Archived project

Survey of Veterans’ Sexual Health and Well-being

Goal: This study evaluated the prevalence and severity of behavioral addictions and other co-occurring disorders among US returning war veterans (OEF/OIF).

Date: 30 December 2014 - 10 September 2020

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Project log

Shane W Kraus
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We have completed this project and successfully published many many papers from it.
 
Thanks Erin. We're happy to close that chapter. It was a productive project but it's now on to other things. I hope all is going well for you!
 
Congratulations! Great work!
 
Shane W Kraus
added a research item
Problematic Pornography Use (PPU) is the most common problem behavior among individuals with compulsive sexual behavior (CSB). Previous research suggests US veterans are at a greater risk of engaging in PPU. The present study sought to investigate further PPU among male military veterans. Data from 172 male veterans who endorsed ever watching pornography and completed the Problematic Pornography Use Scale (PPUS) were included in the study. Participants completed self-report questionnaires, including demographic information, psychiatric co-morbidities, impulsivity, as measured by the UPPS-P, pornography-related behaviors, and pornography craving as measured by Pornography Craving Questionnaire (PCQ). Younger age and lower educational attainment were associated with higher PPUS scores. Depression, anxiety, post-traumatic stress disorder (PTSD), insomnia, and impulsivity were positively associated with higher PPUS scores. There was no statistically significant association between PPU with suicidal ideation or alcohol use disorder. In the multivariable hierarchical regression, depression, frequency of use, and higher PCQ scores were associated with higher PPUS scores, although on the latter two remained significant in the final model. Understanding the risk factors via more frequent screening for PPU will help with the development of treatment protocols for this problematic behavior.
Shane W Kraus
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Background and aims: To address current gaps around screening for problematic pornography use (PPU), we initially developed and tested a six-item Brief Pornography Screen (BPS) that asked about PPU in the past six months. Methods and participants: We recruited five independent samples from the U.S. and Poland to evaluate the psychometric properties of the BPS. In Study 1, we evaluated the factor structure, reliability, and elements of validity using a sample of 224 U.S. veterans. One item from the BPS was dropped in Study 1 due to low item endorsement. In Studies 2 and 3, we further investigated the five-item the factor structure of the BPS and evaluated its reliability and validity in two national U.S. representative samples (N = 1,466, N = 1,063, respectively). In Study 4, we confirmed the factor structure and evaluated its validity and reliability using a sample of 703 Polish adults. In Study 5, we calculated the suggested cut-off score for the screen using a sample of 105 male patients seeking treatment for compulsive sexual behavior disorder (CSBD). Results: Findings from a principal components analysis and confirmatory factor analysis supported a one-factor solution which yielded high internal consistency (α = 0.89-0.90), and analyses further supported elements of construct, convergent, criterion, and discriminant validity of the newly developed screen. Results from a Receiver Operating Characteristic (ROC) curve suggested a cut-off score of four or higher for detecting possible PPU. Conclusions: The BPS appears to be psychometrically sound, short, and easy to use in various settings with high potential for use in populations across international jurisdictions.
