Cynthia Thomsen

United States Navy · Naval Health Research Center

Posttraumatic stress disorder (PTSD) and major depressive disorder (MDD) frequently co-occur and can cause significant impairment. Data are lacking as to whether interventions targeting both PTSD and MDD may improve treatment outcomes among individuals with this comorbidity compared with existing evidence-based PTSD treatments alone. This randomize...

Background: Approximately half of those who attempt suicide report experiencing suicidal ideation and suicidal planning in advance; others deny these experiences. Some researchers have hypothesized that rapid intensification is due to past suicidal ideation and/or behaviors that are "mentally shelved" but remain available for rapid access later....

Introduction: Recent research on traumatic brain injury (TBI) has suggested that the mechanism of injury (i.e., whether the TBI was caused by high-level blast [HLB] vs. direct physical impact to the head) may be an important factor in injury severity, symptomology, and recovery because of differences in physiological effects of each type of injury...

Introduction: To determine whether rates of all-cause and cause-specific mortality are elevated for active duty US service members who sustained traumatic limb injuries in service, compared to the broader population of deploying service members. To assess differences in mortality rates between service members with traumatic limb injuries that did...

Background Approximately half of patients who attempt or die by suicide screened negative for suicidal ideation during their most recent medical visit. Maladaptive beliefs and schemas can increase cognitive vulnerability to suicidal behavior, even among patients without recent or past suicidal thoughts and behaviors. Assessing these beliefs could i...

Psychological comorbidity, the co‐occurrence of mental health disorders, is more often the rule than the exception among individuals with posttraumatic stress disorder (PTSD). Research shows that prevalence estimates for specific psychological disorders differ by gender; however, little is known about whether these patterns persist in the presence...

Because traumatic brain injury (TBI)—most often caused by exposure to high-level blast (HLB)—is a leading cause of medical evacuations of deployed U.S. service members in recent conflicts, researchers seek to identify risk factors for TBI. Previous research using self-reported data has identified low-level blast (LLB) as one such risk factor and su...

Purpose: Over 95% of patients who screen positive on the Patient Health Questionnaire-9 (PHQ-9) suicide risk item do not attempt or die by suicide, which could lead to unnecessary treatment and/or misallocation of limited resources. The present study seeks to determine if suicide risk screening can be meaningfully improved to identify the highest-...

Increasing rates of posttraumatic stress disorder (PTSD) in military populations during recent conflicts have sparked concerns regarding the incidence of other commonly associated problems, such as intimate partner violence (IPV). From a clinical perspective, it is important to understand patterns of PTSD symptomology that may indicate heightened r...

Objective: To examine the persistence of concussion-related symptoms following injury as a function of mechanism of injury (high-level blast [HLB] vs impact) and low-level blast (LLB) exposure among Marines. Setting: Upon return from deployment and approximately 6 months later, respectively, Marines completed the Post-Deployment Health Assessmen...

The consequences of blast exposure (including both high-level and low-level blast) have been a focal point of military interest and research for years. Recent mandates from Congress (e.g., National Defense Authorization Act for Fiscal Year 2018, section 734) have further accelerated these efforts, facilitating collaborations between research teams...

The measurement of self-reported suicide risk can be complicated in medical settings due to patient apprehension about the potential consequences of self-disclosure. The Suicide Cognitions Scale (SCS) was designed to assess suicide risk by measuring a range of suicidogenic cognitions (e.g., hopelessness, perceived burdensomeness) collectively refer...

Although blast exposure has been recognized as a significant source of morbidity and mortality in military populations, our understanding of the effects of blast exposure, particularly low-level blast (LLB) exposure, on health outcomes remains limited. This scoping review provides a comprehensive, accessible review of the peer-reviewed literature t...

Introduction Subsyndromal PTSD (sub-PTSD) is associated with functional impairment and increased risk for full PTSD. This study examined factors associated with progression from sub-PTSD to full PTSD symptomatology among previously deployed military veterans. Materials and Methods Data were drawn from a longitudinal survey of Navy and Marine Corps...

Introduction It is estimated that sailors who are assigned to surface ships and submarines are deployed for more than 1 year across their careers and they spend 15% to 23% of their time away from home. Research suggests that shipboard sailors experience rates of behavioral health issues similar to those with ground combat experiences. Despite the r...

Traumatic brain injury (TBI), which can result from either direct impact to the head or blast exposure, has been the leading cause of morbidity and mortality in recent military conflicts. However, little research has compared mTBIs by mechanism of injury. The present research addressed two research questions: (1) Are blast-related mTBIs (mbTBIs) as...

The purpose of this special section is to highlight the intersection of sexual assault and intimate partner violence – sexual intimate partner violence (SIPV) – within the Department of Defense (DoD). As an introduction to this special section, the editors first define SIPV, and argue that it has been a neglected issue within the DoD. They explore...

