctoral Study Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Education Walden University August 2015 Military education programs exist to assist military members in completing their college education prior to exiting the military. At a southwestern United States Army Installation, members have expressed dissatisfaction with the education programs. The purpose of this case study was to examine the education programs from the participants' perspectives. Mezirow's transformative learning theory was used as the framework for the study. The research questions elicited program participants' perceptions of various aspects of the programs, the potential for conversion of a basic skills program to a 2-year degree program, and suggestions for leaders for implementation of programs. The sample of participants included 15 military members stationed at the Army Installation who were enrolled in college and exiting the military within 12-24 months, were serving on active duty at the Installation, had been on repeated deployments, were 18 years or older, and had been in the military 4 or more years. Data were collected through interviews and responses were coded and analyzed for common themes. Results from emergent themes were used to develop a project that included strategies for military leaders to assist military members in their degree completion. Recommendations included a timeline for leaders to implement strategies to assist military members desiring an education, converting the current Basic Skills Education Program to a 2-year general studies degree program, implementing adjustments for deployment, and creating an education buddy team for military members enrolled in college. Implications for social change include improving military education assistance programs to allow more military members to complete their education in order to assist them in entering the civilian workforce in their own communities or others after their military obligation has expired.

Mental health services are greatly underutilized by military service members and veterans. Among the reasons for this underutilization is that the services offered may not be a good fit for the specific problems facing service members/veterans and/or their families. The current study presented service members with descriptions of several approaches to treatment and asked them to indicate the likelihood of using each. Service members indicated the highest likelihood for using self-directed services, followed by individual treatment with a professional. They reported being least likely to use group approaches. These results may inform decisions about the implementation and dissemination of information about existing and new services.

The psychometric properties of a new high-level mobility outcome measure for Service Members (SMs) with traumatic lower limb loss called the Comprehensive High-level Activity Mobility Predictor (CHAMP) was developed in order objectively evaluate functional abilities and measure change in function throughout the rehabilitation process. The CHAMP was administered to a population of SMs with traumatic lower limb loss who were representative of those who have suffered limb loss in recent conflicts. In addition, a population of non-amputee Active Duty soldiers completed the CHAMP and provided normative data for high-level mobility and threshold levels of performance for those SMs with lower limb loss. A simple grading system, absent of floor and ceiling effects, generates a composite score providing a single numeric value representing the physical performance factors of high-level mobility in different plane of motion and under different conditions. The CHAMP was found to be a safe, reliable, valid, and responsive performance-based outcome measure of high-level mobility. It was found to have excellent interrater and test-retest reliability suggesting that it is a stable and repeatable measure of high-level mobility. Convergent construct validity and known group methods were utilized to establish the CHAMP as a valid measure of high-level mobility. Predictive models of CHAMP performance were established utilizing variables representing impairments of body structure and function and contextual factors by level of lower limb amputation. The CHAMP has the potential to be used for lower limb amputees throughout the rehabilitation process and could translate to the non-amputee population for assessment of high-level mobility capabilities.

Mattering involves feeling as though oneself belongs in a community and tends to influence one’s college experience. The issue of mattering has been explored in social psychology and education literature. Such research has sought to understand the transitions and necessary role changes of college students. Unfortunately, there has been a lack of studies on perceived mattering within one specific college student population—student veterans and active service members (SV/ASM). Higher learning institutions have expressed concerns about the academic progress of the SV/ASM population upon transitioning into college. However, no previous studies have examined the relationship between SV/ASM’s sense of mattering and their academic success. As such, the purpose of this study was twofold. First, it attempted to develop a mattering scale in order to examine SV/ASM mattering. Second, it explored the predictive ability of perceived mattering variables to SV/ASM’s academic success, as measured by their cumulative grade point average (GPA). The Mattering Scales for Adult Students in Higher Education (MHE) was used in this quantitative study with demographic questions. A sample of 129 SV/ASM enrolled at a research-based university in the midwestern region of the United States was used in this survey. An exploratory factor analysis was applied to operationalize the construct of mattering from MHE in order to investigate the SV/ASM’s feelings of mattering regarding the higher education environment. Hierarchical multiple regression analyses were utilized to examine the effects of the mattering variables from MHE on the SV/ASM’s GPA. This study found that four mattering dimensions in the higher education environment could be employed to measure SV/ASM’s sense of mattering: peers, faculty, advising, and administration. The findings revealed that the SV/ASM generally have a neutral sense of mattering to their non-military peers and the university’s administration, while expressing a positive sense of mattering to their faculty members and advisors. The findings also indicated that peers and administration may impact SV/ASM’s academic success. Therefore, higher learning institutions should strive to provide tailored administration and positive peer interactions for SV/ASM in order to promote their overall academic success in higher education.

