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Trauma exposure, mental health, and quality of life among injured service members: Moderating effects of perceived support from friends and family
Abstract
Poor mental health and quality of life (QOL) are common among service members exposed to trauma and may be more pronounced among those injured on combat deployment. It is vital to identify factors that attenuate these issues. This study examined whether perceived support from friends and family buffer associations between level of trauma exposure, mental health symptoms (i.e., posttraumatic stress disorder [PTSD], depression), and QOL. Military health care records and cross-sectional web-assessment data were collected for 1,643 individuals who were participating in a large-scale surveillance project of patient-reported outcomes of Service members injured on combat deployment. General linear models revealed perceived support from family and friends were independently related to lower depression and PTSD symptoms, and higher QOL. Perceived support from friends buffered associations between trauma exposure and depression symptoms and QOL, but not PTSD symptoms. In contrast, individuals with high family support reported the lowest levels for both PTSD and depression symptoms at low levels of trauma exposure. At high levels of trauma exposure, however, symptoms were similar across levels of family support. A similar trend was observed for QOL. Such evidence reinforces the importance of interpersonal relationships and support for injured service members, and highlights the need to address these topics in existing treatment and rehabilitation programs.
... Social support and social relationships include family, friends, coworkers, subordinates, peers and leaders from across an individual's personal environment. Positive social relationships provide tangible resources to enhance the ability to cope with adversity and can serve as a buffer for negative impacts on psychological resilience (McCabe et al., 2020). Comparatively, poor social relationships can be deleterious on one's ability to cope with adversity if the relative weight of vulnerabilities outweighs protective factors. ...
... Focusing on the resilience factor of social support, Harland et al. (2005) determined that views on leadership are related to resilience. This relationship has the potential for positive or negative outcomes on resilience (McCabe et al., 2020). To increase the body of knowledge on the relationship between leadership and resilience, especially in military populations, this study was designed to explore the perception of leadership in self and as a social factor in relation to resilience. ...
Resilient qualities, which derive from protective factors, enable an individual to balance exposure to vulnerabilities in military service and throughout life. Protective factors arise from within an individual, from social factors, and from an individual's environment. Research on social factors, such as strong leadership and peer relationships, continues to emerge and significantly relate to resilience. Of specific interest to organisations is how perceptions of leadership contribute to resilience as an individual and social protective factor. Knowing more about how soldiers perceive themselves on authentic leadership and resilience would better help researchers and practitioners understand the contribution of leadership on perceived resilience. The current study examined the perception of authentic leadership in self and first-line leaders with resilience in a population of 179 soldiers (N = 179; M = 26.86 years, SD = 6.42). The results noted a significant correlation between the perception of authentic leadership in oneself and resilience (r = 0.506, p < 0.001). A subsequent analysis examining the perception of authentic leadership in one's first-line leader and subordinate resilience was also significant (r = 0.394, p < 0.001), supporting previous findings. These results demonstrate that perceptions of leadership matter as an individual and social factor in military personnel.
... Regardless of the context, among the most important predictors of QoL is exposure to trauma life events (Roberts et al., 2013). Previous studies focused on the tangible consequences of exposure to trauma (Cieslak et al., 2014;Juczyński & Ogińska-Bulik, 2018;McCabe et al., 2020a) and, by extension, on the responses individuals exhibit in relation to this phenomenon. In this line, studies in the specialized literature have sought to further highlight the responses individuals provide to trauma, especially in the aftermath of significant events such as the September 11 attacks (North et al., 2011), the Gaza Strip (Mahmoudian, 2023;Qeshta et al., 2019) conflicts, or the armed conflict between Russia and Ukraine (Hăisan et al., 2022;Huțul et al., 2023;Maftei et al., 2022). ...
The present study investigated the level of trauma exposure among university students in relation with trauma appraisal and Quality of Life. We also aimed to investigate the mediating role of trauma appraisals on the relationship between trauma exposure and Quality of Life. The research was conducted on a sample of 202 students (20.8% males, 78.2% females). They completed instruments designed to assess trauma appraisals, trauma exposure, and Quality of Life. The outcomes highlighted the direct relationship between trauma exposure and Quality of Life, and also the mediating role of alientation – a subdimension of trauma appraisal, on the aforementioned relationship. The present study contributes to the literature by enhancing knowledge about the relationship between trauma exposure, Quality of Life, and trauma appraisal within university students. We also discuss the theoretical and practical implications of the results.
... However, some people will continue to experience symptoms such as avoidance, negative alteration in cognition and mood and changes in arousal and reactivity that later can be referred to as PTSD (APA, 2018). Moreover, PTSD symptoms may extensively impair individuals' ability to function appropriately in terms of social and family relationships and negatively affect their quality of life (Dauphin, 2020;McCabe et al., 2020). PTSD prevalence rates vary widely, depending on various risk factors, including individuals' socio-demographic ones, type of trauma, sources and availability of social support and the intensity of the acute response to the traumatic event (Farooqui et al., 2017;Marthoenis et al., 2019). ...
Purpose: This systematic review (SR) aims to evaluate and summarize the effectiveness of using eye movement desensitization and reprocessing (EMDR) intervention among individuals diagnosed with post-traumatic stress disorder (PTSD), as well as to highlight the standardized EMDR-based interventional protocol.
Design/methodology/approach: This SR is guided according to preferred reporting items for SRs and meta-analyses standards. Several online databases were used in searching for eligible studies in peer-reviewed journals relevant to the study keywords. The included studies were SRs and clinical trials that used EMDR interventions among patients experiencing PTSD symptoms, older than 18 years and were published in English language from 2015 to 2022. Three researchers independently contributed to study selections, data extraction and study evaluations from different aspects, including quality assessment, risk of bias and study synthesis.
Findings: A total of eight published studies met the inclusion criteria and were included in this SR; four articles were randomized controlled trials and four were SR and meta-analysis studies. In all included studies, the EMDR was used as a primary psychotherapy intervention for PTSD symptoms. The results of this extensive and comprehensive review showed that EMDR is an effective psychotherapeutic intervention to reduce and control the severity of symptoms among individuals with PTSD.
Practical implications: This paper, a review of the literature, gives an overview of EMDR effectiveness, provides baseline information and plays a significant role in decreasing the gap in Jordanian literature regarding using EMDR as the strongest evident psychotherapy approach for PTSD treatment to help psychiatrists, psychologists and psychiatric nurses in the health-care sectors to design comprehensive strategies to enhance and improve the quality of health care and patients' status. Social implications-EMDR intervention offers significant alternative treatment opportunities for individuals suffering from PTSD, depression and anxiety. The implementation of EMDR for depression, anxiety and PTSD improves patient outcomes as compared to standard therapeutic modalities in PTSD.
Originality/value: This SR gives an overview and explains strong supportive evidence for the effectiveness of EMDR interventions among individuals with PTSD. Therefore, EMDR therapy could be assumed as one standard treatment option for PTSD, aiming at reducing treatment duration and cost of treatment and restoring the mental well-being and functionality of those suffering from PTSD.
Plain language summary: Why was the study done? Post-traumatic stress disorder (PTSD) is a global-concern mental illness that occurs because of exposure to a traumatic life experience such as a natural disaster, a severe accident, or a physical or sexual assault in adulthood or childhood. The consequences of PTSD warrant mental health professionals to find effective interventions to maintain and restore mental well-being. Therefore, the selection of interventions is a cornerstone element in deciding successful interventions. Research using validated screening measures assessed whether this was sustained during the contemporary era. Yet, these studies have not been brought together in an organized manner to offer an inclusive summary of this evidence. What did the researchers do? We reviewed literature examining the effectiveness of using eye movement desensitization and reprocessing (EMDR) intervention among patients diagnosed with PTSD to assess the role of EMDR in reducing the severity of symptoms in patients with PTSD and to highlight the standardized EMDR-based interventional protocol. What did the researchers find? Eight studies were identified. Most studies indicated that EMDR was used as a primary psychotherapy intervention for PTSD symptoms. The results of this extensive and comprehensive review showed that EMDR is an effective psychotherapeutic j MENTAL HEALTH AND SOCIAL INCLUSION j intervention to reduce and control the severity of symptoms among individuals with PTSD. What do the findings mean? This review suggests EMDR therapy could be supposed to be one standard treatment option for PTSD, aiming at reducing treatment duration and cost of treatment and restoring the mental well-being and functionality of those suffering from PTSD.
... Military combatants often face potentially traumatic events that place them at risk for long-term mental health disorders, such as depression and PTSD (Arditte Hall et al., 2019;Hassija et al., 2012;Snir et al., 2017). It has been well-established that combat trauma produces a long-term negative effect on psychopathology and mental pain (McCabe et al., 2020) in both cross-sectional (e.g., Bartone & Homish, 2020) and longitudinal (e.g., Walker et al., 2021) studies. ...
Background:
Perpetrating or witnessing acts that violate one's moral code are frequent among military personnel and active combatants. These events, termed potentially morally injurious events (PMIEs), were found to be associated with an increased risk of depression, in cross-sectional studies. However, the longitudinal contribution of PMIEs to depression among combatants remains unclear.