Together, posttraumatic stress disorder (PTSD) and major depressive disorder (MDD) are debilitating and commonly comorbid; however, the effects of this comorbidity on psychological outcomes during exercise programs, such as surf therapy, have not been examined. This study compared changes in depression/anxiety and positive affect during surf therap...

Introduction: Traumatic brain injury (TBI) has been the leading cause of morbidity and mortality in recent military conflicts and deployment-related TBIs are most commonly caused by blast. However, knowledge of risk factors that increase susceptibility to TBI following an acute, high-level blast is limited. We hypothesized that recurrent occupatio...

This cross-sectional study examines firearm ownership and storage practices among US military personnel who have experienced thoughts of suicide.

Background: Primary care is the most frequently visited clinic type immediately prior to suicidal behavior, with nearly half of suicide decedents visiting a primary care provider within a month of their death. Data supporting the efficacy of suicide risk screening in this setting is lacking, however. Improved suicide risk screening in primary care...

Many active duty service members suffer from major depressive disorder (MDD). Although traditional treatments exist, alternative approaches may also be effective in treating depressive symptoms. Previous research has shown that physical activity has significant positive effects on depression symptoms in individuals with MDD, and that these benefits...

Problem: For crews of naval ships, effective decision-making during stressful situations is essential to successful performance of their operational missions. Recent mishaps at sea have shown that fatigue, communication deficits, and other factors can have deleterious consequences for decision-making during unexpected or emergency events. One strat...

Objectives: Although surf programs for individuals with psychological and physical conditions exist, data evaluating such programs are limited. This study examined psychological outcomes among 74 active duty service members participating in the Naval Medical Center San Diego surf therapy program. Design: The study used a single-group, longitudinal...

Among active duty service members, posttraumatic stress disorder (PTSD) diagnoses have increased dramatically since 2000. Because psychiatric comorbidity is more common for PTSD than for other mental health disorders, we examined the prevalence estimates of disorders comorbid or trimorbid with PTSD in this study. The medical records of 523,626 fema...

Using longitudinal survey data, this study explores patterns and predictors of the sexual harassment and sexual assault of women by male Navy personnel (N = 573) in their second year of service. A modified version of the Malamuth Confluence Model, informed by the Navy Sexual Assault Continuum of Harm, was used to predict both types of sexual aggres...

This article concludes the special issue dedicated to examining the problems of sexual harassment (SH) and sexual assault (SA) in the U.S. military. After reviewing the reasons for devoting a special issue to this topic, we briefly describe the contributions of each article in this special issue. Next, we discuss 3 thematic domains that emerged acr...

This article provides a brief introduction to the problems of sexual harassment and sexual assault within the U.S. military. Its purpose is to provide context for the remaining articles in this special issue and to highlight their contributions. Two key themes are common throughout these articles: the importance of appreciating how context influenc...

Sexual violence within the U.S. military—encompassing instances of sexual harassment or sexual assault in which the victim and/or the perpetrator is a service member—has received increasing attention from military leadership, the U.S. government, and the American public. This chapter overviews what is currently known about sexual assault and sexual...

Posttraumatic stress disorder (PTSD) commonly co-occurs with major depressive disorder (MDD) in both civilian and military/veteran populations. Existing, evidence-based PTSD treatments, such as cognitive processing therapy (CPT), often reduce symptoms of both PTSD and depression; however, findings related to the influence of comorbid MDD on PTSD tr...

Background: Organizational commitment is a psychological state that has a strong impact on the likelihood that employees will remain with an organization. Among military personnel, organizational commitment is predictive of a number of important outcomes, including reenlistment intentions, job performance, morale, and perceived readiness. Because...

This chapter briefly reviews research regarding the impact of premilitary interpersonal violence on the long-term adjustment of military personnel. It further presents new data regarding methodological issues in assessing the impact of premilitary childhood sexual abuse (CSA) severity on enlisted Navy personnel, with a specific focus on the nature...

Growing research recognizes the reciprocal relationship between stressful life events and psychiatric health, yet this topic has seldom been examined in military populations. This study examined the reciprocal relationships between psychological symptoms and stressful life events over time among veterans of Operations Iraqi Freedom and Enduring Fre...

Recently, there has been increasing concern regarding the problem of sexual violence in the military. Because sexual harassment and assault are more closely intertwined in the military than in most civilian contexts, the military context affords a unique opportunity to study the interrelationships between these two types of sexual violence. In this...

This study examined child maltreatment perpetration among 99,697 active-duty U.S. Air Force parents who completed a combat deployment. Using the deploying parent as the unit of analysis, we analyzed whether child maltreatment rates increased postdeployement relative to predeployment. These analyses extend previous research that used aggregate data...

