Military-to-civilian transition strains and risky behavior among post-9/11 veterans.

Many military veterans face significant challenges in civilian reintegration that can lead to troublesome behavior. Drawing on military transition theory (MTT) and using data from a survey of post-9/11 veterans in two metropolitan areas (n = 783), we investigate previously unexamined relationships between post-discharge strains, resentment, depression, and risky behavior, taking into account a set of control variables, including combat exposure. Results indicated that unmet needs at time of discharge and perceived loss of military identity are associated with increased risky behavior. Much of the effects of unmet discharge needs and loss of military identity are mediated by depression and resentment toward civilians. The results of the study are consistent with insights from MTT, providing evidence of specific ways in which transitions can affect behavioral outcomes. Moreover, the findings highlight the importance of helping veterans meet their post-discharge needs and adapt to changing identity, in order to reduce the risk of emotional and behavioral problems.

Satisfaction of the Use of Telehealth and Access to Care for Veterans During the COVID-19 Pandemic.

Background: While many health care providers have shifted toward telehealth services in response to the COVID-19 pandemic, little is known about the perception and acceptance of such services, particularly among vulnerable populations. Veterans, who are at increased risk of physical and mental health needs, may benefit from the use and availability of telehealth services. Materials and Methods: Cross sectional survey data related to telehealth use, satisfaction, and access were collected through an online survey. Participants from previous research studies and veterans receiving care at a national veteran behavioral health organization were invited to participate. Results: A total of 404 veterans participated. Before the pandemic, many veterans had never used telehealth for physical (72%) or mental (76%) health care. Since the start of the pandemic, 62% of participants reported they received some care through telehealth services. Most participants found telehealth valuable and helpful (82%), indicated the technology was well explained (77%), and felt that issues were resolved quickly and easily (67%). Access to care was limited among participants who utilize massage therapy (64%), dental care (53%), routine checkups (50%), acupuncture (50%), and physical therapy (48%). Discussion: These findings showed an increase in the use of telehealth services and overwhelming satisfaction among veterans. Despite this, some veterans indicated barriers to receiving physical and mental health care. Conclusions: This provides an opportunity to expand the use of telehealth services to meet the health care needs of veterans. Barriers to care should be addressed to minimize the impact on the well-being of veterans.

Military Sexual Assault as a Mediator of the Association Between Posttraumatic Stress Disorder and Depression Among Lesbian, Gay, and Bisexual Veterans.

Lesbian, gay, and bisexual (LGB) civilians report higher rates of sexual assault, posttraumatic stress disorder (PTSD), and depression compared to their heterosexual counterparts. In this study, we compared military sexual assault (MSA), PTSD, and depression in LGB individuals and their non-LGB peers in two community samples of veterans (N = 2,583). Participants were selected for inclusion if they identified as LGB (n = 110) and were matched 1 to 3 on gender and age with non-LGB veterans (n = 330). Chi-square analyses showed significant differences for LGB veterans compared to non-LGB veterans for experiencing MSA (32.7% vs. 16.4%, respectively), p < .001; probable PTSD (41.2% vs. 29.8%, respectively), p = .039; and probable depression (47.9% vs. 36.0%, respectively), p = .039. Multivariable logistic regression analyses showed LGB veterans were 1.93 times more likely to have experienced MSA compared to non-LGB veterans, 95% CI [1.30, 2.88], p = .001. The experience of MSA significantly mediated associations with probable PTSD, odds ratio (OR) = 1.43, 95% CI [1.13, 1.80], p = .003, and probable depression, OR = 1.32, 95% CI [1.07, 1.64], p = .009. As the experience of MSA fully mediates the presence of PTSD and depression among LGB veterans, we highly recommend health providers assess for MSA among LGB veterans, especially those who meet clinical thresholds for PTSD and depression.

Sexual assault in the military.

Military sexual assault is a pervasive problem throughout the military services, despite numerous initiatives to end it. No doubt the military's lack of progress stems from the complexity of sexual assaults, yet in order to develop effective strategies and programs to end sexual assault, deep understanding and appreciation of these complexities are needed. In this paper, we describe the root causes and numerous myths surrounding sexual assault, the military cultural factors that may unintentionally contribute to sexual assault, and the uncomfortable issues surrounding sexual assault that are often ignored (such as the prevalence of male sexual assault within the military). We conclude by offering a broad, yet comprehensive set of recommendations that considers all of these factors for developing effective strategies and programs for ending sexual assault within in the military.

Suicides in the military: the post-modern combat veteran and the Hemingway effect.

