Researchers examining issues of recent veterans of military conflicts in Iraq and Afghanistan have found evidence of psychological distress and difficulty adjusting to civilian life post-deployment. Changes in educational benefits offered to veterans will likely facilitate greater numbers of veterans to enter academia in the coming years. This survey of 49 college student veterans at a large Midwestern university was designed to reveal the frequency and intensity of psychological distress, PTSD and alcohol misuse. Relationships between these constructs and the constructs of social support, stigma and barriers to psychological care, life satisfaction, traumatic experiences, attitudes toward help seeking, and service utilization are reported. A history of mental health service utilization since military service was reported by many respondents. PTSD and alcohol misuse symptoms were reported by many college student veterans and incidence in this sample was greater than the incidence previously reported in the literature on veterans. Stigma was found to be negatively correlated with attitudes toward help seeking. Post deployment social support was found to be negatively associated with psychological distress and positively associated with service utilization. Implications and limitations of these findings are presented and future directions for research and intervention are discussed.

Literature review: Background: Military-related stressors can adversely affect veterans’ mental health, in particular PTSD. This can have a detrimental impact on intimate relationships and family adjustment. To date, couple based interventions for PTSD and relational functioning in military couples have not been systematically reviewed. Objectives: This review summarises and synthesises literature investigating couple based interventions for PTSD and relational functioning in military couples. Method: A systematic review of all literature to date across 24 databases using an advanced combination of search terms. Ten studies were included (nine USA; one Australian). Results: A wide range of couple based interventions were identified: complementary and alternative therapies (CAM), sport and recreation programmes, retreats, courses as well as structured disorder focused couple therapies. There was preliminary evidence of support for couple based interventions treating PTSD, with relatively stronger support for disorder focused couple therapies over sports and recreation activities, CAM and retreats/courses. There was relatively little support for improved relational functioning assessed in couple based interventions treating PTSD. However, spouses tended to report a greater degree of improved relational functioning compared to veterans. Conclusions: There was relatively stronger evidence to support disorder focused couple therapies over other treatment modalities. However, there was a lack of robust designs used in effectiveness research of couple based interventions in military populations. There is potential for couple based interventions to be effective in treating PTSD in the UK military. Empirical study: Objective: Deployment to the armed conflicts in Afghanistan (Operation HERRICK/Enduring Freedom) and Iraq (Operation TELIC/Iraqi Freedom) can adversely affect the physical and mental health of those deployed. This study explored the association between traumatic brain injury (TBI), post-traumatic stress disorder (PTSD), the mediating effect of maladaptive emotional regulation strategies (MERS) and the effect of cause of injury (no injury, blunt force related or blast force related) in UK military veterans. Methods: 16 month longitudinal follow-up was conducted on a sample of 123 veterans (Murphy et al., 2015). Regression based secondary data analyses investigated the mediating effects of MERS (n=116) whilst correlational analyses explored the effect of injury mechanism on the relationship between TBI severity and PTSD severity (n=29). Results: Findings revealed support for the role of anger in mediating the effect that TBI severity had on PTSD severity. There was no support that the mechanism of injury was associated with greater reporting of psychological symptoms (anger, alcohol use or PTSD) or that MERS influenced the association between TBI severity and PTSD recovery at 16 month follow-up. Conclusion: Findings contribute to the understanding of how anger may underlie the relationship between TBI severity and PTSD severity, i.e., TBI severity was positively associated with PTSD scores and this effect operated due to increased TBI severity leading to higher rates of expressed anger which in turn increased PTSD symptoms. Future research using larger samples is required to further understand how the complicating factors of MERS and cause of physical injury affect outcome in veterans with co-occurring TBI and PTSD.

Research shows that faculty, staff, and administrators at institutions of higher learning have a fundamental responsibility to create a safe and effective learning environment for returning military combat veterans. Studies of student veterans have shown that combat veterans have both unique strengths and barriers that must be taken into account if they are to complete an advanced degree. This study contributes to the literature on educational barriers faced by student veterans and their educators. Knowles' andragogy theory provided the theoretical framework for this transcendental-phenomenological research study. Ten randomly chosen student military veterans from Tacoma Community College in Tacoma, Washington, participated in guided 60-minute interviews to discuss pedagogical tools and administrative actions found to be helpful or hindering to students' academic success. Interviews were recorded and transcribed for analysis, and participants' accounts of their experiences produced the textural and structural descriptions that led to identification of salient themes. The findings of this study revealed the Veterans' needs to feel respected and treated as competent adults. They needed community colleges to scaffold their cognitive, communal, and emotional needs; they also needed flexibility on attendance and assigned seating, faculty polices, and pedagogical offerings. Serious social problems can emerge if the educational needs of this at-risk student population are unaddressed. Social change will come as a result of scaffolding student veterans through a successful journey toward their desired goals. This process will enrich the lives of this population by opening the door to better jobs, higher pay, and a higher quality of life for both the student and his or her family.