Patterns of healthcare use in a sample of young adults entering the US Navy (N = 1137) were examined in a longitudinal survey study. Baseline data provided information about healthcare use as a civilian, whereas follow-up data were used to examine changes in patterns of use over time following entry into the Military Health System (MHS). Entrance i...

Objective: To conduct the first population-based study comparing child maltreatment rates perpetrated by civilian parents in military families before, during, and after combat-related deployments. Method: The sample included children in United States Air Force families who experienced at least 1 child maltreatment incident perpetrated by their civi...

Posttraumatic stress disorder is often diagnosed with other mental health problems, particularly depression. Although PTSD comorbidity has been associated with more severe and chronic symptomology, relationships among commonly co-occurring disorders are not well understood. The purpose of this study was to review the literature regarding the develo...

The authors examined spouse abuse perpetration among all married U.S. Air Force personnel who deployed in support of Operation Iraqi Freedom/Operation Enduring Freedom. Using Poisson and conditional Poisson regression, they compared rates of spouse abuse perpetration predeployment and postdeployment in the population of married U.S. Air Force perso...

Objective: To conduct the first population-based study comparing the frequency of child maltreatment among active-duty United States Air Force (USAF) maltreating parents before and after combat-related deployment. Method: By combining archival databases, we identified 2,287 children with a total of 2,563 substantiated maltreatment incidents perpetr...

Objective: To conduct the first population-based study comparing spouse abuse rates before and after combat-related deployments during Operation Iraqi Freedom/Operation Enduring Freedom among married U.S. Air Force personnel. Method: The sample included all married Air Force members with at least one substantiated incident of spouse physical or emo...

Little information is available about couples experiencing intimate partner violence (IPV) who voluntarily seek couples therapy. We examined the characteristics of 129 couples who sought therapy for IPV to learn more about this population. A majority of the sample, 74%, experienced bilateral physical violence, 16% experienced unilateral male violen...

This study explored individual and military risk factors for intimate partner aggression (IPA) perpetration among Navy personnel in their second year of service. We found some evidence that job stress was related to higher perpetration among men. Contrary to expectations, ship duty was related to lower perpetration rates, even though it involves mo...

The U.S. Navy Sexual Assault Intervention Training (SAIT) program for women was evaluated in a randomized clinical trial. The SAIT uses multiple presentation modalities (lecture, slides, discussion, film) to provide information related to sexual assault, including risk factors, consequences, prevention, and relevant military regulations. Female per...

Previous research on the association between maltreatment in childhood and later religious beliefs and behaviours suggests that maltreatment may have either negative or positive influences on religiosity. However, methodological limitations of previous studies may limit their generalisability. The present study attempted to address these limitation...

This chapter focuses on the Domestic Violence Focused Couples Treatment (DVFCT) program, which is the result of efforts over the past twelve years to develop and test a safe and effective approach to providing conjoint treatment to couples who wish it. DVFCT is delivered in eighteen weekly sessions in either a multicouple group format or an individ...

Although research has documented negative effects of combat deployment on mental health, few studies have examined whether deployment increases risky or self-destructive behavior. The present study addressed this issue. In addition, we examined whether deployment effects on risky behavior varied depending on history of pre-deployment risky behavior...

: anche se la trasmissione intergenerazionale della violenza familiare č stata ben documentata, il meccanismo responsabile di questo effetto non č stato ancora completamente accertato. Il presente studio valuta se i sintomi traumatici mediano la relazione fra una storia di maltrattamento fisico infantile (CPA, Child Physical Abuse) e il rischio in...

Substantiation rates for alleged incidents of spouse (N = 33,787) and child (N = 31,986) maltreatment reported to the U.S. Air Force (AF) Family Advocacy Program between 2000 and 2007 were examined. For spouse maltreatment, physical abuse and multiple forms of maltreatment were most likely to be substantiated and neglect was least likely to be subs...

A randomized clinical trial was conducted to evaluate the effectiveness of the Navy Sexual Assault Intervention Training (SAIT) program for men. A four-group Solomon design was used to control for possible pretest sensitization effects. Male Navy personnel (N = 1,505) were assessed for rape knowledge, rape myth acceptance (two scales), and rape emp...

Although the intergenerational transmission of family violence has been well documented, the mechanisms responsible for this effect have not been fully determined. The present study examined whether trauma symptoms mediate the relationship between a childhood history of child physical abuse (CPA) and adult CPA risk, and whether any such mediation w...

This study examined the incidence and consequences of receipt of intimate partner violence (IPV) as reported by 1,035 (576 female and 459 male) Navy personnel during their second year of service. Overall, 21.1% of respondents reported that they had been victims of some form of IPV during their second year of service, of which 10.5% of respondents e...