Method:
Participants were 374 active-duty combatants who participated in a longitudinal study with four measurement points: T1-one year before enlistment, T2-at discharge from army service, and then again 6- and 12-months following discharge (T3 and T4, respectively). At T1, personal characteristics assessed through semi-structured interviews. At T2-T4, PMIEs and depressive symptoms were assessed.
Results:
At discharge (T2), a total of 48.7% of combatants reported experiencing PMIEs incident, compared with 42.4% at T3 and 30.7% at T4. We found a significant interaction effect in which combatants endorsing PMIEs at discharge reported higher severity of depression symptoms at discharge (T2) than combatants who reported no PMIEs. This effect decreased over time as depression levels were lower at T3 and T4.
Conclusions:
PMIE experiences, and especially PMIE-Betrayal experiences, were found to be valid predictors of higher severity of depression symptoms after the first year following discharge.
... In contrast, lack of social support and feelings of social isolation are the most important predictors of psychological illnesses such as posttraumatic stress after exposure to crises or traumatic events [63][64][65][66]. Reavell and Fazil [42] found that high mental health problems were linked to increased susceptibility to injury, while social support was crucial in reducing symptoms of traumatization and depression. ...
Coping with a siege, worsening health, and deteriorating social, educational, and economic conditions, along with isolation.
The limited chances to meet basic needs and aspirations impact the mental health and perception of the civilian population.
quality of life. In this cross-sectional investigation, we explored the consequences of mental distress, fear of COVID-19,mand social support for QoL in the Gaza strip.
... A previous study has suggested an indirect relationship between family support and quality of life, indicating that the relationship between a psychiatric disorder and quality of life 6 months later was mediated by perceived emotional support from the family (García-Carmona et al., 2021). Further, a study conducted among injured service members in the United States found that individuals who received substantial family support reported lower levels of posttraumatic stress disorder (PTSD) when exposed to trauma (McCabe et al., 2019). The study also highlighted similar trends in terms of the quality of life of the affected individuals. ...
The study aimed to compare the quality of life (QoL) in two communities with different exposures to conflict and investigate the inter-relationship between posttraumatic stress disorder (PTSD), social support, and QoL. This is a cross-sectional with 413 participants. Study instruments included the PTSD module of the Composite International Diagnostic Interview (CIDI), the World Health Organization Quality of Life BREF (WHOQoL-BREF), and the Multidimensional Scale of Perceived Social Support (MSPSS). The family domain of social support was protective of both PTSD and QoL. Except for the relationship between community’s location and the physical subscale of the QoL, a hierarchical regression analysis showed that all the independent variables were significantly associated with the QoL domains. Direct exposure to crises impaired QoL more than areas indirectly exposed. PTSD and the family domain of social support play a significant role in the QoL outcome. This suggests that therapeutic intervention to improve QoL should target these key variables.
... Most of the literature on military reintegration has focused on post-combat deployment problems and disorder-specific readjustment problems, either mental or physical, such as PTSD, traumatic brain injury, suicidal ideation, and physical injuries encountered (McCabe et al., 2020;Williamson et al., 2021;Winter et al., 2020). Only some have focused on understanding the transition experience of retired armed forces personnel from military to civilian life and how they see through the cultural gap, readjust, create new meanings, and reshape their identities. ...
Military organizations often demonstrate contrasting features compared to civilian ones, including indoctrination of military identity and mind-set. Therefore, on returning after retirement, military personnel undergo acculturation to reconnect to the civilian world. Many military retirees face difficulty readjusting in multiple professional and personal life domains, and report decreased life satisfaction due to this transition. The present review conducted a thematic meta-synthesis of 28 studies that had qualitatively assessed military to civilian transition experiences. The aim was to understand the military-civilian culture gap and identify the challenges faced during this transition. The analysis led to six themes - "Military Institutionalization, Military-Civilian Cultural Contrast, The Three S's of Transition Challenges - Stereotypes, Skills, and Support, The Losses of Identity, Reconnecting with Family, Friends, and Civilian Counterparts, and Facilitators in Transition - Covering the Military-Civilian Gap." Based on these findings, the review further presents possible intervention suggestions for retirement adjustment and future research direction.
... Once again, the empirical evidence supports the exact opposite pattern. PTE exposure is related to worse quality of life (Harrison, Brown, & Cho, 2020;McCabe, Watrous, & Galarneau, 2020;Monson, Caron, McCloskey, & Brunet, 2017;Park et al., 2016), worse social functioning (Afifi et al., 2007;Davidson, Shannon, Mulholland, & Campbell, 2009;Sweeting, Garfin, Holman, & Silver, 2020), higher rates of social isolation (Copeland et al., 2018), lower levels of social support (Van Voorhees et al., 2018), less relationship satisfaction (Blais, 2021), more self-destructive behaviors (Rizeq & McCann, 2021), and greater feelings of vulnerability (Roe-Burning & Straker, 1997). This body of evidence demonstrating the enormity of negative outcomes in the domains that comprise PTG following trauma exposure makes it difficult to argue that, more times than not, PTE exposure leads to a net gain in mental well-being. ...
Over the last 2.5 decades, trauma researchers have increasingly become interested in posttraumatic growth (PTG) - the concept that some people experience growth as a result of trauma exposure. I begin by reviewing extant research on PTG, with a focus on measurement and conceptual issues. Expanding on arguments made by others, I distinguish between three forms of PTG, 1) perceived PTG, which is an individual's beliefs about their own PTG, 2) genuine PTG, which is veridical growth following adversity, and 3) illusory PTG, which is motivated fabrications of PTG. Perceived PTG is extremely common, as over half of individuals exposed to a potentially traumatic event (PTE) report moderate or greater levels of PTG. I review evidence that most self-reports of PTG are greatly exaggerated and argue that perceived PTG is mostly illusory PTG. I propose five reasons for the disconnect between perceived PTG and genuine PTG, including design flaws in the current measurements, emotional biases that favor perceived PTG, the inherent appeal of PTG, cultural expectations, and problems of definition. I then review the empirical evidence concerning the prevalence rate of genuine PTG, coming to the bold conclusion that the occurrence of genuine PTG is very rare, contradicting current fundamental beliefs about PTG. I recommend researchers focus on the key areas of measurement and etiology of genuine PTG, which are necessary to create interventions that foster genuine PTG. I conclude by outlining a path to steer the scientific progression of PTG back in the right direction.
... Especially, somatoform dissociation is more likely to be related to ACEs than psychoform dissociation as the ACEs are often related to physical and emotional trauma (Kate et al., 2020). Although many studies have shown that social and interpersonal environments (e.g., perceived support, quality of parenting) may buffer the effects of adverse experiences on mental health problems (e.g., Evans et al., 2013;Gewirtz-Meydan, 2020;McCabe et al., 2020), little is known about what specific social and interpersonal factors would moderate the relationship between ACEs (which by definition occur before 18 years old) and somatoform dissociation in adulthood. Although a large body of work has found that ACEs are associated with dissociation, more research is needed to investigate which types of ACEs are particularly associated with somatoform dissociation (Kienle et al., 2017). ...
The impacts of adverse childhood experiences (ACEs) have been well documented. One possible consequence of ACEs is dissociation, which is a major feature of post-traumatic psychopathology and is also associated with considerable impairment and health care costs. Although ACEs are known to be associated with both psychoform and somatoform dissociation, much less is known about the mechanisms behind this relationship. Little is known about whether social and interpersonal factors such as family environments would moderate the relationship between ACEs and somatoform dissociation. This paper discusses the importance of family environments in trauma recovery. We then report the findings of a preliminary study in which we examined whether the association between ACEs and somatoform dissociation would be moderated by family well-being in a convenience sample of Hong Kong adults (N = 359). The number of ACEs was positively associated with somatoform dissociative symptoms, but this association was moderated by the level of family well-being. The number of ACEs was associated with somatoform dissociation only when the family well-being scores were low. These moderating effects were medium. The findings point to the potential importance of using family education and intervention programs to prevent and treat trauma-related dissociative symptoms, but further investigation is needed.
Keywords: Childhood adversities; Trauma; Somatoform dissociation; Mental health; Family interventions
... Additional aspects of HRQOL may also be addressed. For example, data show that perceived social support from friends was associated with fewer mental health symptoms and higher HRQOL, suggesting that interventions to optimize social support among injured SMs may be beneficial [54]. Although preliminary studies among active duty SMs and veterans [55,56] demonstrate that integrating mental health care into primary care settings can increase mental health visits and reduce PTSD severity, future studies should also examine whether similar interventions yield improvements in other domains of HRQOL (e.g., physical health and functioning). ...
PurposePosttraumatic stress disorder (PTSD) and depression are strong predictors of poor health-related quality of life (HRQOL) among injured U.S. military service members (SMs). Patterns of HRQOL between injury categories and injury categories stratified by mental health (MH) symptoms have not been examined. Among deployment-injured SMs and veterans (n = 4353), we examined HRQOL and screening data for PTSD and/or depression within specific injury categories.Methods
Participants included those enrolled in the Wounded Warrior Recovery Project with complete data for HRQOL (SF-36) from June 2017 to May 2020. Injuries were categorized using the Barell Injury Diagnosis Matrix (Barell Matrix). Mean physical component summary (PCS) and mental component summary (MCS) scores were calculated for each injury category and stratified by the presence or absence of probable PTSD and/or depression.ResultsThe average follow-up time that participants were surveyed after injury was 10.7 years. Most participants were male, non-Hispanic White, served in the Army, and enlisted rank. Mechanism of injury for 77% was blast-related. Mean PCS and MCS scores across the entire sample were 43.6 (SD = 10.3) and 39.5 (SD = 13.3), respectively; 50% screened positive for depression and/or PTSD. PCS and MCS scores were significantly lower within each injury category among individuals with probable PTSD and/or depression than those without.Conclusion
Among deployment-injured SMs, those with probable PTSD and/or depression reported significantly lower HRQOL within injury categories and HRQOL component (i.e., physical or mental) than those without. Findings are consistent with prior reports showing mental health symptoms to be strongly associated with lower HRQOL and suggest integration of mental health treatment into standard care practices to improve long-term HRQOL.
