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Introduction
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Publications
Publications (208)
Self-criticism, or negative self-evaluation characterized by often unrealistic personal standards and a harsh self-view, is a relevant transdiagnostic construct for mental health. Yet, the psychometric properties of scales assessing self-criticism have not been examined in military veterans, a population with a high burden of psychiatric symptoms....
Objective: Defined as dispositional qualities that elevate well-being, character strengths such as love and kindness can be developed and enhanced to improve quality of life. Yet, little is known how specific strengths are associated with posttrauma mental health. The present study explored their concurrent associations with posttraumatic stress sy...
Purpose of Review
As evidence accumulates for the pernicious effects of exposure to potentially morally injurious events (PMIEs) on mental health, the need for improved measurement of moral injury has grown. This article summarizes the psychometric properties of scales that assess cognitive, emotional, social, and spiritual concerns linked to PMIE...
Research on the consequences of experiencing intimate partner violence (IPV) has predominantly focused on specific physical and mental health outcomes and have emphasized the impacts for women. Fewer studies have comprehensively documented IPV impacts on other aspects of psychosocial well‐being and examined effects for both women and men. A sample...
Disordered eating is a prevalent and relevant health concern that remains understudied among U.S. military veterans. Avoidant/restrictive food intake disorder (ARFID) is a newly recognized feeding and eating disorder characterized by overly restrictive eating due to (a) picky eating, (b) lack of appetite, and (c) fear of aversive consequences relat...
Objectives
In 2023, the U.S. Veterans Health Administration convened a State of the Art meeting to evaluate the existing evidence and make recommendations for measuring the well-being of the whole person in clinical care, health research, and population health evaluation. In this article, we describe findings and recommendations concerning each of...
Background
Measuring patient well-being during clinical care may enhance patient-centered communication and treatment planning. The Veterans Health Administration (VHA) piloted the use of the Well-Being Signs (WBS), a self-report measure of psychosocial well-being, in clinical care.
Objective
To understand early WBS implementation and health care...
Posttraumatic stress disorder (PTSD) is a debilitating condition often accompanied by significant functional impairments affecting quality of life and well-being. While Cognitive Processing Therapy (CPT) is a leading, evidence-based psychotherapy for PTSD, demonstrating substantial efficacy in core symptom reduction, its impact on psychosocial func...
This cohort study examines whether 3 well-being domains—vocational, financial, and social—are associated with the risk of developing subsequent posttraumatic stress disorder (PTSD) after a traumatic event.
Objective
Trauma exposure, particularly interpersonal trauma, is prevalent among individuals with eating disorders (EDs), and trauma exposure and the subsequent development of posttraumatic stress disorder have been associated with poorer outcomes for ED treatment. To our knowledge, there are no published investigations of trauma exposure among ind...
Objective: The purpose of the study was to compare lesbian, gay, bisexual, transgender, queer+ (LGBTQ+) veterans’ and nonveterans’ prevalence of potentially traumatic events (PTEs) and other stressor exposures, mental health concerns, and mental health treatment. Method: A subsample of veterans and nonveterans who identified as LGBTQ+ (N = 1,291; 8...
The present study sought to investigate whether gender moderates the relationship between military sexual trauma (MST) and posttraumatic stress disorder (PTSD) treatment utilization, among veterans with clinically significant PTSD symptoms. Participants were 2,664 veterans with probable PTSD from a nationwide, population-based survey. Participants...
Objective: Comorbidity between posttraumatic stress disorder (PTSD) and disordered eating (DE) symptoms is common, reflecting a possible reciprocal relationship between these disorders. Network analysis may reveal candidate mechanisms underlying their comorbidity and highlight important treatment targets. Method: Two national samples of U.S. vetera...
Military veterans experience higher rates of suicidal ideation compared to nonveteran populations. Importantly, suicidal ideation often precedes and predicts fatal and nonfatal suicide attempts, and thus it is critical to better understand factors that increase risk for suicidal ideation to inform suicide prevention efforts in this population. One...
Despite efforts to identify risk factors associated with suicidal ideation (SI), less work has been conducted to highlight protective factors to promote prevention. Perceived social support has been shown to positively impact a wide range of psychological outcomes; however, prior efforts exploring whether perceived social support moderates the rela...
Sexual minority veterans are at heightened risk for mental health conditions compared with their heterosexual peers. Subpopulations of the sexual minority community, including veterans, are at even greater risk for mental health conditions. Despite this heightened risk, little is known about mental health treatment seeking among sexual minority vet...