Shane W Kraus
added a research item
Introduction: Sending sexually explicit text messages ("sexting") is prevalent among US adults; however, the mental health correlates of this behavior among adults have not been studied adequately. Furthermore, there are few studies examining the related but distinct behavior of posting sexually explicit photos or videos of oneself online (posting sexual images [PSI]) and the mental health correlates of this behavior. Aim: To examine associations between sexting, PSI, impulsivity, hypersexuality, and measures of psychopathology. Methods: Using a national convenience sample of 283 US post-deployment, post-9/11 military veterans, we evaluated the prevalence of 2 behaviors: sexting and PSI and the associations of these behaviors with psychopathology, suicidal ideation, sexual behaviors, hypersexuality, sexually transmitted infections, trauma history, and measures of impulsivity. Main outcome measure: Measures of psychopathology including depression, anxiety, post-traumatic stress disorder, insomnia, substance dependence, hypersexuality, and suicidal ideation, as well as measures of impulsivity, sexual behavior, and trauma. Results: Sexting was found to be common among post-9/11 veterans (68.9%). A smaller number of veterans engaged in PSI (16.3%). PSI veterans were more likely to be younger, male, less educated, and unemployed. After adjusting for covariates, no associations were detected between PSI or sexting and the examined measures of psychopathology. However, PSI was associated with higher levels of impulsivity and hypersexuality, whereas sexting was not associated with these measures. Clinical implications: Results from this study suggest that not all digital sexual behaviors are associated with psychopathology. However, PSI was associated with hypersexuality and impulsivity. Those who engage with PSI may benefit from guidance on how to manage their impulsivity to prevent ego-dystonic sexual behaviors. Strengths & limitations: The strengths of this study include differentiating PSI from sexting broadly, highlighting that digital sexual behaviors are heterogeneous. Limitations include the study's cross-sectional design, which limits causal interpretations. More research is also needed in civilian populations. Conclusion: PSI was less prevalent than sexting in our sample. This behavior was associated with impulsivity and hypersexuality but not with elevated levels of psychopathology. Sexting was not associated with any of these measures. Turban JL, Shirk SD, Potenza MN, et al. Posting Sexually Explicit Images or Videos of Oneself Online Is Associated with Impulsivity and Hypersexuality but Not Measures of Psychopathology in a Sample of US Veterans. J Sex Med 2019; XX:XXX-XXX.
Shane W Kraus
added a research item
Background: Posttraumatic stress symptoms are common after discharge from military service in male and female Post-9/11 veterans, many of whom experienced combat. Objective: This is a study of the impacts of childhood and adult assaults are studied both separately and together on the level of posttraumatic stress symptoms in male and female Post-9/11 veterans (N = 850) after discharge from military service. Participants and setting: This cross-sectional secondary analysis uses data from the baseline interviews of the Survey of Experiences of Returning Veterans (SERV) cohort study. Methods: Childhood sexual and physical abuse, adult sexual and physical assault, and combat exposure were the main exposures of interest and the primary outcome measurement was the Posttraumatic Symptom Checklist-Civilian, assessing symptom severity post discharge from military service. Results: Our sample reported high rates of childhood abuse, adult victimization, combat exposure, and posttraumatic stress symptoms. Tested separately, models including different types of victimization had both unique (f2 = 0.30) and cumulative (f2 = 0.32) effects on severity of posttraumatic stress symptoms in male and female veterans. Conclusions: Our results underscore the importance of assessing childhood and adult trauma history in returning veterans in addition to traumas they experienced during their service. These findings highlight the importance of focusing on building resilience in our military servicemembers.
Shane W Kraus
added a research item
Emotion dysregulation, a risk factor for suicide ideation and attempts, has not been studied in U.S. veterans of Operations Enduring and Iraqi Freedom and New Dawn (OEF/OIF/OND). Data were collected through standardized telephone interviews and computer-based surveys from 278 OEF/OIF/OND veterans (70.6% male, 29.4% female). Bivariate analyses indicated that emotion dysregulation was associated with suicidal ideation during the past-three-months (r ¼ 0.30, p <0.05) and lifetime suicide attempts (r ¼ 0.21, p < 0.05). When PTSD and depression symptoms were added to a sequential logistic regression model, emotion dysregulation was no longer significantly associated with ideation or attempt. Emotion dysregulation was associated with suicidal ideation and attempt; however, current distress had greater associations. Dysregulation is one of several factors in veteran suicide risk.