This study examined the frequency and characteristics of repeated attempted and completed rape (ACR) incidents reported by newly enlisted male navy personnel (N=1146) who participated in a longitudinal study during the transition from civilian to military life. Overall, 13% (n=144) reported engaging in sexual behavior that approximates legal defini...

The present study describes the sources of Air Force (AF) Family Advocacy Program referrals (N = 42,389) for child and spouse maltreatment between 2000 and 2004. Sources of referrals were stable over time, with military sources accounting for the majority of both child and spouse referrals. Most (85%) of spouse maltreatment referrals came from AF l...

Female (n = 5,226) and male (n = 5,969) U.S. Navy recruits completed a survey assessing their premilitary histories of adult sexual assault (SA), defined as attempted or completed rape since the age of 14. The survey was completed under anonymous or identified conditions. Overall, 39% of women reported premilitary SA victimization and 13% of men ad...

To examine relationships between childhood maltreatment and alcohol-related problems among U.S. Navy recruits. An anonymous sample of 5697 Navy recruits completed a survey regarding their alcohol consumption, alcohol problems (binge drinking, drinking until drunk, alcohol dependence, alcohol-related arrests), and experiences of childhood physical a...

A prospective study examined whether adult premilitary sexual victimization predicted women's military attrition. In a survey of female Navy recruits (N = 2,431), 56% reported some form of adult unwanted sexual contact before entering the military, with 25% reporting completed rape. Approximately one-third of respondents left the Navy before comple...

Individuals in the military are often required to endure high levels of stress as a result of demanding operational requirements or deployments. Individuals who enter the military with pre-existing mental health problems such as posttraumatic stress disorder (PTSD) are likely to be at heightened risk of adverse reactions to military stressors. The...

A prospective study of U.S. Navy recruits (N = 5,498) examined whether premilitary intimate partner violence (IPV) was associated with attrition. Overall, more than one-fourth of recruits reported premilitary physical IPV and more than two-thirds reported premilitary verbal IPV. Women reported more perpetration and receipt of IPV than men, and marr...

Theory and research suggest that posttraumatic stress disorder (PTSD) may mediate the relationship between child sexual abuse and adult sexual assault. However, little empirical research has examined the mediational role of PTSD. In the present study, the authors use structural equation modeling to examine the degree to which the three symptom clus...

Prospective survey methods were used to investigate the effects of child sexual abuse (CSA) and premilitary rape on the likelihood that female U.S. Navy recruits (N = 465) would experience rape during their first year of military service and to examine ethnic differences in sexual victimization and revictimization. Rape during the first year of mil...

We empirically examined the hypothesis that Conservative Protestants are at greater risk than Mainline Protestants, Catholics, or the religiously unaffiliated to perpetrate child physical abuse (CPA), and explored whether other aspects of religiosity (interest, participation, orthodoxy, intrinsic and extrinsic orientation) were related to CPA risk....

Interpersonal schemata were examined to explain the association between childhood exposure lo violence - including child physical abuse (CPA), child sexual abuse, and domestic violence - and adult risk of CPA perpetration. In a sample of male and female U.S. Navy recruits (N = 4,812), all forms of childhood violence and models of the self and other...

Interpersonal schemata were examined to explain the association between childhood exposure to violence-including child physical abuse (CPA), child sexual abuse, and domestic violence-and adult risk of CPA perpetration. In a sample of male and female U.S. Navy recruits (N = 4,812), all forms of childhood violence and models of the self and others we...

Individuals in the military are often required to endure high levels of stress as a result of demanding operational requirements or deployments. Individuals who enter the military with pre-existing mental health problems such as posttraumatic stress disorder (PTSD) are likely to be at heightened risk of adverse reactions to military stressors. The...

A longitudinal design was used to compare rates of severe intimate partner violence (SIPV) perpetration during the year before enlistment and the second year of service in a sample of 542 female and 421 male Navy personnel. Overall, 11% reported perpetration of SIPV during the year before service. Premilitary SIPV perpetration rates were significan...

An experimental design was used to determine outcomes of a domestic violence-focused treatment program for couples that choose to stay together after mild-to-moderate violence has occurred. Forty-two couples were randomly assigned to either individual couple or multi-couple group treatment. Nine couples served as the comparison group. Male violence...

In a prospective study of U.S. Navy recruits (n = 5,491), we examined the relationship between childhood exposure to family violence (child physical abuse, child sexual abuse [CSA], and domestic violence) and attrition. Overall, 55% of recruits experienced one or more forms of childhood family violence and 34% of recruits attrited within 4 years af...

This study examined psychosocial characteristics of individuals at risk for perpetrating both intimate partner violence (IPV risk) and child physical abuse (CPA risk). The sample consisted of 775 female and 592 male Navy recruits. The psychosocial variables assessed included symptoms of dysphoria, posttraumatic stress, self-dysfunction, alcohol-rel...