... Further, social support can stem from varied sources, and just as social relationships may differ by personal and situational characteristics (Antonucci et al., 2012), the function of support provided by different sources may vary (Antonucci et al., 2012;Prang et al., 2015). As such, it is important to investigate the role of social support in psychological recovery (McCabe et al., 2020;Prang et al., 2015). Yet there is a paucity of literature regarding how support from family, friends, and significant others is associated with postinjury outcomes (Woodward et al., 2015;Zimet et al., 1988). ...
Purpose/objective:
The role of perceived social support from specific sources (e.g., families, friends, and significant others) on the development of postinjury posttraumatic stress disorder (PTSD) and associated psychological symptoms (e.g., depression and anxiety) remains relatively unexplored. We examined the predictive role of social support from specific sources on psychological symptoms among emergency department (ED) patients following motor vehicle crash (MVC). Research Methods/Design: Sixty-three injured patients (63.5% female; 37 years old on average) with moderately painful complaints were recruited in the EDs of two Level-1 trauma centers within 24 hr post-MVC. In the ED, participants completed surveys of baseline psychological symptoms and perceived social support; follow-up surveys were completed at 90 days postinjury.
Results:
Most of the sample (84.1%) was discharged home from the ED with predominantly mild injuries and did not require hospitalization. After adjusting for race, sex, age, and baseline symptoms, hierarchical regression analyses demonstrated that lower perceived social support in the ED predicted higher PTSD symptoms and depressive symptoms (but not anxiety) at 90 days. This effect seemed to be specific to significant others and friends but not family.
Conclusions/implications:
MVC-related injuries are robust contributors to psychological sequelae. These findings extend prior work by highlighting that perceived social support, particularly from significant others and friends, provides unique information regarding the development of psychological symptoms following predominantly mild MVC-related injuries. This data may serve to inform recovery expectations. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
... For example, certain health behaviours among service members may help (eg, physical activity, healthful diet) 23 or hinder (eg, excessive alcohol consumption, cigarette use) 24 25 health and well-being. In addition, interpersonal factors such as social support 26 and social integration 27 or intrapersonal factors such as hardiness and resilience 28 may have direct impacts on mental health and QOL. Continued multidisciplinary research is needed to better understand factors that contribute to the health and readiness of service members injured on combat deployment to ensure optimal recovery from injury. ...
Introduction
The ‘ golden hour ’ is a universal paradigm that suggests trauma patients have lower morbidity and mortality when provided with medical care within 1 hour after injury. The objective of this study was to examine whether transport time from point of injury to a military treatment facility (MTF) in-theatre was associated with patient-reported outcomes, such as post-traumatic stress disorder (PTSD), depression and quality of life (QOL), among US service members with combat-related injury.
Methods
Participants were injured between March 2003 and March 2016 and completed standardised assessments of PTSD, depression and QOL for theWounded Warrior Recovery Project (WWRP) between January 2013 and November 2017. Multivariable regressions were used to assess the relationship between transport time (≤1 hour or >1 hour from injury to MTF) and positive screens for PTSD and depression, and QOL, respectively.
Overall, 45.6% of participants (n=879) arrived at an MTF within 1 hour postinjury. About 8 years passed between when participants were injured on deployment and when they completed their first WWRP assessment. Approximately 48% of participants screened positive for PTSD and 51.3% for depression, with a mean QOL score of 0.513 (SD=0.150). After adjusting for covariates, transport time was not significantly associated with PTSD (OR 1.04, 95% CI 0.79 to 1.38; p=0.77), depression (OR 0.92, 95% CI 0.69 to 1.21; p=0.55) or QOL (β=0.009; p=0.38).
Conclusion
Transport time was not associated with patient-reported outcomes among US service members with combat-related injury. These findings are important as we seek to understand how combat casualties may be affected by extended medical evacuation or transport times anticipated in future expeditionary operations.
Objectives
We studied posttraumatic stress symptoms (PTSS) and disorder (PTSD), associated factors, and quality of life (QOL) of a group of passengers ( n = 58) affected by the 2023 Odisha train accident, comparing it with health professionals ( n = 42) such as doctors and nurses who treated them, and individuals from the local community ( n = 65). We also checked the anxiety and depression of passengers.
Methods
In a cross-sectional study, we assessed accident experience and used the PTSD checklist, WHO-QOL-BREF, General Anxiety Disorder, and Patient Health Questionnaire scales.
Results
The PTSS were common; specifically, intrusive memories (36.4%), feeling upset while reminded of the experience (33.9%), and avoidance of memories (30.9%). Strong negative feelings, loss of interest, feeling distant, and irritability or anger outbursts were significantly more common among passengers than others. PTSD was present in 20.7% of passengers, 19.0% of health professionals, and 7.7% of local participants. Seeing dead bodies significantly contributed to PTSD. Clinical levels of anxiety (58.3%) and depression (50%) were present in passengers, which were significantly associated with PTSD, along with fear of death. Passengers had the worst QOL and health satisfaction among the groups.
Conclusions
Following the train accident, stress-related psychiatric problems were common and highlighted the intervention needs of the affected people.
Military service members experience higher levels of cumulative trauma than the general population, increasing their risk of mental health problems. This scoping review synthesizes evidence on protective factors that contribute to posttraumatic
wellbeing among military service members and veterans. PubMed and PsycINFO databases were searched using keywords for military/veterans, traumatic event exposure, posttraumatic stress, and wellbeing outcomes (e.g., quality of life [QoL]).
Article abstracts and full texts were screened by two reviewers, with a third reviewer resolving conflicts. Inclusion criteria consisted of the following: (a) empirical study, (b) military/veteran sample, (c) exposed to posttraumatic stress disorder (PTSD) criterion A event, (d) =1 protective factor examined, (e) =1 wellbeing outcome examined. After data extraction, Bibliometric Network Analysis was used to visualize the topics covered. Literature searches yielded 1,341 articles. Of these, 104 articles were retained after screening. Of the wellbeing outcomes studied, QoL, functioning, and posttraumatic growth were well-researched. Across intervention types (CBT-based, third wave, and complementary), some interventions were efficacious for wellbeing outcomes (mainly QoL), but many had negligible or nonsignificant effects. Other than social support, external resources, and systemic supports were understudied. Intensive interventions and those involving daily practice most effectively promoted wellbeing. Protective factors such as social support, executive functioning, optimism, and system-level resources should be better incorporated into PTSD care for service members/veterans.
Background
The present study aimed to investigate the relation between lifelong exposure to traumatic life events, social support, and health‐related quality of life (QOL) in a sample of older people.
Method
A sample of 172 participants (mean age = 68.81, SD = 7.15; 68.6% female and 31.4% male) was involved in this study. The participants completed scales measuring lifelong exposure to traumatic events, social support, and health‐related QOL.
Results
The results showed that lifelong exposure to traumatic events was negatively related to physical and mental health‐related QOL. Moreover, social support moderated the relation between traumatic life events exposure and mental health‐related QOL.
Discussion
Geriatric services could identify and implement adequate measures to provide social support and to improve different dimensions of QOL among older adults.
Bu çalışmanın amacı deprem mağduru üniversite öğrencilerinin sahip oldukları sosyal destek ağlarının travma sonrası psikolojik iyileşme üzerindeki etkilerine yönelik algı ve görüşlerinin ortaya çıkartılmasıdır. Fenomenolojik desen ile gerçekleştirilen çalışmada Kahramanmaraş depremini deneyimleyen üniversite öğrencileri ile nitel görüşmeler gerçekleştirilmiştir. Araştırmada amaçlı örnekleme tekniklerinden biri olan maksimum çeşitlilik örneklemesi kullanılmıştır. Çalışma grubunu, 2023-2024 eğitim ve öğretim yılının güz döneminde öğrenimine devam eden ve gönüllü olarak çalışmaya katılan 38 üniversite öğrencisi (21’i kadın ve 17’si erkek) oluşturmuştur. Araştırmacı tarafından hazırlanan demografik bilgi formu ve yarı yapılandırılmış görüşme formu veri toplama araçları olarak kullanılmıştır. Nitel verilerin analizi için içerik analizi yürütülmüştür. Bulgular sonucunda Sosyal Destek Ağlarının Doğası ve Çeşitliliği, Sosyal Destek Ağlarının Duygusal Etkileri, Sosyal Destek Alanları, Sosyal Destek ve Güvende Hissetme, Sosyal Destek Ağlarının İyileşme ve Güçlenme Üzerindeki Etkileri ana temaları altında on beş alt tema olduğu tespit edilmiştir. Bulgular alanyazın ışığında tartışılmıştır.