Shane W Kraus
added a research item
Background and objectives: Little research has examined the clinical characteristics of U.S. post-9/11 military veterans coping with alcohol problems. Specifically, we examined psychopathology and hypersexuality among male and female post-9/11 veterans with and without a lifetime history of alcohol-use disorders (AUDs). Methods: Using data from a baseline telephone interview and follow-up web-based survey, we examined frequencies of AUDs, mental health and addictive disorders, sexual behaviors, hypersexuality, and problematic use of pornography in a national convenience sample of 283 U.S. veterans. Results: Many (39.1%) veterans met lifetime criteria for AUDs. Bivariate associations revealed that veterans with lifetime AUDs met clinically significant levels of posttraumatic stress disorder and criteria for drug-use disorders (lifetime). Veterans with lifetime AUDs also attended religious services less often, engaged in more solitary masturbation in the past month, and reported more issues with problematic use of pornography and hypersexuality compared with veterans without AUDs. Results from a logistic regression found that lifetime drug-use disorders (odds ratio [OR] = 4.22) and posttraumatic stress disorder symptoms (OR = 1.98) were significant predictors of veterans with lifetime AUD status. Discussion and conclusions: We found differences among veterans with lifetime AUDs compared with those without on select measures of psychopathology, sexual behavior, and hypersexuality. Scientific significance: Further screening for substance-use disorders and hypersexuality in Veterans Affairs is strongly encouraged while veterans are transitioning back into civilian life (Am J Addict 2019;00:00-00).
Shane W Kraus
added 2 research items
Background and aims: The current study evaluated the clinical characteristics of pornography users who screened positive on the Brief Pornography Screener (BPS), a 5-item questionnaire developed to detect compulsive use of pornography among non-clinical and clinical populations. Methods: Two-hundred-and-twenty-three US military veterans were administered the BPS and measures assessing frequency of pornography use, craving for pornography, emotional regulation, hypersexuality, impulsivity, and clinical measures of psychopathology. Results: Of the 223 pornography users, 60 (27.3%) of individuals scored at or above the clinical cut-off score of 4 (range 1-10) on the BPS. More men (32.2%) than women (7.5%) reported compulsive use of pornography. Nearly one third (29.5%) of compulsive users viewed pornography daily as compared to 6.8% of non-compulsive users. Compulsive users of pornography scored higher on measures of poor emotional regulation, hypersexuality, impulsivity (negative and positive urgency), and craving for pornography. No significant differences were noted between compulsive and non-compulsive users on measures of anxiety, depression, alcohol and drug use, insomnia, and gambling behaviors. Conclusions: Compulsive users of pornography demonstrated different clinical characteristics from noncompulsive users. The findings suggest that transdiagnostic features may be more relevant than psychiatric diagnoses in targeting prevention efforts.
Background and aims: The topic of sexting was recently publicized in the US given its widely reported behavior among active duty soldiers. To date, no studies have examined the prevalence of sexting and associated risks among military veterans. Methods: We evaluated the prevalence of sexting (sending sexually explicit text messages, images or videos) with clinical correlates of psychopathology, hypersexuality, impulsivity, problematic use of pornography, suicidal ideation, and sexually transmit¬ted infections among 283 US postdeployment military veterans. Results: 75.6% of men and 2.2% of women reported having sexted in their lifetime; 21.8% of men and 2.4% of women had sent naked pictures or videos of themselves to another person. Veterans with a history of sexting were more likely to report higher levels of impulsivity, hypersexuality, problematic use of pornography, insomnia, depression, and alcohol dependence. Veterans with a history of sexting reported more past year sexual intercourse partners compared to those without. However, no significant differences were noted for suicidal ideation, drug dependence, anxiety disorders, or sexually transmitted infections. Conclusions: Sexting among US military veterans appears prevalent, particularly among males. The findings suggesting that sexting is associated with increased impulsivity, hypersexuality, psychopathology, and numbers of sexual partners suggest a need for further research and targeted interventions.
