Sarah Carter

Uniformed Services University of the Health Sciences | USUHS · Department of Medical & Clinical Psychology

Social support, including support from spouses, may buffer against posttraumatic stress disorder (PTSD) symptoms. The current study assessed whether the frequency of spousal communication during a recent deployment, a potentially important source of support for soldiers, was related to postdeployment PTSD symptoms. Data came from 193 married male A...

Military deployments are stressful for service members and partners. Communication is an important factor in trying to maintain a relationship during these separations. This article presents a brief overview of communication in long-distance relationships for context, then reviews articles on communication during military deployments. This review r...

Military spouses often have concerns regarding the impact of their communication on soldiers during deployment. However, literature is mixed regarding how communication between soldiers and spouses may impact soldiers' self-reported work functioning during deployment, suggesting the need to evaluate moderating factors. In the current study, three r...

This study examined the effectiveness of an evidence-based, community-delivered adaptation of couple relationship education (CRE) program (specifically, The Prevention and Relationship Enhancement Program [PREP]) delivered at two Army installations. The study is a randomized controlled trial with 2 years of follow-up examining marital quality and s...

Romantic relationships can both attenuate and exacerbate suicide risk. Suicide prevention strategies in the United States have emphasized the importance of healthy connections with others; however, suicide prevention efforts overwhelmingly continue to focus on individual‐level interventions. This presents a missed opportunity to prevent suicide thr...

Background Sexual harassment pervades higher education and disproportionately impacts women in medicine. The Department of Education’s guidance related to Title IX, a federal civil rights law intended to protect against discrimination based on sex in educational programs or activities receiving federal financial assistance, was revised in 2020 to n...

Objective: In the evidence-based suicide prevention intervention, Caring Letters, healthcare providers send brief, caring messages to patients following psychiatric inpatient care, a time of elevated suicide risk. However, recent studies with military populations have found mixed results. An adaptation of Caring Letters employed a peer framework i...

Caring Letters is a prevention program aimed at reducing suicide risk; however, clinical trials indicate mixed results among military and veteran samples. The present study aimed to pilot a new version of the Caring Letters intervention that was adapted to military culture in order to emphasize peer support. The supportive letters, traditionally se...

Cognitive flexibility has been linked with positive psychological health outcomes, whereas cognitive rigidity has been linked with suicide risk. We examined associations among cognitive flexibility and certain suicide risk indicators among a sample of patients psychiatrically hospitalized for suicide risk (n = 40). Data were collected during two pi...

While elevated suicide risk in the American military and veteran population has led to the development of targeted interventions, the increased risk of suicidal ideation and behavior among transgender and gender diverse (TGD) servicemembers requires that interventions address suicide risk within the context of minority stressors and gender-affirmin...

Widespread attempts to implement suicide prevention efforts may be hindered by stigma regarding suicidal thoughts and behaviors (STBs). Despite extensive literature linking general mental health stigma to numerous negative outcomes (i.e., reduced help-seeking), limited research has extended findings to STB-specific stigma. Thus, the present study a...

Increasingly complex and unpredictable personnel and operational demands require Special Operations Forces (SOF) members and their families to remain flexible, adaptive, and resilient within ever-changing circumstances. To mitigate the impact of these stressors on psychological health and fitness, researchers and educators at the Uniformed Services...

The Veterans Crisis Line (VCL) is a national resource offering Veterans 24/7 access to crisis responders and follow-up by a licensed mental health clinician at a Veterans Affairs medical center. This quality improvement project aimed to improve local suicide prevention efforts at the VA Puget Sound Health Care System by characterizing 344 VCL calls...

Objective: Evaluate suicide attempt prevalence and potentially related sociodemographic and psychiatric factors among racial and ethnic groups. Methods: Between 2012 and 2013, the National Epidemiologic Survey on Alcohol and Related Conditions-III (NESARC-III) conducted semi-structured interviews with 36,309 adults in the USA. We identified life...

An examination of the changes in social interactions with family members, peers, and supervisors experienced by U.S. Service members following their discharge from hospitalization for a suicidal crisis

Suicide is a considerable public health concern, particularly among U.S. veterans. Despite inpatient psychiatric hospitalization being a primary recommended treatment for acute suicidality, available inpatient group treatments remain limited. The current quality improvement project (QIP) aimed to examine the feasibility and acceptability of a newly...

Introduction. Changes in social interactions following psychiatric hospitalization, a period characterized by heightened suicide risk, are important to understand. Objective. We qualitatively explored perceived changes in social interactions one month after inpatient psychiatric discharge following a suicidal crisis. Methods. A total of 113 United...

Background Suicide is a serious and growing public health concern, both for the United States (U.S.) and for the Department of Defense (DoD). Methods Using the social–ecological framework, we provide examples of how three newly developed, DoD‐funded pilots/programs have incorporated a public health approach to help prevent military suicide. Key R...

Military deployments are known to be stressful for both military service members (SMs) and their romantic partners. Little is known about how coping strategies used during deployment may relate to one’s own and one’s partner’s relationship satisfaction following deployment. This project investigated the retrospective report of how 154 SMs and their...