Objectives:
Telomere length (TL) is a robust indicator of cellular aging. TL erosion has been associated with exposure to social and traumatic stressors. Loneliness and perceived social support are strongly linked to increased morbidity and mortality, but have yet to be investigated in relation to TL after extreme stress. The present study examined whether loneliness and lack of perceived social support following wartime captivity may be associated with TL as repatriated prisoners of war (ex-POWs) enter old age and contribute to its prediction.
Method:
A cohort of Israeli ex-POWs from the 1973 Yom Kippur War (n = 83) were assessed. Questionnaires were utilized to assess loneliness and perceived social support 18 years after the repatriation (T1), and Southern blotting was used to measure TL 24 years later (T2). A zero-order Pearson correlation test and a hierarchical regression analysis were utilized in order to examine the research questions.
Results:
Loneliness and lack of perceived social support each significantly predicted shorter TL in later life, and together added 25.8% to the overall explained variance.
Conclusions:
This is the first study to empirically demonstrate that loneliness and lack of perceived social support in early adulthood may be associated with shorter TL during transition to old age in a population that has endured extreme stress. Although the study design precludes causal inferences, several psychobiological mechanisms may explain the findings. The potential clinical significance of social deficits for longevity and heath in related populations is therefore addressed, and an agenda for future investigations is suggested. (PsycINFO Database Record
PurposeLittle is known about the long-term, health-related quality of life (HRQOL) of those wounded in combat during Operations Enduring Freedom, Iraqi Freedom, and New Dawn. The present study described the overall HRQOL for a large group of US service members experiencing mild-to-severe combat-related injuries, and assessed the unique contribution of demographics, service- and injury-related characteristics, and mental health factors on long-term HRQOL. Method
The Wounded Warrior Recovery Project examines patient-reported outcomes in a cohort of US military personnel wounded in combat. Participants were identified from the Expeditionary Medical Encounter Database, a US Navy-maintained deployment health database, and invited to complete a web-based survey. At the time of this study, 3245 service members consented and completed the survey. Hierarchical linear regression analyses were conducted to assess the unique contribution of each set of antecedents on HRQOL scores. ResultsHRQOL was uniquely associated with a number of demographics, and service- and injury-related characteristics. Nevertheless, screening positive for posttraumatic stress disorder (B = − .09; P < .001), depression (B = − .10; P < .001), or both as a set (B = − .19; P < .001) were the strongest predictors of lower long-term HRQOL. Conclusions
Postinjury HRQOL among service members wounded in combat was associated with service and injury experience, and demographic factors, but was most strongly linked with current mental health status. These findings underscore the significance of mental health issues long after injury. Further, findings reinforce that long-term mental health screening, services, and treatment are needed for those injured in combat.
Purpose:
Unintentional injuries have a significant long-term health impact in working age adults. Depression, anxiety and post-traumatic stress disorder are common post-injury, but their impact on self-reported recovery has not been investigated in general injury populations. This study investigated the role of psychological predictors 1 month post-injury in subsequent self-reported recovery from injury in working-aged adults.
Methods:
A multicentre cohort study was conducted of 668 unintentionally injured adults admitted to five UK hospitals followed up at 1, 2, 4 and 12 months post-injury. Logistic regression explored relationships between psychological morbidity 1 month post-injury and self-reported recovery 12 months post-injury, adjusting for health, demographic, injury and socio-legal factors. Multiple imputations were used to impute missing values.
Results:
A total of 668 adults participated at baseline, 77% followed up at 1 month and 63% at 12 months, of whom 383 (57%) were included in the main analysis. Multiple imputation analysis included all 668 participants. Increasing levels of depression scores and increasing levels of pain at 1 month and an increasing number of nights in hospital were associated with significantly reduced odds of recovery at 12 months, adjusting for age, sex, centre, employment and deprivation. The findings were similar in the multiple imputation analysis, except that pain had borderline statistical significance.
Conclusions:
Depression 1 month post-injury is an important predictor of recovery, but other factors, especially pain and nights spent in hospital, also predict recovery. Identifying and managing depression and providing adequate pain control are essential in clinical care post-injury.
Mental health disorders continue to plague service members and veterans; thus, new approaches are required to help address such outcomes. The identification of risk and resilience factors for these disorders in specific populations can better inform both treatment and prevention strategies. This study focuses on a unique population of U.S. Army Special Operations personnel to assess how specific avenues of social support and personal morale are related to mental health outcomes. The results indicate that, whereas personal morale and friend support reduce the relationship between combat experiences and posttraumatic stress disorder (PTSD), strong unit support exacerbates the negative effects of combat experiences in relation to PTSD. The study thus shows that although informal social support can lessen postdeployment mental health concerns, military populations with strong internal bonds may be at greater risk of PTSD because the support that they receive from fellow service members may heighten the traumatic impact of combat experiences. (PsycINFO Database Record
Can social resilience be trained? We report results of a double-dissociative randomized controlled study in which 48 Army platoons were randomly assigned to social resilience training (intervention condition) or cultural awareness training (active control group). The same surveys were administered to all platoons at baseline and after the completion of training to determine the short-term training effects, generalization effects beyond training, and possible adverse effects. Multilevel modeling analyses indicated that social resilience, compared with cultural awareness, training produced small but significant improvements in social cognition (e.g., increased empathy, perspective taking, & military hardiness) and decreased loneliness, but no evidence was found for social resilience training to generalize beyond these training foci nor to have adverse effects. Moreover, as predicted, cultural awareness, compared with social resilience, training produced increases in knowledge about and decreases in prejudice toward Afghans. Additional research is warranted to determine the long-term durability, safety, and generalizability of social resilience training. (PsycINFO Database Record
(c) 2015 APA, all rights reserved).
Background and objectives:
Deployment-related risk factors for suicidal ideation among Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF) veterans have received a great deal of attention. Studies show that mental health symptoms mediate the association between most deployment stressors and suicidal ideation; however, family-related factors during deployment are largely unexplored. We examined posttraumatic stress disorder (PTSD) and depression symptoms as mediators of the associations between deployment family support and stress and post-deployment suicidal ideation in combat-exposed OEF/OIF veterans.
Design:
National cross-sectional mail survey.
Methods:
1046 veterans responded to the survey. The sample for this study was 978 veterans who experienced combat. Regression-based path analyses were conducted.
Results:
Family support and stress had direct associations with suicidal ideation. When PTSD and depression symptoms were examined as mediators of these associations, results revealed significant indirect paths through these symptoms.
Conclusions:
This study contributes to the literature on suicidal ideation risk factors among OEF/OIF veterans. Deployment family support and family stress are associated with suicidal ideation; however these associations occur primarily through mental health symptomatology, consistent with findings observed for other deployment factors. This research supports ongoing efforts to treat mental health symptomatology as a means of suicide prevention.
Objective:
This study examined whether individual differences in loneliness and/or daily exacerbations in loneliness relate to daily pain and frequency and perception of interpersonal events among individuals with fibromyalgia (FM).
Method:
In total, 118 participants with FM completed electronic diaries each evening for 21 days to assess the occurrence of positive and negative interpersonal events, event appraisals, and pain. Multilevel modeling was used to examine relations of chronic and transitory loneliness to daily life outcomes, controlling for daily depressive symptoms.
Results:
Chronic and transitory loneliness were associated with more frequent reports of negative and less frequent reports of positive interpersonal daily events, higher daily stress ratings and lower daily enjoyment ratings, and higher daily pain levels. Neither chronic nor transitory loneliness moderated the relations between daily negative events and either stress appraisals or pain. However, both chronic and transitory loneliness moderated the relation between daily positive events and enjoyment appraisals. Specifically, on days of greater numbers of positive events than usual, lonely people had larger boosts in enjoyment than did nonlonely people. Similarly, days with greater than usual numbers of positive events were related to larger boosts in enjoyment if an individual was also experiencing higher than usual loneliness levels.
Conclusions:
Chronic and transient episodes of loneliness are associated with more negative daily social relations and pain. However, boosts in positive events yield greater boosts in day-to-day enjoyment of social relations for lonely versus nonlonely individuals, and during loneliness episodes, a finding that can inform future interventions for individuals with chronic pain.
In this study, we identified deployment-related and demographic predictors of several factors of posttraumatic growth in a sample of combat-exposed Gulf War I veterans. Participants were obtained via a Veterans Administration registry of Gulf War I veterans and were mailed a survey containing a number of scales assessing predeployment, deployment, and postdeployment factors from the Deployment Risk and Resilience Inventory and the Posttraumatic Growth Inventory. Military status and perceived threat were significant predictors of appreciation of life. Relating to others, personal strength, and posttraumatic growth as a whole were best predicted by the postdeployment variable of social support. Minority status was the only significant predictor of new possibilities, with ethnic minorities reporting more new possibilities postdeployment. Limitations and suggestions for future research are discussed.