Shane W Kraus
added a research item
U.S. combat veterans frequently encounter challenges after returning from deployment, and these challenges may lead to difficulties in psychological and social functioning. Currently, research is limited on gender-related differences within this population, despite female veterans comprising a growing portion of the U.S. military with roles and exposures similar to their male counterparts. Using secondary analysis, we examined 283 returning combat veterans (female = 29.4%) for differences in psychopathology and trauma history. Female veterans were more likely to report a history of sexual trauma than their male counterparts, whereas male veterans were more likely to report greater frequency of gambling in the past year, impulsivity, and hypersexuality. No gender-related differences were identified for depression, anxiety, insomnia, or substance-use disorders, although both men and women veterans had higher rates than those found in the general population. While both male and female combat veterans repo
Shane W Kraus
added 2 research items
Compulsive sexual behavior: Individual, neurobiological, and psychological considerations Chair: Shane W. Kraus VISN 1 MIRECC, VA CT Healthcare System Yale University School of Medicine The current symposium will review data from four studies discussing the role of individual, neurobiological, and psychological factors in the assessment and treatment of compulsive sexual behavior. Abstract (2500 characters) Compulsive sexual behavior (CSB) is characterized by inappropriate or excessive sexual fantasies or behaviors that lead to subjective distress or impairment in one’s daily functioning across several important life domains. Currently, there is no widely accepted framework on how to best conceptualize and/or treat individuals with CSB, and it is debated as to whether to view CSB as an impulse-control disorder, a feature of hypersexual disorder, or a behavioral addiction. Recent data suggest that “behavioral addictions” (e.g., gambling, shopping, sex) may share clinical, genetic, neurobiological, and phenomenological (e.g., escalation of behavior over time, craving, attentional bias) parallels with substance addictions, raising questions about how best to classify, prevent and treat CSB. The symposium will describe data on individual, neurobiological, and psychological factors in CSB. Dr. Voon will present data on cue reactivity, cue conditioning, and attentional bias in CSB, with findings providing support for incentive motivation theories underlying CSB. Dr. Gola will present data on brain reward pathways in individuals with CSB. Individuals with CSB as compared to those without had increased activation of the ventral striatum for erotic but not monetary incentives. Mr. Grubbs will present data from two samples examining the relationship between pornography users’ behaviors and their perceptions of what constitutes “pornography addiction.” Individual difference variables such as religious and spiritual struggles and conservative sexual values were associated with perceived addiction to pornography. Dr. Kraus will present data from a sample of US Veterans and describe the psychometric properties of a newly developed questionnaire designed to identify behaviors, thoughts, and experiences associated with compulsive use of pornography. Item loadings from a principal component analysis, a high internal consistency reliability coefficient, and a moderate mean inter-item correlation supported interpreting the screening instrument as a single scale that demonstrated construct, convergent and discriminant validity. Finally, Dr. Potenza will serve as discussant and explore the findings in the settings of DSM-5 and ICD-11, and describe the implications for classification, assessment, prevention, treatment, and policy. Subject Area: Clinical Neuroimaging studies in compulsive sexual behaviours Valerie Voon Department of Psychiatry, University of Cambridge Increased erotic incentives sensitivity but not diminished reactivity for other rewards underlies compulsive sexual behaviors. Mateusz Gola Institute of Psychology, Polish Academy of Science and Institute for Neural Computations, University of California San Diego Małgorzata Wordecha, Laboratory of Brain Imaging, Neurobiology Center, Nencki Institute of Experimental Biology, Polish Academy of Science, Warsaw University Guillaume Sescousse, Radboud University, Donders Institute for Brain, Cognition and Behaviour Bartosz Kossowski, Laboratory of Brain Imaging, Neurobiology Center, Nencki Institute of Experimental Biology, Polish Academy of Science and Institute of Radioelectronics, Warsaw University of Technology Artur Marchewka, Laboratory of Brain Imaging, Neurobiology Center, Nencki Institute of Experimental Biology, Polish Academy of Science Predicting perceived addiction to internet pornography over time: The role of personality and religious beliefs Joshua B. Grubbs Case Western Reserve University Joshua Wilt, Case Western Reserve University Julie J. Exline, Case Western Reserve University Kenneth I. Pargament, Bowling Green State University Pornography Use Screener: Psychometric properties Shane W. Kraus, VISN 1 MIRECC, VA CT Healthcare System and Yale University School of Medicine Steve Martino, VISN 1 MIRECC, VA CT Healthcare System and Yale University School of Medicine Rani A. Hoff, VISN 1 MIRECC, VA CT Healthcare System and Yale University School of Medicine Elizabeth Dombrowski, VA CT Healthcare System Marc N. Potenza, Yale University School of Medicine Discussant Marc N. Potenza Yale University School of Medicine
Compulsive sexual behavior (CSB) is generally characterized by inappropriate or excessive sexual fantasies or behaviors that lead to distress or impairment in a person’s daily functioning. Information will be presented on CSB and other psychopathology in two samples of adults recruited from the United States. In Sample 1, 103 men seeking treatment for CSB were assessed for psychopathology at a private and a public university clinic. In Sample 2, 626 male and female veterans were assessed for the prevalence of CSB and other co-occurring psychiatric disorders. Among treatment-seeking men, 94% met criteria for at least one Axis-I psychiatric disorder, and 57% of the sample met criteria for two or more psychiatric disorders. Among a national representative sample of returning veterans, approximately 11% (13.5% of men, 6.2% of women) endorsed symptoms associated with CSB. For the 71 veterans reporting problems managing their sexual behavior, high rates of co-occurring disorders such as PTSD (69%), insomnia (55%), depression (45%), panic (43%), alcohol dependence (17%), and drug dependence (17%) were observed. Areas in which additional research is needed to better understand the complex treatment needs of individuals seeking treatment for CSB will be discussed.