The COVID‐19 pandemic disrupted life around the globe and negatively impacted mental health (MH), including among military veterans. Building on previous research with U.S. veterans, the present study examined the association between a broad array of pandemic stressors and well‐being on MH outcomes. A total of 372 veterans (51.3% women) from all se...
Meaning in life refers to the “sense made of, and significance felt regarding, the nature of one's being and existence.” Meaningful living promotes well‐being, resilience, and personal growth. Yet, much remains unknown about how meaning changes over time and determinants of meaning, particularly during major life transitions. We identified distinct...
Veterans who identify as gay, lesbian, bisexual, queer, and other minoritized sexual orientations (LGBQ+) experience significant stigma-related barriers to health care, including discrimination in care settings, which can lead to avoiding needed services. While research on general health care utilization is a growing area, mental health help seekin...
Background
Sexual violence (SV) and intimate partner violence (IPV) experiences are major social determinants of adverse health. There is limited prevalence data on these experiences for veterans, particularly across sociodemographic groups.
Objective
To estimate the prevalence of SV before, during, and after military service and lifetime and past...
Revisions to the posttraumatic stress disorder (PTSD) criteria in the DSM-5 included a new criterion in the alterations in arousal and reactivity cluster (i.e., engagement in reckless and self-destructive behaviors; Criterion E2). Despite its clinical significance, little is known about how this symptom corresponds to engagement in specific direct...
Background
Identifying predictors of suicidal ideation (SI) is important to inform suicide prevention efforts, particularly among high-risk populations like military veterans. Although many studies have examined the contribution of psychopathology to veterans’ SI, fewer studies have examined whether experiencing good psychosocial well-being with re...
Purpose
Social determinants of health (SDoH) refer to the conditions in the environments in which people live that affect health outcomes and risks. SDoH may provide proximal, actionable targets for interventions. This study examined how SDoH are associated with posttraumatic stress disorder (PTSD) and depression symptoms among Veterans and non-Vet...
Background:
Veterans' success with navigating the challenges of transition from military service may contribute to their risk for suicidal outcomes. The concept of well-being can help to conceptualize and assess successful navigation of reintegration challenges and may serve as an optimal target for public health-oriented suicide prevention.
Meth...
Background:
Research comparing prevalence of alcohol use problems and alcohol treatment utilization between veterans and nonveterans is lacking. Whether predictors of alcohol use problems and alcohol treatment utilization differ in veterans vs. nonveterans is also unclear.
Methods:
Using survey data from national samples of post-9/11 veterans an...
Background
VA primary care patients are routinely screened for current symptoms of PTSD, depression, and alcohol disorders, but many who screen positive do not engage in care. In addition to stigma about mental disorders and a high value on autonomy, some veterans may not seek care because of uncertainty about whether they need treatment to recover...
Large-scale epidemiological studies suggest that veterans may have poorer physical health than nonveterans, but this has been largely unexamined in post-9/11 veterans despite research indicating their high levels of disability and healthcare utilization. Additionally, little investigation has been conducted on sex-based differences and interactions...
Little is known about the impact of perceived neighborhood danger on military veterans' mental health, a population potentially at higher risk for this experience, or whether interpersonal social support and neighborhood cohesion can help buffer against poor mental health. This study examined: (1) the impact of perceived neighborhood danger on depr...
Objective:
The current study sought to compare rates of posttraumatic stress disorder (PTSD) treatment utilization (medication and psychotherapy) among veterans and nonveterans-and to investigate which factors are associated with treatment utilization among veterans versus nonveterans.
Methods:
Participants were 2775 individuals (veteran, n=2508...
The Posttraumatic Cognitions Inventory (PTCI) is a self-report measure of negative posttraumatic cognitions, which is an important construct in the development and maintenance of posttraumatic stress disorder (PTSD). Evidence for the most appropriate PTCI item and factor structure is mixed, and this measure has not been extensively studied in veter...
Reports an error in "The role of PTSD symptom severity and relationship functioning in male and female veterans' mental health service use" by Kelly L. Harper, Dawne Vogt, Annie Fox, Yael I. Nillni and Tara Galovski (Psychological Trauma: Theory, Research, Practice, and Policy, Advanced Online Publication, Sep 29, 2022, np). In the original article...
Purpose:
The COVID-19 pandemic has had a profound impact on mental health around the world. Although there have been reports that the incidence of eating disorders (EDs) has increased during the pandemic, few longitudinal studies have examined recent changes in EDs. Men and women with military histories may be particularly vulnerable to EDs, under...