The development of a self-report measure of subjectively assessed social support, the Multidimensional Scale of Perceived Social Support (MSPSS), is described. Subjects included 136 female and 139 male university undergraduates. Three subscales, each addressing a different source of support, were identified and found to have strong factorial validity: (a) Family, (b) Friends, and (c) Significant Other. In addition, the research demonstrated that the MSPSS has good internal and test-retest reliability as well as moderate construct validity. As predicted, high levels of perceived social support were associated with low levels of depression and anxiety symptomatology as measured by the Hopkins Symptom Checklist. Gender differences with respect to the MSPSS are also presented. The value of the MSPSS as a research instrument is discussed, along with implications for future research.
review the evidence concerning the importance of matching the characteristics of a stressful event confronting an individual and the specific forms of social support that are most beneficial in that context
begin with a review of multidimensional models of social support, with a focus on commonalities among theoretical conceptualizations / measures that have been developed to assess multiple components of social support will then be reviewed, with a focus on empirical tests of multidimensionality / remainder of the chapter will address the issue of whether individual components of support are differentially associated with positive physical and mental health outcomes as a function of the kind of stress faced by the individual (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Abstract Evidence across a multitude of contexts indicates that social support is associated with reduced risk for mental health symptoms. More information is needed on the effectiveness of different sources of support, as well as sex differences in support. Associations between social support from two sources - the military unit and friends and family - and mental health symptoms were examined in a study of 1571 Marine recruits assessed at the beginning and end of a highly stressful 13-week training program. Military social support buffered the stressor exposure-posttraumatic stress symptomatology (PTSS) relationship, whereas the relationship between stressor exposure and PTSS was highest when civilian social support was high. Further inspection of the interactions revealed that military support was most important at high levels of stressor exposure. Sex differences in the relationship between social support and symptoms were found, such that support from military peers was associated with lower levels of PTSS for men, whereas civilian support was associated with lower PTSS for women. While civilian social support was associated with lower levels of depression symptom severity in both women and men, the relationship was stronger for women. Reviewed implications focus on the importance of considering the recipient, source, and context of social support.
This cross-sectional study investigated the relationship between psychiatric diagnosis and impaired work functioning among American service members returning from Operation Iraqi Freedom-Operation Enduring Freedom (OEF-OIF).
Participants were 797 OEF-OIF veterans, of whom 473 were employed. They were referred for further psychiatric assessment by primary care providers at six Veterans Affairs medical centers and underwent a behavioral health interview that assessed psychiatric and health status and work impairment as measured by the Work Limitations Questionnaire (WLQ). The four WLQ subscales (mental-interpersonal demands, time management, output, and physical demands) and an aggregated measure of productivity loss were considered in the analysis. Associations between patient characteristics, psychiatric status, and work impairments were investigated with regression models.
Major depressive disorder, posttraumatic stress disorder, and generalized anxiety or panic disorder were significantly associated with impairments in mental-interpersonal demands, time management, and output. Alcohol dependence and illicit drug use were associated with impairments in output and physical demands. On average these productivity losses were four times those found in a previous study of nonveteran employees with no psychiatric disorders.
Veterans' ability to maintain gainful employment is a major component of successful reintegration into civilian life, and psychiatric disorders have a negative impact on work performance. This study demonstrated that multiple dimensions of job performance are impaired by psychiatric illness among OEF-OIF veterans. Delivery of empirically supported interventions to treat psychiatric disorders and development of care models that focus on work-specific interventions are needed to help veterans return to civilian life.
Examine substance use and mental health issues among U.S. military personnel.
Data were from the 2008 (and before) population-based Department of Defense Health Related Behavior Surveys. The sample size for the 2008 survey was 28,546 (70.6% response rate).
Analyses examined substance use, stress, depression, post-traumatic stress disorder (PTSD), suicidal ideation and attempts, deployment, and job satisfaction. Trends show reductions in tobacco use and illicit drug use, but increases in prescription drug misuse, heavy alcohol use, stress, PTSD, and suicidal attempts. Deployment exacerbated some of these behavior changes. Despite the demanding lifestyle, job satisfaction was high.
The military has shown progress in decreasing cigarette smoking and illicit drug use. Additional emphasis should be placed on understanding increases in prescription drug misuse, heavy alcohol use, PTSD, and suicide attempts, and on planning additional effective interventions and prevention programs. Challenges remain in understanding and addressing military mental health needs.
Depression is associated with negative work outcomes such as reduced work participation (WP) (e.g., sick leave duration, work status) and work functioning (WF) (e.g., loss of productivity, work limitations). For the development of evidence-based interventions to improve these work outcomes, factors predicting WP and WF have to be identified.
This paper presents a systematic literature review of studies identifying factors associated with WP and WF of currently depressed workers.
A total of 30 studies were found that addressed factors associated with WP (N = 19) or WF (N = 11). For both outcomes, studies reported most often on the relationship with disorder-related factors, whereas personal factors and work-related factors were less frequently addressed. For WP, the following relationships were supported: strong evidence was found for the association between a long duration of the depressive episode and work disability. Moderate evidence was found for the associations between more severe types of depressive disorder, presence of co-morbid mental or physical disorders, older age, a history of previous sick leave, and work disability. For WF, severe depressive symptoms were associated with work limitations, and clinical improvement was related to work productivity (moderate evidence). Due to the cross-sectional nature of about half of the studies, only few true prospective associations could be identified.
Our study identifies gaps in knowledge regarding factors predictive of WP and WF in depressed workers and can be used for the design of future research and evidence-based interventions. We recommend undertaking more longitudinal studies to identify modifiable factors predictive of WP and WF, especially work-related and personal factors.
The current combat operations in Iraq and Afghanistan have involved US military personnel in major ground combat and hazardous security duty. Studies are needed to systematically assess the mental health of members of the armed services who have participated in these operations and to inform policy with regard to the optimal delivery of mental health care to returning veterans.
We studied members of 4 US combat infantry units (3 Army units and a Marine Corps unit) using an anonymous survey that was administered to the subjects either before their deployment to Iraq (n=2530) or 3 to 4 months after their return from combat duty in Iraq or Afghanistan (n=3671). The outcomes included major depression, generalized anxiety, and posttraumatic stress disorder (PTSD), which were evaluated on the basis of standardized, self-administered screening instruments.
Exposure to combat was significantly greater among those who were deployed to Iraq than among those deployed to Afghanistan. The percentage of study subjects whose responses met the screening criteria for major depression, generalized anxiety, or PTSD was significantly higher after duty in Iraq (15.6% to 17.1%) than after duty in Afghanistan (11.2%) or before deployment to Iraq (9.3%); the largest difference was in the rate of PTSD. Of those whose responses were positive for a mental disorder, only 23% to 40% sought mental health care. Those whose responses were positive for a mental disorder were twice as likely as those whose responses were negative to report concern about possible stigmatization and other barriers to seeking mental health care.
This study provides an initial look at the mental health of members of the Army and the Marine Corps who were involved in combat operations in Iraq and Afghanistan. Our findings indicate that among the study groups there was a significant risk of mental health problems and that the subjects reported important barriers to receiving mental health services, particularly the perception of stigma among those most in need of such care. The recent military operations in Iraq and Afghanistan, which have involved the first sustained ground combat undertaken by the United States since the war in Vietnam, raise important questions about the effect of the experience on the mental health of members of the military services who have been deployed there. Research conducted after other military conflicts has shown that deployment stressors and exposure to combat result in considerable risks of mental health problems, including posttraumatic stress disorder, major depression, substance abuse, impairment in social functioning and in the ability to work, and the increased use of healthcare services. One study that was conducted just before the military operations in Iraq and Afghanistan began found that at least 6% of all US military service members on active duty receive treatment for a mental disorder each year. Given the ongoing military operations in Iraq and Afghanistan, mental disorders are likely to remain an important healthcare concern among those serving there. Many gaps exist in the understanding of the full psychosocial effect of combat. The all-volunteer force deployed to Iraq and Afghanistan and the type of warfare conducted in these regions are very different from those involved in past wars, differences that highlight the need for studies of members of the armed services who are involved in the current operations. Most studies that have examined the effects of combat on mental health were conducted among veterans years after their military service had ended. A problem in the methods of such studies is the long recall period after exposure to combat. Very few studies have examined a broad range of mental health outcomes near to the time of subjects' deployment. Little of the existing research is useful in guiding policy with regard to how best to promote access to and the delivery of mental health care to members of the armed services. Although screening for mental health problems is now routine both before and after deployment and is encouraged in primary care settings, we are not aware of any studies that have assessed the use of mental health care, the perceived need for such care, and the perceived barriers to treatment among members of the military services before or after combat deployment. We studied the prevalence of mental health problems among members of the US armed services who were recruited from comparable combat units before or after their deployment to Iraq or Afghanistan. We identified the proportion of service members with mental health concerns who were not receiving care and the barriers they perceived to accessing and receiving such care.
Significant mental health symptoms are reported in troops deployed to Iraq and Afghanistan (OEF/OIF). Symptomatic troops are more likely to be discharged and become eligible for Department of Veterans Affairs (DVA) care. Prevalence and predictors of mental health symptoms were assessed in 339 OEF/OIF veterans and reservists registering at the San Diego DVA. Participants completed self-report questionnaires assessing combat exposure, posttraumatic stress disorder (PTSD) symptom frequency and severity, depression, and substance and alcohol abuse. A minority of participants (36%) did not screen positive for mental health symptoms; the remainder met threshold for caseness of PTSD, depression, or substance and alcohol abuse. Using a hierarchical logistic regression model, gender, age, race, and rank were not significantly related to PTSD caseness, whereas most recent branch of service and report of injury during combat were. Follow-up analyses revealed that trauma history and combat exposure varied by branch of service. Knowledge of base rates and vulnerability factors can aid in rapid detection of "at risk" individuals.