Suicides in the military have increased over the last ten years. Much effort has been focused on suicide prevention and treatment, as well as understanding the reasons for the sharp increase in military suicides. Despite this effort, the definitive causes of military suicides remain elusive. Further, highly effective suicide prevention and treatment approaches have not yet been developed. The purpose of this article is to present a short review of the current state of suicide prevention interventions within the context of the military. The root causes of suicidal behavior and the role of combat in the military are each discussed. Interpersonal-psychological theory of suicide and the military transition theory are introduced as guiding frameworks for understanding suicides and suicidal behavior amongst active military personnel and military veterans. The article concludes with a set of recommendations for moving forward in understanding and addressing suicides in the military.

Social workers' knowledge and perceptions of effectiveness and acceptability of medication assisted treatment of substance use disorders.

Data from a national study of 345 privately funded, community-based substance use disorder (SUD) treatment centers were used to investigate social workers' knowledge, perceptions of effectiveness, and perceptions of the acceptability of medication assisted treatments (MATs) for SUDs. Results reveal the importance of exposure to MATs for social workers to develop a knowledge base regarding the effectiveness of various pharmacological agents. Results also underline the importance of social workers' perceptions of effectiveness in forming opinions regarding the acceptability of the use of MATs in SUD treatment. Lastly, a 12-Step orientation toward treatment has a negative influence on social workers' opinions regarding the acceptability of MATs.

Comparing the training effectiveness of virtual reality and role play among future mental health providers.

OBJECTIVE: The present study compares the effectiveness of a standardized peer-to-peer role play (RP) and a virtual client-trainer (VC-T) in training graduate-level students in the development of interviewing and clinical skills related to working with the military population. The study examines each training modality in six areas: (a) self-efficacy, (b) initial engagement, (c) recognizing and responding to symptoms of posttraumatic stress disorder, (d) recognizing and responding to symptoms of suicide, (e) military cultural competence, and (f) overall competence. METHOD: A quasi-experimental nonequivalent groups study design was used. The sample comprised students enrolled in a graduate-level program (RP = 61; VC-T = 75). Participants completed pretest measures, attended training, and completed posttest measures. RESULTS: Broadly, the findings revealed that RP and the VC-T are equally effective in increasing trainees' self-efficacy, recognition and response to posttraumatic stress disorder symptoms, recognition and response to suicide symptoms, military cultural competence, and overall competence. These results suggest that regardless of training modality, trainees demonstrated increased clinical skills and competencies needed for working with the military population. CONCLUSIONS: The results suggest that both RP and the VC-T are equally effective, which opens the possibilities of implementing the VC-T as a training tool that has greater reach compared with RP. As more graduate programs offer an online version of their traditional on-ground coursework, the VC-T is an opportunity to have 1 training platform for both on-ground and online students. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

An Examination of Stalking Experiences During Military Service Among Female and Male Veterans and Associations With PTSD and Depression.

Stalking is associated with mental health concerns, although little is known about the influence of stalking and mental health concerns among veterans. This study evaluated stalking experienced during military service in two community-based, nonclinical samples of veterans (N = 1,980). Models explored (a) types of stalking, (b) characteristics of veterans who experienced stalking, and (c) the associations between stalking with posttraumatic stress disorder (PTSD) and depression. Types of stalking varied by sex; female veterans were significantly more likely to experience stalking than male veterans (58.5% vs. 34.6%, p < .001, respectively). Female veterans reported unwanted messages, emails, or phone calls (37.2%), and male veterans experienced someone showing up unannounced or uninvited (23.5%) most frequently. Stalking experiences also differed by age with female and male veterans 18 to 39 years old significantly more likely to have experienced stalking (p < .001 and p < .001, respectively) than veterans over age 40. Associations between prior stalking experiences and mental distress were found for both female and male veterans. Both female and male veterans who experienced stalking were significantly more likely to have probable PTSD (odds ratio [OR] = 1.88, 95% confidence interval [CI] = [1.04, 3.39] and OR = 3.08, 95% CI = [2.27, 4.18], respectively) and depression (OR = 2.54, 95% CI = [1.38, 4.58] and OR = 2.78, 95% CI = [2.05, 3.79], respectively). These findings highlight (a) the rates of stalking experienced during military service, (b) the need for assessment of stalking to inform treatment, and (c) lay the foundation for the Department of Defense (DoD) to further evaluate stalking among military populations.

Can Mindfulness Help to Predict Veterans' Mental Health Service Utilization?