Objective:
Previous research has shown that difficulties in intimate relationships promote mental health treatment seeking for male veterans, but findings for female veterans have been mixed. The current study sought to further evaluate whether intimate relationship functioning is a motivator for mental health treatment seeking for male and female...
Objective: Disordered eating (DE) in military veterans has been linked to trauma exposure, but the mechanisms underlying this association remain unclear. The current study documented the direct associations of DE with multiple trauma types in a gender-balanced sample of veterans and examined indirect associations of trauma and DE via self-reported...
Objective
Many war-zone deployed post-9/11 veterans report negative mental health symptoms related to their military service, which can have consequences for physical health symptoms and the impact of physical health on functioning. The current study examined the bidirectional relationships between mental health symptoms and physical health functio...
Introduction
Active duty service members transitioning to civilian life can experience significant readjustment stressors. Over the past two decades of the United States’ longest sustained conflict, reducing transitioning veterans’ suicidal behavior and homelessness became national priorities. However, it remains a significant challenge to identify...
Objective: Despite theorizing that posttraumatic stress disorder (PTSD) symptomatology may be exacerbated during the military-to-civilian transition, little research has delved into the trajectory of trauma-related symptomatology or the impact of diverse factors on timing of PTSD onset. To understand risk and protective factors for PTSD during the...
Background
Prior research has examined how the post-military health and well-being of both the larger veteran population and earlier veteran cohorts differs from non-veterans. However, no study has yet to provide a holistic examination of how the health, vocational, financial, and social well-being of the newest generation of post-9/11 U.S. militar...
Posttraumatic stress disorder (PTSD) and chronic pain are highly prevalent and co-morbid among veterans. Moral injury (MI), which results from traumatic experiences that conflict with deeply held moral beliefs, is also associated with pain. However, relationships between different types of exposures to potentially morally injurious events (PMIEs) a...
Reports an error in "Development and validation of a brief warfare exposure measure among U.S. Iraq and Afghanistan war veterans: The Deployment Risk and Resilience Inventory-2 Warfare Exposure-Short Form (DRRI-2 WE-SF)" by Michelle J. Bovin, Aaron Schneiderman, Paul A. Bernhard, Shira Maguen, Claire A. Hoffmire, John R. Blosnich, Brian N. Smith, R...
Objective: Trauma-exposed veterans may be more likely to experience posttraumatic stress disorder (PTSD), chronic pain, and sleep disturbance together rather than in isolation. Although these conditions are independently associated with distress and impairment, how they relate to social functioning and suicidal ideation (SI) when experienced comorb...
Objective: It is important to assess warfare experiences beyond direct combat exposure, as these exposures can negatively impact military veterans’ health. Although two validated scales from the Deployment Risk and Resilience Inventory-2 [DRRI-2] together capture a broad range of stressful warfare experiences, the length of this combined measure (3...
Background
The transition from military service to civilian life is a high-risk period for suicide attempts (SAs). Although stressful life events (SLEs) faced by transitioning soldiers are thought to be implicated, systematic prospective evidence is lacking.
Methods
Participants in the Army Study to Assess Risk and Resilience in Servicemembers (ST...
Reports an error in "Recovering from intimate partner violence through Strengths and Empowerment (RISE): Development, pilot testing, and refinement of a patient-centered brief counseling intervention for women" by Katherine M. Iverson, Sara B. Danitz, Mary Driscoll, Dawne Vogt, Alison B. Hamilton, Megan R. Gerber, Shannon Wiltsey Stirman, Danielle...
Background
The purpose of this study was to determine whether changes in work, intimate relationship, and parental psychosocial functioning domains were associated with suicidal ideation severity, over time.
Methods
This secondary data study was conducted on Veterans Administration data. Participants were 183 women veterans who served in Iraq and/...
Introduction
Little is known about predictors of military veterans’ suicidal ideation as they transition from service to civilian life, a potentially high-risk period that represents a critical time for intervention. This study examined factors associated with veterans’ suicidal ideation in the first year after military separation.
Methods
A natio...
Although it is well-established that sexual assault results in variable and long-lasting negative impacts on emotional well-being, perceptions of physical health, and relationship functioning, these “psychosocial” outcomes may vary based on the type(s) of sexual trauma experienced. To identify the differential impact of sexual trauma type(s) on psy...
LAY SUMMARY
Military members want to do well when they leave service. Good well-being is one way of thinking about success in the transition to life after service. The word well-being has different meanings to different people, which can be confusing. To help Veterans, it must be clearly defined. Some see well-being as something inside a person; ot...