Background: Patient disclosure of prior suicidal behaviors is critical for effectively managing suicide risk; however, many attempts go undisclosed. Aims: The current study explored how responses following a suicide attempt disclosure may relate to help-seeking outcomes. Method: Participants included 37 veterans with a previous suicide attempt rece...

Objective: There is significant debate about the feasibility of using predictive models for suicide prevention. Although statistical considerations have received careful attention, patient perspectives have not been examined. This study collected feedback from high-risk veterans about the U.S. Department of Veterans Affairs (VA) prevention program...

To improve the identification and intervention of suicide risk, the Veterans Health Administration implemented the use of electronic patient record flags (PRF) to indicate when a veteran is identified as high risk for suicide and to increase the clinical contacts made with the veteran. The current study utilized an intersectional approach to assess...

Background: Concerns exist regarding the perceived risks of conducting suicide-focused research among an acutely distressed population. Aims: The current study assessed changes in participant distress before and after participation in a suicide-focused research study conducted on a psychiatric inpatient unit. Method: Participants included 37 vetera...

Qualitative analysis of a pilot suicide prevention study utilizing peer support.

Objective: Transgender people are less likely to have health insurance, which has been associated with reduced utilization of health care. In the current study, the authors sought to assess the role of health insurance in mental health care utilization among transgender individuals. Methods: A total of 4,334 adults who self-identified as transge...

Introduction: Despite recent advancements in the development of new suicide prevention interventions, suicide rates continue to rise in the United States. As such, suicide prevention efforts must continue to focus on expanding dissemination of suicide-specific interventions. Methods: This review explores telemental health through two-way synchro...

Objectives. To characterize housing instability among transgender veterans using Veterans Health Administration (VHA) health care in the United States.Methods. We used administrative data on veterans screened for housing instability from 2013 to 2016; participants included 5717 transgender veterans and 17 133 cisgender veterans. We defined housing...

To minimize potential distractions for deployed military service members (SMs), some nondeployed romantic partners have reported engaging in protective buffering, or intentionally withholding information or concerns to protect their deployed partner. This study assessed the associations of protective buffering and psychological distress and marital...

Service members and veterans (SM/Vs) with posttraumatic stress disorder (PTSD) can receive significant benefits from social support by a spouse or romantic partner. However, little is known about how providing support impacts partners. This study sought to identify (a) how provision of support is associated with partners' daily negative and positiv...

Purpose: The aim was to examine social support and community connection as moderators of the relationship between discrimination and suicidal ideation (SI) in transgender veterans. Methods: A national convenience sample of 298 transgender veterans completed an online cross-sectional survey from February to May 2014. Hierarchical regressions usin...

To shield a romantic partner from potential distress due to stressors occurring during deployment, service members (SMs) may engage in protective buffering, or withholding information or concerns from a romantic partner. This study utilized data from 54 couples collected before, during, and after a military deployment to assess whether SMs engaged...

Deployment to a combat zone is a fundamental mission for most military forces, but prior research suggests that there is a complex and nuanced association between deployment and related risk factors for suicide. Deployment and combat experiences vary greatly among military personnel and can affect a variety of protective and risk factors for suicid...

Recent advances in statistical methods and computing power have improved the ability to predict risks associated with mental illness with more efficiency and accuracy. However, integrating statistical prediction into a clinical setting poses new challenges that need creative solutions. A case example explores the challenges and innovations that eme...

Suicide behaviors are frequently conceptualized as a mental health problem. There is certainly a substantial body of research indicating that various mental health disorders increase the risk of suicide and suicide attempts.¹ Further, psychological autopsies conducted on those who died by suicide reveal mental health diagnoses in about 90% of cases...

Long-distance communication has been frequently identified as essential to military couples trying to maintain their relationship during a deployment. Little quantitative research, however, has assessed the types of topics discussed during such communication and how those topics relate to overall relationship satisfaction. The current study draws o...

Progress in clinical science, theory, and practice requires the integration of advances from multiple fields of psychology, but much integration remains to be done. The current article seeks to address the specific gap that exists between basic social psychological theories and the implementation of related therapeutic techniques. We propose severa...

Little is known about the role of romantic partner symptom accommodation in PTSD symptom maintenance. To explore the bidirectional associations of posttraumatic stress disorder (PTSD) symptoms and romantic partner symptom accommodation over time, military servicemen (n = 64) with symptoms of PTSD and their co-habiting heterosexual civilian romantic...

There are few quantitative studies of communication between service members (SMs) and spouses during military deployments. Approximately one year post-deployment, 224 SMs and 214 of their spouses completed measures of relationship satisfaction. SMs also retrospectively reported on frequency of synchronous (real-time; e.g., phone) and asynchronous (...

Post-traumatic distress after military combat is a major cost of war. One under-investigated factor potentially associated with PTSD symptoms is specific beliefs about one's military service. This study examined post-deployment self-reports from 272 active-duty U.S. Army soldiers, to investigate potential associations between military-related PTSD...

The association of service members' combat-related PTSD with partners' distress is weaker when spouses/partners believe that service members experienced more traumatic events during deployment. Also, when simultaneously examining partners' perceptions of all PTSD symptoms, perceptions of reexperiencing symptoms (the symptoms most obviously connecte...