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The current best practices of user-centered design (UCD) may not be optimal with respect to eliciting information from representative users from special populations. This research extended elicitation approaches traditional focus on user needs and context to include criteria describing obstacles users encounter. Military veterans were selected for this research effort as representative users for a use case in technology design that addresses the difficulties associated with community reintegration. This work provides several contributions to the UCD field. First, different elicitation methods were compared by the depth and breadth of design space criteria elicited. Guidelines were generated for designer use of phenomenology in practice. Obstacles were added as an important facet of design, with corresponding grammar rules for construction. Finally, an algorithm was applied as a method for generating personas. Additionally, this dissertation contributes to the field of veteran research. Some example contributions include a set of design space criteria for designers to consider when designing for veterans, and two veteran personas grounded in data procured from the analysis. This research effort was conducted in three phases: elicitation, first-cycle analysis, and second-cycle analysis. The elicitation process engaged 40 military veterans to complete an interview session and a design session. These sessions explored the lived experience of veterans as they reintegrate into communities, and gathered their ideas for technology to assist with veteran reintegration. The researchers who conducted first-cycle coding focused on categorizing the most important participant statements (meaning units) using a codebook. This analysis resulted in over 3,000 meaning units. Additionally, the meaning unit corpus was subjected to systematic second-cycle analyses, using standardized linguistic structures to generate design space criteria. In total, over 6,000 design space criteria were discovered, and these criteria were synthesized to create personas using a situated data mining (SDM) algorithm. Results suggest that the interview session was crucial to elicit higher quantity and broader coverage of design space criteria. It is recommended that designers conduct and analyze interviews that focus on understanding the lived experience of users (not on their technology ideas) as part of a UCD approach. / Ph. D.

BACKGROUND: There have been prevailing gender differences in negative mental health outcomes for U.S. female service members (FSMs) returning from combat deployments with rates of depression and post-traumatic stress nearly twice that of their male peers. AIM: The aim of this research study was to examine the extent to which the absence or presence of social support, social conflict, and stressful life events either facilitated or hindered optimal mental health during the post-deployment period and shaped FSMs’ mental health in the context of the post-deployment experience. RESEARCH QUESTIONS: What was the nature of the relationship between social support, social conflict, and stressful life events and mental health symptoms (PTSD, depression, anxiety, and alcohol abuse) in FSMs after deployment to Iraq? And was the degree of social support or the degree of social conflict more highly associated with negative mental health symptoms (greater PTSD symptoms, greater depression symptoms, greater anxiety symptoms, and greater alcohol abuse symptoms) in FSMs after deployment to Iraq? THEORETICAL FRAMEWORK: The theoretical framework for this study was derived from Vaux’s theory of social support (Vaux, 1988) and from a model developed by Berkman and Glass (2000) that hypothesized how social support and social networks have direct effects on an individual’s physical, mental, and social health. These two frameworks were viewed from a feminist standpoint perspective. METHODS: This descriptive, correlational, cross-sectional design used a convenience sample of 150 active duty FSMs who were 6-12 months post-deployment from Iraq and stationed at Fort Campbell, Kentucky. FINDINGS: During preliminary exploratory data analyses and statistical assumption testing, significant between group differences were found between the officer and enlisted FSMs on four variables: annual household income, stressful life events, education, and prior exposure to violence (physical assault, sexual assault, or domestic violence). Additionally, significant differences emerged in bivariate correlations between the predictor and outcome variables when the 13 officer FSMs were separated out from the original sample during statistical analyses. These findings suggested these were two distinct populations; therefore, the sample was divided into two groups based on rank. For the officer FSMs, there were no significant bivariate correlations between social support, social conflict, or post-deployment stressful life events and any of the mental health outcomes although a one-tailed analysis was conducted due to low sample size (n = 13). In contrast, the two-tailed analysis of the enlisted FSMs (n = 137) showed significant positive bivariate correlations (p < .01) between social conflict and stressful life events and the outcome variables depression, PTSD, and anxiety symptom severity. Furthermore, the analysis demonstrated a significant inverse correlation between social support and the outcome variables depression, PTSD, and anxiety symptom severity. Hierarchical linear regression of the enlisted FSM group showed that depression symptom severity was best explained by the presence of comorbid PTSD symptoms and the absence of social support. The presence of social conflict was excluded in the final model, and stressful life events were not found to be significant in explaining depression symptom severity. Overall, comorbid PTSD symptom severity and the absence of social support accounted for 71% of the variance in depression symptom severity in this group of enlisted FSMs. In contrast, greater PTSD symptom severity in the post-deployment period was best explained by greater comorbid depression symptom severity, the presence of social conflict, and greater stressful life events. The absence of social support did not significantly contribute to the model for PTSD symptom severity. Comorbid depression symptom severity, stressful life events, and the presence of social conflict, which were entered in three steps, accounted for 74% of the variance in PTSD symptom severity reported by this group of enlisted FSMs. And finally, greater anxiety symptom severity was best explained by greater comorbid depression symptom severity, the presence of social conflict, and the absence of social support. The presence of social conflict had a stronger relationship with anxiety symptom severity than the absence of social support in the final model. In addition, the presence of more stressful life events did not significantly contribute to the overall variance in anxiety symptom severity. Comorbid depression symptom severity, the absence of social support, and the presence of social conflict accounted for 68% of the variance in anxiety symptoms reported by this group of enlisted FSMs. The implications and recommendations based on these findings span strategic planning for the military, nursing practice, and future research. / text