Objective
Healthcare use is elevated among individuals with eating disorders (EDs); however, most people with EDs do not receive ED-specific care, likely due to factors such as the cost and availability of treatment as well as stigma. U.S. military veterans historically have been understudied in ED research. We investigated healthcare use and barri...
Suicide risk is elevated among military service members who recently transitioned to civilian life. Identifying high-risk service members before this transition could facilitate provision of targeted preventive interventions. We investigated the feasibility of doing this by attempting to develop a prediction model for self-reported suicide attempts...
Introduction
Veterans transitioning from military service to civilian life manage numerous changes simultaneously, in health, employment, social relationships, and finances. Financial problems may impact financial well-being as well as adjustment to civilian life in general; yet, research on Veterans’ financial challenges remains limited. This stud...
Background: Many pregnant and postpartum Veterans have experienced multiple lifetime traumas, including military sexual trauma, intimate partner violence, and combat trauma. These women may be particularly vulnerable to increased post-traumatic stress disorder and other mental health problems following additional trauma exposures or stressful event...
This study assessed the effectiveness of employment programs components, which resulted in the identification of content and process components that increase employability. Employment program use was studied among 1172 United States of America military veterans to determine which content (i.e., interviewing skills) and process (i.e., working with a...
Objective:
It is well documented that sexual minority individuals are more likely to report disordered eating (DE) than those identifying as heterosexual. Although DE is prevalent in veterans, investigation of potential disparities in DE among sexual minority veterans is limited. This study examined rates of DE in post-9/11 United States (U.S.) ve...
Background:
Although the transition out of military service is a high-risk time for suicidal ideation (SI), a paucity of research examines the development of SI during this transition process and veteran subgroups at risk for SI as they readjust to civilian life.
Methods:
A population-based, longitudinal post-9/11 veteran cohort reported SI freq...
Background
Our goal was to examine the association between moral injury, mental health, and suicide attempts during military service and after separation by gender in post-9/11 veterans.
Methods
A nationally representative sample of 14057 veterans completed a cross-sectional survey. To examine associations of exposure to potentially morally injuri...
Objectives
To examine whether the U.S. military veteran population experiences improvements or declines in their health and broader well-being during the first three years after leaving military service and to document differences based on gender, military rank, and warzone deployment history.
Methods
A population-based sample of 3733 newly separa...
Background
Prior research has found that 25% of women veterans who are new to the Department of Veterans Affairs (VA) health care system discontinue services within 3 years of initial use. Although it has been suggested that providing more gender-sensitive care might improve women veterans' health care experiences, no study has yet documented an em...
Background
Despite some evidence for gender differences in associations between military veterans’ mental health and suicidal ideation (SI), gender-specific prospective studies are lacking. The aims of this prospective study were to: (1) examine gender differences in veterans’ initial status and trajectories of mental health severity and SI status...
Objective: Recovering from Intimate Partner Violence through Strengths and Empowerment (RISE) is a brief, variable-length (1-6 sessions), modular, individualized psychosocial counseling intervention for women experiencing intimate partner violence (IPV). Pilot findings demonstrated the potential helpfulness, acceptability, and feasibility of RISE;...
Objective: Caregivers with a history of trauma exposure may struggle to parent effectively, particularly when symptoms of PTSD are prominent. Consequently, identifying factors that buffer associations between PTSD and poor parental functioning is critical to help trauma-exposed families thrive. One important source of resilience may spring from bei...
Objective:
In the general population, history of trauma is associated with a range of adverse perinatal outcomes, which have long-term negative consequences for both mother and child. Research examining the impact of trauma, particularly trauma occurring during military service, on perinatal outcomes among women veterans is still in its nascence....
LAY SUMMARY
Veterans may struggle with the conflicts that arise from juggling competing work and family demands after they leave military service. Over time, these feelings of conflict can have a negative impact on their mental health. The current study sought to explore the impact of conflict between work and family roles on war-zone-deployed U.S....
Early detection of eating disorders (EDs) is crucial for both prevention and treatment; however, few ED measures have been validated among older adults, men, and racially/ethnically diverse individuals, who may have varying symptom presentations. We examined the psychometric quality of three self-report ED measures within a diverse sample of U.S. m...
It has become commonplace to adapt the terminology used to reference mental illness in stigma measures to avoid further stigmatizing people who have experienced a mental health problem. However, to our knowledge, no study has examined the effect of modifying terminology in stigma measures on levels of stigma endorsement or on the relationship betwe...
This article describes the rationale, development, and preliminary examination of a brief, variable-length (up to six sessions), modular-based counseling intervention for women who experience intimate partner violence (IPV). Recovering from IPV through Strengths and Empowerment (RISE) is an empowerment and skills-focused treatment that incorporates...