Shane W Kraus
added a research item
Compulsive sexual behavior (CSB) is often characterized by inappropriate or excessive sexual fantasies or behaviors that cause impairment in one or more important areas of daily functioning. The present study examined the prevalence of CSB in a national sample of US male Operation Enduring Freedom (OEF), Operation Iraqi Freedom (OIF), and/or Operation New Dawn (OND) veterans, and investigated correlates of CSB including sociodemographic and other psychiatric disorders. Four hundred and ninety five male veterans were assessed for CSB and other psychiatric disorders during a baseline interview. Approximately 13.8% (n = 68) endorsed one or more CSB symptoms (e.g., overly preoccupied with sexual behavior, frequent sexual fantasies, urges or repetitive behaviors that feel ‘out of control’). Bivariate analyses indicated that men with CSB were more likely to be African American and attended religious services more frequently than did men without CSB. In terms of psychiatric disorders, CSB was significantly and positively related to affective and impulse control disorders. Similarly, CSB was significantly and positively associated with suicidality, sexually transmitted infection, sexual trauma (victimization), poor mental health functioning, and PTSD symptom severity. Results from a multiple regression analysis found that African American/black race (OR=2.90, 95% CI = 1.31-6.39), monthly or greater religious services attendance (OR=2.07, 95% CI=1.00-4.26), anxiety disorder (OR=2.57, 95% CI=1.16-5.72), suicidality (OR=2.61, 95% CI = 1.24-7.11), sexually transmitted infection (OR=3.22, 95% CI=1.35-7.65), and sexual trauma (OR=2.35, 95% CI =1.02-5.38) were significant predictors of CSB among male OEF/OIF/OND veterans. Current findings could be used to develop screening practices across the Veteran Affairs Healthcare System aimed at identifying veterans needing treatment for CSB and other mental health related problems.
Shane W Kraus
added a research item
Compulsive sexual behavior (CSB) is defined as difficulties in controlling inappropriate or excessive sexual fantasies, urges, or behaviors that cause subjective distress or impairment in important areas of daily functioning. Using data from a baseline telephone interview, we examined the prevalence of CSB in a convenience sample of 820 post-deployed US military male and female veterans and investigated correlates of CSB with sociodemographics and other mental health and sexual history characteristics. More men (13.8%) than women (4.3%) endorsed CSB-related symptoms. Given the limited sample size of women reporting CSB, correlational analyses were conducted only with men. After adjusting for significant sociodemographics, results indicated that gambling, suicidality, and sexually transmitted infections were significantly associated with male CSB. Current results suggest that CSB may be prevalent among US military veterans post deployment and associated with significant negative health indices in men. CSB warrants attention regarding screening and intervention.
Shane W Kraus
added a project goal
This study evaluated the prevalence and severity of behavioral addictions and other co-occurring disorders among US returning war veterans (OEF/OIF).