Thesis (M.S.W.)--Smith College School for Social Work, Northampton, Mass., 2007 / Thesis submitted in partial fulfillment for the degree of Master of Social Work. Includes bibliographical references (leaves 61-63).

There is currently a crisis in military veteran mental health care. At 5-30% of veterans receive a PTSD diagnosis. Veterans face a large gap that exists in accessing and receiving high quality care. One intervention that is becoming more popular is equine assisted counseling (EAC). The purpose of the present study was to examine the effectiveness of Relational Equine-Partnered Counseling (REPC) in reducing symptoms of PTSD in military veterans. I also examined specific PTSD symptom clusters including intrusion, avoidance, negative alterations in cognitions and mood, and alterations in arousal and reactivity. The present study utilized a single-case design consisting of a baseline phase, intervention phase, and post-intervention phase. Participants included four military veterans presenting for war zone-related PTSD: four males and one female, aged 32-67 years, two White/European non-Hispanic, one African American non-Hispanic, and one mixed ethnicity. Symptoms were assessed weekly using the Clinician-Administered PTSD Scale and the PTSD Checklist (PCL-5). The data were analyzed by visual analysis and statistical effect size. The results were mixed across the participants. All participants experienced decreased means between the baseline and intervention phases. However, interpretation of the results indicated that the intervention was effective in some areas for some of the participants. All participants reported that the intervention was beneficial in targeting specific symptoms. Overall, the results indicated that REPC may have some benefit in reducing distress related to PTSD. More research is needed to further explore the effectiveness of REPC on the reduction of PTSD-related distress.

The purpose of the present study was to explore a theoretically based social-cognitive model of posttraumatic stress disorder (PTSD) by investigating attachment-related and social-cognitive predictors of PTSD in a sample of 125 post-9/11 U.S. combat veterans. Subjects completed an online survey assessing PTSD symptomology, attachment-related internal working models, perceived social support, and mentalizing capacity. Path analysis provided empirical support for a respecified version of the model. More negative internal working model of self and poorer mentalizing capacity predicted higher PTSD symptom levels. Contrary to previous findings, greater perceived social support predicted higher, not lower, PTSD symptom levels. Mentalizing capacity mediated the relationship between internal working model of self and PTSD symptoms in a complementary manner, whereas perceived social support as a mediator was dampening. The relationship between internal working model of others and PTSD symptom levels was fully mediated by perceived social support, which buffered the effect of negative working model of others on PTSD symptom levels. These findings underscore the importance of social-cognitive processing, rooted in early attachment experiences, in the development and symptomology of PTSD in trauma-exposed veterans. In preparing clients for trauma work, clinicians may consider employing modalities that promote earned secure attachment and highlight mentalization in the therapeutic change process.