Given military veterans' underutilization of posttraumatic stress disorder (PTSD) treatment, it is important to explore factors that may facilitate or stand in the way of treatment seeking for this population. The purpose of this study was to provide an initial examination of military veterans' mental health literacy as it relates to PTSD and its t...
Prior research has examined the independent effects of demographic and military characteristics, trauma history, and coping resources on military veterans' health. However, there is limited knowledge of how these factors intersect with one another and with veterans' health to impact their broader well-being as they readjust to civilian life. Data f...
Background:
Rising US suicide rates are particularly notable among military veterans, especially women. It is unknown whether these differences extend to suicidal ideation (SI) and suicide attempts (SA), which are major predictors of suicide. Literature comparing SI and SA prevalence and timing of onset between veterans and nonveterans is limited....
Military veterans have greater exposure to adverse childhood experiences (ACEs) than civilians and many also encounter warfare exposures, which can increase the likelihood of mental health problems. The purpose of this study was to test an interaction between childhood traumas and warfare exposures on the mental health of a sample of nearly 10,000...
Adverse childhood experiences (ACEs) are robustly associated with physical and mental health problems over the life span. Relatively limited research has examined the breadth of ACEs among military veteran populations, for whom ACEs may be premilitary traumas associated with suicidal ideation and attempt. Using data from the Comparative Health Asse...
Prior research on the relationship between veterans’ mental health and psychosocial functioning has primarily relied on male samples. Here, we investigated prospective longitudinal relationships between mental health and psychosocial functioning in 554 female Iraq and Afghanistan War veterans who were surveyed three times between two- and seven-yea...
Given the diversity of military veterans and growing evidence of ethnoracial disparities in posttraumatic stress disorder (PTSD) within this population, elucidating the role of discrimination-related stress in contributing to these disparities is crucial. We examined the relative impact of discriminatory stress (i.e., due to race/ethnicity, religio...
Background
Although research has shown that exposure to potentially traumatic and morally injurious events is associated with psychological symptoms among veterans, knowledge regarding functioning impacts remains limited.
Methods
A population-based sample of post-9/11 veterans completed measures of intimate relationship, health, and work functioni...
Fidelity monitoring is a critical indicator of psychotherapy quality and is central to successful implementation. A major barrier to fidelity in routine care is the lack of feasible, scalable, and valid measurement strategies. A reliable, low-burden fidelity assessment would promote sustained implementation of cognitive behavioral therapies (CBTs)....
Moral injury (MI) may occur in the context of committing transgressions (i.e., self‐directed MI reactions), witnessing transgressions, or being the victims of others’ transgressions (i.e., other‐directed MI reactions) that violate an individual's moral principles. Veterans with MI may experience impaired social well‐being (SWB). Studies on MI and v...
Objective:
Adverse childhood experiences (ACEs) are early life experiences of abuse and neglect, and observed violence, among others. For military veterans, both ACEs and combat exposure are associated with mental health problems.
Method:
This study examines the relationship between ACEs and combat exposure on the current mental health in a larg...
Our goal was to identify gender differences in the prevalence and outcomes of exposure to potentially morally injurious events (PMIEs) in a sample of U.S. military veterans. In a national sample of post-9/11 veterans (n = 7,200) weighted to reflect the larger population of newly separated U.S. veterans, we conducted gender-stratified analyses of th...
Background:
Numerous programs exist to support veterans in their transitions to civilian life. Programs are offered by a host of governmental and non-governmental stakeholders. Veterans report encountering many barriers to program participation. This study identified barrier reduction strategies offered by programs that new post-9/11 veterans repo...
Objective:
The Veterans Metrics Initiative is a longitudinal survey study examining the military-to-civilian transition of a cohort of new post-9/11 veterans. This study identified the programs and services used by new post-9/11 veterans who screened positive for mental health problems (N=3,295) and factors that predicted use.
Methods:
The popul...
Posttraumatic stress disorder (PTSD) has been found to lead to several adverse perinatal outcomes in the general population. Preliminary research has found that women veterans with PTSD have an increased prevalence of preterm birth, gestational diabetes, and preeclampsia. Less research has examined the role of moral injury (MI) in perinatal outcome...
Background - Numerous programs exist to support veterans in their transitions to civilian life. Programs are offered by a host of governmental and non-governmental stakeholders. Veterans report encountering many barriers to program participation. This study identified barrier reduction strategies offered by programs that new post-9/11 veterans repo...