High rates of alcohol misuse after deployment have been reported among personnel returning from past conflicts, yet investigations of alcohol misuse after return from the current wars in Iraq and Afghanistan are lacking.
To determine whether deployment with combat exposures was associated with new-onset or continued alcohol consumption, binge drinking, and alcohol-related problems.
Data were from Millennium Cohort Study participants who completed both a baseline (July 2001 to June 2003; n=77,047) and follow-up (June 2004 to February 2006; n=55,021) questionnaire (follow-up response rate = 71.4%). After we applied exclusion criteria, our analyses included 48,481 participants (active duty, n = 26,613; Reserve or National Guard, n = 21,868). Of these, 5510 deployed with combat exposures, 5661 deployed without combat exposures, and 37 310 did not deploy.
New-onset and continued heavy weekly drinking, binge drinking, and alcohol-related problems at follow-up.
Baseline prevalence of heavy weekly drinking, binge drinking, and alcohol-related problems among Reserve or National Guard personnel who deployed with combat exposures was 9.0%, 53.6%, and 15.2%, respectively; follow-up prevalence was 12.5%, 53.0%, and 11.9%, respectively; and new-onset rates were 8.8%, 25.6%, and 7.1%, respectively. Among active-duty personnel, new-onset rates were 6.0%, 26.6%, and 4.8%, respectively. Reserve and National Guard personnel who deployed and reported combat exposures were significantly more likely to experience new-onset heavy weekly drinking (odds ratio [OR], 1.63; 95% confidence interval [CI], 1.36-1.96), binge drinking (OR, 1.46; 95% CI, 1.24-1.71), and alcohol-related problems (OR, 1.63; 95% CI, 1.33-2.01) compared with nondeployed personnel. The youngest members of the cohort were at highest risk for all alcohol-related outcomes.
Reserve and National Guard personnel and younger service members who deploy with reported combat exposures are at increased risk of new-onset heavy weekly drinking, binge drinking, and alcohol-related problems.
In this article, we attempt to distinguish between the properties of moderator and mediator variables at a number of levels. First, we seek to make theorists and researchers aware of the importance of not using the terms moderator and mediator interchangeably by carefully elaborating, both conceptually and strategically, the many ways in which moderators and mediators differ. We then go beyond this largely pedagogical function and delineate the conceptual and strategic implications of making use of such distinctions with regard to a wide range of phenomena, including control and stress, attitudes, and personality traits. We also provide a specific compendium of analytic procedures appropriate for making the most effective use of the moderator and mediator distinction, both separately and in terms of a broader causal system that includes both moderators and mediators.
The purpose of this article is to determine whether the positive association between social support and well-being is attributable more to an overall beneficial effect of support (main- or direct-effect model) or to a process of support protecting persons from potentially adverse effects of stressful events (buffering model). The review of studies is organized according to (a) whether a measure assesses support structure or function, and (b) the degree of specificity (vs. globality) of the scale. By structure we mean simply the existence of relationships, and by function we mean the extent to which one’s interpersonal relationships provide particular resources. Special attention is paid to methodological characteristics that are requisite for a fair comparison of the models. The review concludes that there is evidence consistent with both models. Evidence for a buffering model is found when the social support measure assesses the perceived availability of interpersonal resources that are responsive to the needs elicited by stressful events. Evidence for a main effect model is found when the support measure assesses a person’s degree of integration in a large social network. Both conceptualizations of social support are correct in some respects, but each represents a different process through which social support may affect well-being. Implications of these conclusions for theories of social support processes and for the design of preventive interventions are discussed.
In this review, the authors examine the evidence linking social support to physiological processes and characterize the potential mechanisms responsible for these covariations. A review of 81 studies revealed that social support was reliably related to beneficial effects on aspects of the cardiovascular, endocrine, and immune systems. An analysis of potential mechanisms underlying these associations revealed that (a) potential health-related behaviors do not appear to be responsible for these associations; (b) stress-buffering effects operate in some studies; (c) familial sources of support may be important; and (d) emotional support appears to be at least 1 important dimension of social support. Recommendations and directions for future research include the importance of conceptualizing social support as a multidimensional construct, examination of potential mechanisms across levels of analyses, and attention to the physiological process of interest.
Background:
Posttraumatic stress disorder (PTSD) and problematic alcohol use commonly co-occur among military service members. It remains critical to understand why these patterns emerge, and under what conditions.
Objectives:
This study examined whether PTSD symptoms (PTSS) and alcohol involvement (quantity and frequency of use, heavy episodic drinking, and alcohol problems) are indirectly related through four distinct drinking motivations. A secondary aim was to identify factors, specifically forms of social support, which buffer these associations.
Methods:
Using baseline data from a randomized-controlled trial of health and well-being among civilian-employed separated service members and reservists, the present study examined these issues using a subsample of 398 current drinkers.
Results:
Parallel mediation models revealed PTSS-alcohol consumption associations were indirect through coping and enhancement motivations. PTSS was only related to alcohol problems through coping motivations. In addition, the indirect effect of PTSS on average level of consumption via coping motives was conditional on perceived support from friends and family, whereas the indirect effect for alcohol problems was conditional only on friend support. In contrast, the indirect effects of PTSS on alcohol consumption variables (but not problems) via enhancement motives were conditional on perceived support from friends and family. Conclusions/Importance: Future research and screening efforts should attend to individual motivations for drinking as important factors related to alcohol use and problems among service members experiencing PTSS, and emphasize the importance of communication, trust, and effective supports among military and nonmilitary friends and family.
Although most military personnel returning from recent deployments will readjust successfully to life in the United States, a significant minority will exhibit PTSD or some other psychiatric disorder. Practitioners should routinely inquire about war-zone trauma and associated symptoms when conducting psychiatric assessments. Treatment should be initiated as soon as possible, not only to ameliorate PTSD symptoms but also to forestall the later development of comorbid psychiatric and/or medical disorders and to prevent interpersonal or vocational functional impairment. If evidence-based practices are utilized, complete remission can be achieved in 30%-50% of cases of PTSD, and partial improvement can be expected with most patients. We can all look forward to future break-throughs that will improve our capacity to help people with PTSD.
Introduction
For the purposes of this review, caregivers are individuals who provide care that is typically unpaid and usually takes place at home. This systematic review aims to identify burden among spouses/partners caring for wounded, injured or sick military personnel and the factors associated with caregiver burden.
Methods
A systematic review was undertaken using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses reporting guidelines. Five electronic databases and relevant websites were searched. Two reviewers appraised the quality of the studies and carried out data extraction.
Results
Ten original papers were identified, of which eight were quantitative studies and two were qualitative. These papers highlighted the potential negative impact caregiving can have on spouses/partners and also some of the positive aspects of caring that can strengthen intimate relationships.
Conclusions
Caring for an injured or ill military spouse or partner is a difficult task, compounded by the complexity of dealing with potentially both their physical and mental health problems. However, research has also identified some positive aspects of caring that can strengthen intimate relationships.
While commonly studied in the civilian population, few studies have examined mediators between religious functioning and psychological outcomes in military veterans. We examined social support, event centrality, and negative affect as potential mediators between positive and negative religious functioning and mental health outcomes in a sample of 90 veterans. Event centrality and negative affect fully mediated the relationship between religious strain and posttraumatic stress disorder symptoms. Further, social support fully mediated the relationship between religious comfort and positive outcomes. Our results suggest important mediators exist in the relationships between positive and negative forms of religious functioning and mental health in military veterans.
Loneliness has been shown to predict mental health problems and suicide in active duty soldiers. In the present study, we examined distal (e.g., demographic & socioeconomic characteristics) to proximal factors (e.g., platoon relations, relationship quality) that were associated with loneliness in active duty soldiers in the U.S. Army. Results revealed a set of factors that were associated with loneliness in active duty soldiers, including age, frequency of contact with friends and family by phone, childhood trauma, self-reported overall emotional health, intra-platoon harassment, perceived stress, perceived platoon cohesion and support, organizational citizenship behavior, relationship satisfaction with friends, and relationship satisfaction with platoon members. The association between loneliness and both perceived stress and relationship satisfaction with platoon members reached a moderate effect size in the multivariate models. Although some of predictors overlap with those identified in studies of civilians, most were unique to soldiers. Implications are discussed for understanding loneliness in an organization like the military and for the early identification of and intervention with active duty soldiers who may be at risk for mental and behavioral problems.
One of the most important factors predicting the presence of posttraumatic stress disorder (PTSD) after trauma exposure is social support, yet the construct is theoretically complex and remains variably defined. To better inform the trauma literature on the impact of social factors, a theoretical review of social support and PTSD was conducted, and implications for measurement and intervention are outlined. Type of trauma, sex of participant, timing of social support, and support providers are described as significant moderators of the association between social factors and PTSD. The developmental trajectory of the association between social factors and PTSD occurrence is outlined, emphasizing the positive influence of social support initially following trauma, and the deterioration effect of PTSD symptoms on social support over the longer term. Possibilities for future research and intervention at multiple levels and at different time points are described.