At least eighteen countries allow transgender personnel to serve openly, but the United States is not among them. In this article, we assess whether US military policies that ban transgender service members are based on medically sound rationales. To do so, we analyze Defense Department regulations and consider a wide range of medical data. Our conclusion is that there is no compelling medical reason for the ban on service by transgender personnel, that the ban is an unnecessary barrier to health care access for transgender personnel, and that medical care for transgender individuals should be managed using the same standards that apply to all others. Removal of the military’s ban on transgender service would improve health outcomes, enable commanders to better care for their troops, and reflect the military’s commitment to providing outstanding medical care for all military personnel.

Helping individuals develop, foster, and maintain resilience skills is particularly important with Service members as they face multiple deployments and the stress caused by long periods of separations from home and support systems. These separations and prolonged time spent in dangerous environments with the possibility of death and injury can make soldiers more susceptible to stressors that might affect their morale and ability to perform necessary duties required in combat. This study used a quantitative research method approach to better understand how resilience influences performance outcomes among combat veterans. The study was comprised of 76 participants that have served at least one year in combat in Afghanistan or Iraq. Research instruments used to gather data included three psychometric instruments The Connor-Davidson Resilience Scale (CD-RISC), The General Self-Efficacy Scale (GSE), and The Multidimensional Scale of Perceived Social Support (MSPSS). In addition, participant's Army Physical Fitness Test and Weapons qualification scores, taken within a year of the study, were collected. The results of this study indicated two significant correlations exist. Results of this study revealed that increased levels of resilience and self-efficacy shared a positive correlation with greater accuracy with the M16 rifle. Findings from this study indicated that soldiers with strong problem solving skills and confidence in their abilities tend to perform at a higher level with the M-16. Findings from this study should be useful in providing military leaders, soldiers, and health care providers a better understanding of how soldier's resilience influences their ability to perform core tasks.

Poor sexual function is comprised of diminished sexual desire and arousal, presence of sexual pain, inability to reach orgasm, and low satisfaction. Worse sexual function is associated with disordered eating behavior; however, the mechanism through which this association exists remains unclear. Theory of sexual function suggests that depression mediates the association of disordered eating behaviors and poor sexual function in female service members and veterans, but this has yet to be tested empirically. The purpose of the current study was to examine whether depression mediated the association of disordered eating behaviors and sexual dysfunction. Participants (N=511) were partnered females who completed measures of sexual function, disordered eating behavior, depression severity, and demographic and military characteristics. Nearly 60% reported probable sexual dysfunction, 19.6% reported probable eating disorder, and 44.4% reported probable depressive disorder. Higher depression symptoms were associated with lower sexual function (r=-.40, p<.001) and higher disordered eating behavior (r=.45, p<.001). Mediation analyses revealed that the association between disordered eating behavior and sexual function was indirect, through depression severity (indirect effect: -1.12, 95% confidence interval [-1.42, -0.85]). Depression is a potential mechanism through which disordered eating behaviors are related to poor sexual function. Findings are congruent with sexual function theory, and underscore the importance of addressing depression when treating sexual function in those with disordered eating behavior.

<p>  </p> <p>Post-9/11 military service have been marked by a surge in large-scale combat deployments, characterized by deployments that are longer, with shorter periods of ‘dwell time’, and with a high reliance on the reserve component. Many service members and veterans (SMV) demonstrated resilience during this era by adapting successfully to these demands, meanwhile others experienced difficulty coping with stress and deployment-related exposures at some point. Limitations in existing research—including observations from single time points without the benefit of prospective data—complicates the understanding of the impact of military experience, as an early adult turning point, on well-being. The overarching goal of this study is to contribute to the literature assessing the impact of military service on depression trajectories across the transition into adulthood and into mid-life. Specific goals include informing our understanding of 1) the features of depression trajectories from adolescence to middle adulthood, i.e., from pre- to post-military life among those entering the military in young adulthood, compared to their civilian peers; 2) the importance of sociodemographic factors—including characteristics in the family of origin and indicators of social identity—in shaping depression trajectories and the extent to which their effects vary by SMV or civilian roles, and (3) the impact of pre-existing (childhood) risk and resilience factors on depression trajectories and whether their impact varies by SMV or civilian role. Results found that SMVs had lower depression symptoms prior to and at the time of enlistment, relative to civilians, before increasing later in life. Differences between civilians’ and SMVs’ depression trajectories narrowed after adjusting for sociodemographic factors, although SMVs had lower levels of depression than civilians from their 20s into their early 30s. Childhood risk and resilience factors significantly explained variance above and beyond sociodemographic factors for both SMVs and civilians across configurations (i.e., unique and cumulative models), with resilience factors in the family domain yielding particularly large effects with depression trajectories for both SMVs and civilians. Collectively these findings point to the potential for military service to function as a social determinant of health, the family domain as a key target for prevention and intervention, the continued relevance of resilience factors in the face of risk, and the need for the continued study of risk and resilience throughout the life course. </p>