Objectives:
Using data from a prospective cohort study of U.S. service members who joined after September 11, 2001 to determine incidence rates and comorbidities of mental and behavioral disorders.
Methods:
Calculated age and sex adjusted incidence rates of mental and behavioral conditions determined by validated instruments and electronic medical records.
Results:
Of 10,671 service members, 3,379 (32%) deployed between baseline and follow-up, of whom 49% reported combat experience. Combat deployers had highest incidence rates of post-traumatic stress disorder (PTSD) (25 cases/1,000 person-years [PY]), panic/anxiety (21/1,000 PY), and any mental disorder (34/1,000 PY). Nondeployers had substantial rates of mental conditions (11, 13, and 18 cases/1,000 PY). Among combat deployers, 12% screened positive for mental disorder, 59% binge drinking, 16% alcohol problem, 19% cigarette smoking, and 20% smokeless tobacco at follow-up. Of those with recent PTSD, 73% concurrently developed >1 incident mental or behavioral conditions. Of those screening positive for PTSD, 11% had electronic medical record diagnosis.
Conclusions:
U.S. service members joining during recent conflicts experienced high rates of mental and behavioral disorders. Highest rates were among combat deployers. Most cases were not represented in medical codes, suggesting targeted interventions are needed to address the burden of mental disorders among service members and Veterans.
Background and objectives:
The postdeployment social context is likely highly salient in explaining mental health symptoms following deployment. The aim of this study was to examine the role of postdeployment social factors (social support and social reintegration difficulty) in linking deployment-related experiences (warfare exposure, sexual harassment, concerns about relationship disruptions, and deployment social support) and posttraumatic stress disorder (PTSD) symptomatology in male and female veterans.
Design:
A survey was administered to 998 potential participants (after accounting for undeliverable mail) who had returned from deployment to Afghanistan or Iraq. Completed surveys were received from 469 veterans, yielding a response rate of 47%.
Methods:
Hypotheses were examined using structural equation modeling.
Results:
For male and female veterans, deployment factors predicted later PTSD symptoms through postdeployment social support and social reintegration, with lower support and higher social reintegration difficulty both associated with higher PTSD symptomatology. While the final models for women and men indicated similar risk mechanisms, some differences in pathways were observed. Sexual harassment presented more of a risk for women, whereas lower social support was a greater risk factor for men.
Conclusions:
Postdeployment social factors appear to represent potentially important targets for interventions aiming to reduce the potential impact of stressful deployment experiences.
A method for comparing death rates of groups of injured persons was developed, using hospital and medical examiner data for more than two thousand persons. The first step was determination of the extent to which injury severity as rated by the Abbreviated Injury Scale correlates with patient survival. Substantial correlation was demonstrated. Controlling for severity of the primary injury made it possible to measure the effect on mortality of additional injuries. Injuries that in themselves would not normally be life-threatening were shown to have a marked effect on mortality when they occurred in combination with other injuries. An Injury Severity Score was developed that correlates well with survival and provides a numerical description of the overall severity of injury for patients with multiple trauma. Results of this investigation indicate that the Injury Severity Score represents an important step in solving the problem of summarizing injury severity, especially in patients with multiple trauma.
Low social support and small social network size have been associated with a variety of negative mental health outcomes, while their impact on mental health services use is less clear. To date, few studies have examined these associations in National Guard service members, where frequency of mental health problems is high, social support may come from military as well as other sources, and services use may be suboptimal.
Surveys were administered to 1448 recently returned National Guard members. Multivariable regression models assessed the associations between social support characteristics, probable mental health conditions, and service utilization.
In bivariate analyses, large social network size, high social network diversity, high perceived social support, and high military unit support were each associated with lower likelihood of having a probable mental health condition (p < .001). In adjusted analyses, high perceived social support (OR .90, CI .88-.92) and high unit support (OR .96, CI .94-.97) continued to be significantly associated with lower likelihood of mental health conditions. Two social support measures were associated with lower likelihood of receiving mental health services in bivariate analyses, but were not significant in adjusted models.
General social support and military-specific support were robustly associated with reduced mental health symptoms in National Guard members. Policy makers, military leaders, and clinicians should attend to service members' level of support from both the community and their units and continue efforts to bolster these supports. Other strategies, such as focused outreach, may be needed to bring National Guard members with need into mental health care.
This review summarizes the epidemiology of posttraumatic stress disorder (PTSD) and related mental health problems among persons who served in the armed forces during the Iraq and Afghanistan conflicts, as reflected in the literature published between 2009 and 2014. One-hundred and sixteen research studies are reviewed, most of which are among non-treatment-seeking US service members or treatment-seeking US veterans. Evidence is provided for demographic, military, and deployment-related risk factors for PTSD, though most derive from cross-sectional studies and few control for combat exposure, which is a primary risk factor for mental health problems in this cohort. Evidence is also provided linking PTSD with outcomes in the following domains: physical health, suicide, housing and homelessness, employment and economic well-being, social well-being, and aggression, violence, and criminality. Also included is evidence about the prevalence of mental health service use in this cohort. In many instances, the current suite of studies replicates findings observed in civilian samples, but new findings emerge of relevance to both military and civilian populations, such as the link between PTSD and suicide. Future research should make effort to control for combat exposure and use longitudinal study designs; promising areas for investigation are in non-treatment-seeking samples of US veterans and the role of social support in preventing or mitigating mental health problems in this group.
This study aimed to examine the degree to which PTSD affects the relationship between social support and psychological distress for U.S. Afghanistan/Iraq era veterans with and without co-occurring psychiatric disorders. Veterans (N=1,825) were administered self-report questionnaires and a structured diagnostic interview as part of a multi-site study of post-deployment mental health through the Department of Veterans Affairs (VA) Mid-Atlantic Mental Illness Research, Education and Clinical Center (MIRECC). Main and interaction effects models assessed the association between psychological distress and social support for three comparisons conditions (Controls vs. PTSD-only, non-PTSD, and PTSD plus co-morbid diagnoses). Having PTSD was a critical factor in attenuating the strength of this association, more so than other diagnoses. Furthermore, those with PTSD plus co-morbid diagnoses did not demonstrate significantly larger attenuation in that association compared to the PTSD-only group, indicating that psychiatric comorbidity may be less important in considering the role of social support in PTSD. By understanding this relationship, new avenues for engaging and enhancing treatment outcomes related to social support for veterans of this cohort may be identified. Additional longitudinal research could help evaluate the effect of PTSD symptom clusters, social support type, and trauma exposure type on these relationships.
The Quality of Well-being Scale (QWB) is a general measure of health-related quality of life that has been used in a wide variety of population and clinical studies. One of the major disadvantages of the QWB is that it requires a trained interviewer. Recently, a self-administered version of the QWB was developed. The purpose of this study was to compare the self-administered QWB with the established interviewer-administered form. The respondents were 218 English speaking adults who attended primary care clinics. Each respondent was evaluated twice with an interval of one month in-between. At each session respondents were randomly assigned to complete either the interviewer-administered or self-administered QWB, resulting in a 2 × 2 factorial design. Data from the study demonstrated that the self-administered QWB yields scores equivalent to the interviewer-administered form. Further, QWB scores remain stable over the course of a one month interval. The results suggest that an inexpensive self-administered QWB may produce data comparable to the more difficult and expensive interviewer-administered version. Disadvantages of self-administered forms are also discussed.
The CES-D scale is a short self-report scale designed to measure depressive symptomatology in the general population. The items of the scale are symptoms associated with depression which have been used in previously validated longer scales. The new scale was tested in household interview surveys and in psychiatric settings. It was found to have very high internal consistency and adequate test- retest repeatability. Validity was established by pat terns of correlations with other self-report measures, by correlations with clinical ratings of depression, and by relationships with other variables which support its construct validity. Reliability, validity, and factor structure were similar across a wide variety of demographic characteristics in the general population samples tested. The scale should be a useful tool for epidemiologic studies of de pression.
The US military community includes a population of mostly young families that reside in every state and the District of Columbia. Many reside on or near military installations, while other National Guard, Reserve, and Veteran families live in civilian communities and receive care from clinicians with limited experience in the treatment of military families. Though all military families may have vulnerabilities based upon their exposure to deployment-related experiences, those affected by combat injury have unique additional risks that must be understood and effectively managed by military, Veterans Affairs, and civilian practitioners. Combat injury can weaken interpersonal relationships, disrupt day-to-day schedules and activities, undermine the parental and interpersonal functions that support children's health and well-being, and disconnect families from military resources. Treatment of combat-injured service members must therefore include a family-centered strategy that lessens risk by promoting positive family adaptation to ongoing stressors. This article reviews the nature and epidemiology of combat injury, the known impact of injury and illness on military and civilian families, and effective strategies for maintaining family health while dealing with illness and injury.
Notes that researchers sometimes seem to assume that the processes by which relationships are satisfying and beneficial are simply the inverse of, or reflect nothing more than the absence of, the processes by which relationships are distressing and harmful. The authors argue that positive and negative processes in relationships may be better understood as functionally independent, not as opposites of each other. They draw on similar positions supported in other areas of research, including emotion, motivation, self-regulation, and personality. Common among these research areas is a fundamental distinction between rewarding (i.e., positive and desired) and punishing (i.e., negative and unwelcome) features of the social environment. These two dimensions are referred to as
appetite and
aversion, respectively, to capture simultaneously the evaluative and motivational properties of each system. The authors question if the well-documented association between interpersonal circumstances and well-being arise because bad relationships cause distress, because good relationships produce well-being, or both? And, when it comes to relationships, whether aversive and appetitive functions operate through a common process. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
This study examined the nature of the association between social support and posttraumatic stress disorder (PTSD) symptomatology among 2,249 male veterans of the 1990-1991 Gulf War. Using structural equation modeling, a cross-lagged panel analysis indicated a strong negative relationship between PTSD at Time 1 and social support at Time 2, while social support at Time 1 did not predict PTSD at Time 2. Findings suggest that, over time, interpersonal problems associated with PTSD may have a detrimental influence on the quality and quantity of available social support resources. It is recommended that greater focus be placed on the interpersonal skills of those suffering from PTSD.
Despite widespread use of the Center for Epidemiologic Studies Depression Scale [CES-D], there are no investigations that examine its factor structure in a military sample. Separate confirmatory factor analyses were performed on responses to the CES-D obtained from 102 female and 102 male Canadian military peacekeepers in order to compare the fit of a four-factor intercorrelated (lower-order) model to a four-factor hierarchical (higher-order) model. The intercorrelated and hierarchical models fit the data well for both women and men, with hierarchical models fitting the data slightly better for women than men. These findings suggest that, for military women and men, the CES-D can be used to measure a set of distinct but interrelated depressive symptoms as well as a global construct of depression. Implications and future directions are discussed. Depression and Anxiety 17:19–25, 2003. © 2003 Wiley-Liss, Inc.
The study conducted a longitudinal assessment of insomnia as an antecedent versus consequence of posttraumatic stress disorder (PTSD) and depression symptoms among combat veterans.
Two postdeployment time points were used in combination with structural equation modeling to examine the relative strength of two possible directions of prediction: insomnia as a predictor of psychological symptoms, and psychological symptoms as a predictor of insomnia. Participants were active duty soldiers (N = 659) in a brigade combat team who were assessed 4 months after their return from a 12-month deployment to Iraq, and then again eight months later.
Although both insomnia and psychological symptoms were associated at both time periods and across time periods, insomnia at 4 months postdeployment was a significant predictor of change in depression and PTSD symptoms at 12 months postdeployment, whereas depression and PTSD symptoms at 4 months postdeployment were not significant predictors of change in insomnia at 12 months postdeployment.
Results support the role of insomnia in the development of additional psychological problems and highlight the clinical implications for combat veterans, to include the importance of longitudinal assessment and monitoring of sleep disturbances, and the need for early intervention.
We sought to describe sex differences in the prevalence of painful musculoskeletal conditions in men and women Veterans after deployment in Operation Enduring Freedom (Afghanistan) and Operation Iraqi Freedom (Iraq) (OEF-OIF).
This is an observational study using Veterans Affairs (VA) administrative and clinical databases of OEF-OIF Veterans who had enrolled in and used VA care. The prevalence of back problems, musculoskeletal conditions, and joint disorders was determined at years 1 through 7 after deployment for female and male Veterans using ICD-9 code groupings for these conditions.
Female Veterans were younger (mean age 29 vs. 30, P<0.0001), more likely to be African American (26% vs. 13%, P<0.0001), and less likely to be married (34% vs. 47%, P<0.0001). For both female and male Veterans, the prevalence of painful musculoskeletal conditions increased each year after deployment. After adjustment for significant demographic differences, women were more likely than men to have back problems [year 1 odds ratio (OR) 1.06 (1.01, 1.11)], musculoskeletal problems [year 1 OR 1.32 (1.24, 1.40)], and joint problems [year 1 OR 1.36 (1.21, 1.53)] and the odds of having these conditions increased each year for women compared with men in years 1 to 7 after deployment.
To provide quality care to female Veterans, the VA must understand the impact of deployment on women's health. Our findings provide an important picture of the increasing prevalence of musculoskeletal conditions in the female Veteran population and highlight the importance of the VA targeting treatment programs that focus on issues of particular importance to women with musculoskeletal pain.
This study investigates whether modifying the instructions of the Posttraumatic Stress Disorder Checklist (PCL) for military survey research changes posttraumatic stress disorder (PTSD) symptom reporting or prevalence. The sample consisted of 1691 soldiers who were randomly assigned to complete 1 of 3 versions of the PCL, which differed only in the wording of the instructions. Group differences in demographic variables, combat exposure, mean PTSD symptoms, and PTSD prevalence estimates were examined. Results showed that there were no statistically significant differences in the outcomes across the PCL versions. The findings indicate that researchers may make modifications to the PCL instructions to meet research needs without affecting PTSD symptom reporting or prevalence estimates.
This prospective study examined: (a) the effects of Iraq War deployment versus non-deployment on pre- to postdeployment change in PTSD symptoms and (b) among deployed soldiers, associations of deployment/postdeployment stress exposures and baseline PTSD symptoms with PTSD symptom change. Seven hundred seventy-four U.S. Army soldiers completed self-report measures of stress exposure and PTSD symptom severity before and after Iraq deployment and were compared with 309 soldiers who did not deploy. Deployed soldiers, compared with non-deployed soldiers, reported increased PTSD symptom severity from Time 1 to Time 2. After controlling for baseline symptoms, deployment-related stressors contributed to longitudinal increases in PTSD symptoms. Combat severity was more strongly associated with symptom increases among active duty soldiers with higher baseline PTSD symptoms.
Little research has examined the role of protective factors such as psychological resilience, unit support, and postdeployment social support in buffering against PTSD and depressive symptoms, and psychosocial difficulties in veterans of Operations Enduring Freedom (OEF) and Iraqi Freedom (OIF).
A total of 272 OEF/OIF veterans completed a survey containing PTSD and depression screening measures, and questionnaires assessing resilience, social support, and psychosocial functioning.
Lower unit support and postdeployment social support were associated with increased PTSD and depressive symptoms, and decreased resilience and psychosocial functioning. Path analyses suggested that resilience fully mediated the association between unit support and PTSD and depressive symptoms, and that postdeployment social support partially mediated the association between PTSD and depressive symptoms and psychosocial functioning.
Generalizability of results is limited by the relatively low response rate and predominantly older and reserve/National Guard sample.
These results suggest that interventions designed to bolster unit support, resilience, and postdeployment support may help protect against traumatic stress and depressive symptoms, and improve psychosocial functioning in veterans.
The present study examined the temporal relationship between posttraumatic stress disorder (PTSD) and social support among 128 male veterans treated for chronic PTSD. Level of perceived interpersonal support and stressors were assessed at two time points (6 months apart) for four different potential sources of support: spouse, relatives, nonveteran friends, and veteran peers. Veteran peers provided relatively high perceived support and little interpersonal stress. Spouses were seen as both interpersonal resources and sources of interpersonal stress. More severe PTSD symptoms at Time 1 predicted greater erosion in perceived support from nonveteran friends, but not from relatives. Contrary to expectations, initial levels of perceived support and stressors did not predict the course of chronic PTSD symptoms.
A method for comparing death rates of groups of injured persons was developed, using hospital and medical examiner data for more than 2,000 persons. The first step was determination of the extent to which injury severity as rated by the Abbreviated Injury Scale correlates with patient survival. Substantial correlation was demonstrated. Controlling for severity of the primary injury made it possible to measure the effect on mortality of additional injuries. Injuries that in themselves would not normally be life threatening were shown to have a marked effect on mortality when they occurred in combination with other injuries. An Injury Severity Score was developed that correlates well with survival and provides a numerical description of the overall severity of injury for patients with multiple trauma. Results of this investigation indicate that the Injury Severity Score represents an important step in solving the problem of summarizing injury severity, especially in patients with multiple trauma. The score is easily derived, and is based on a widely used injury classification system, the Abbreviated Injury Scale. Use of the Injury Severity Score facilitates comparison of the mortality experience of varied groups of trauma patients, thereby improving ability to evaluate care of the injured.
The psychometric properties of the PTSD Checklist (PCL), a new, brief, self-report instrument, were determined on a population of 40 motor vehicle accident victims and sexual assault victims using diagnoses and scores from the CAPS (Clinician Administered PTSD Scale) as the criteria. For the PCL as a whole, the correlation with the CAPS was 0.929 and diagnostic efficiency was 0.900 versus CAPS. Examination of the individual items showed wide ranging values of individual item correlations ranging from 0.386 to 0.788, and with diagnostic efficiencies of 0.700 or better for symptoms. We support the value of the PCL as a brief screening instrument for PTSD.
This study examined associations of combat exposure and posttraumatic stress disorder (PTSD) with physical health conditions and also incorporated hardiness and social support as mediators and functional health status as an outcome. Data were derived from 1,632 male and female Vietnam veterans who participated in the National Vietnam Veterans Readjustment Study. Path analysis revealed that hardiness and social support operated primarily as intermediary variables between combat exposure and PTSD, and PTSD emerged as the pivotal variable explaining physical health conditions and functional health status. Gender-based differences in means and patterns of associations among variables were found. The results stress the importance of assessing trauma in clinical settings as a meaningful determinant of health outcomes.