Post-9/11 era military veterans are at high risk for posttraumatic stress disorder (PTSD) and depression, but less than half of veterans who screen positive for these disorders seek mental health treatment. Self-stigma of mental illness has emerged as a core barrier to mental health service use (MHSU) in this population. Mindfulness is associated with attention control, nonjudgment, and reduced self-stigma in civilians, but associations between PTSD and depression, mindfulness, self-stigma, and MHSU have never been investigated in military veterans. The present study used a logistic regression modeling strategy to investigate main and interaction effects for PTSD, depression, mindfulness, and self-stigma on MHSU. Study findings demonstrated a positive main effect for PTSD and negative main effects for mindfulness and self-stigma on MHSU, and a positive interaction effect for mindfulness and PTSD on MHSU. Findings suggest that more mindful individuals with PTSD symptoms are more likely to seek mental health services, whereas less mindful individuals with PTSD symptoms are less likely to seek treatment. More research into the potential for mindfulness to enhance MHSU outcomes for military veterans appears warranted.

Implementing the Knowledge Assessment of CPT Critical Skills (KACCS) Scale.

Cognitive processing therapy (CPT) has been endorsed as an evidence-based therapy for PTSD. It is currently being implemented within the Veterans Health Administration (VA) as a manualized, trauma-focused psychotherapy in line with recommendations from the most recent VA/DOD Clinical Practice Guideline for the management of PTSD. While research on CPT implementation has focused on individual factors that facilitate or hinder adoption, little is known on whether trainees retain core concepts of CPT. The present research addresses this gap in the literature by conducting a validation study of the Knowledge Assessment of CPT Critical Skills (KACCS) Scale among known user groups of CPT (no experience, immediate user, expert user) and, subsequently, an implementation study of the KACCS Scale among clinician trainees participating in an online CPT training. The validation study found that the KACCS Scale can discriminate among various CPT user groups (no experience, intermediate, expert), while the implementation study found that the KACCS Scale provides specific information on core concepts that have been learned at the end of training. The KACCS Scale could benefit from further validation studies and, subsequently, be added to the current CPT instrumentation to monitor learning and retention of core concepts at various training periods (initial workshop, consultation, booster workshop).

PTSD in U.S. Veterans: The Role of Social Connectedness, Combat Experience and Discharge.

Service members who transition out of the military often face substantial challenges during their transition to civilian life. Leaving military service requires establishing a new community as well as sense of connectedness to that community. Little is known about how social connectedness may be related to other prominent transition outcomes, particularly symptoms of posttraumatic stress disorder (PTSD). The purpose of this study was to explore the role of social connectedness in the development of PTSD, as well as its relationship to the known risk factors of combat exposure and discharge status. Data used were drawn from a needs assessment survey of 722 veterans. A path model was specified to test direct and indirect effects of combat experiences, non-honorable discharge status, and social connectedness on PTSD symptoms. Results demonstrated positive direct effects for combat experiences and non-honorable discharge status on PTSD symptoms while social connectedness demonstrated a negative direct effect. Both combat experiences and non-honorable discharge status demonstrated negative direct effects on social connectedness and indirect on PTSD through the social connectedness pathway. Study findings indicate social connectedness may be an important factor related to PTSD in veterans as well as an intervention point for mitigating risk related to combat exposure and discharge status.

Expanding the Understanding of Risk Behavior Associated With Homelessness Among Veterans.

INTRODUCTION: To advance large-scale efforts to end veteran homelessness, an understanding of factors that contribute to housing insecurity is necessary. Common risk behaviors (e.g., substance use and risky sexual practices) are associated with lengthier experiences of homelessness among the general homeless population, but less understood among homeless veterans. Additionally, whether emerging risk behaviors among veterans (e.g., sensation seeking and aggression) are associated with lengthy homeless experiences is unknown. MATERIALS AND METHODS: Data were drawn from a sample of Los Angeles County veterans surveyed using a mixed nonprobability sampling strategy, which included recruiting veterans via national and local veterans service organizations, college organizations, and social media campaigns. Measures aligning with factors of sensation seeking (reckless driving, gambling, suicidal ideation); substance use (alcohol misuse, tobacco use, driving while intoxicated); risky sexual practices (risking getting a sexually transmitted disease); and aggression (looking to start a fight) were tested in multivariate, multinomial logistic regression analyses to determine their association with varying lengths of homelessness in the past year (less than 1 month, 2-6 months, 6 months to 1 year). RESULTS: Risking getting a sexually transmitted disease, gambling, suicidal ideation, alcohol misuse, tobacco use, driving while intoxicated, and looking to start a fight were associated with 6 or more months of homelessness. Several indicators of risk were associated with brief periods of homelessness, including gambling and looking to start a fight. Although a clear exposure-response effect was not detected with risk behaviors, results suggested there may be some wavering of engagement in risk behaviors over time. CONCLUSION: Findings suggest sensation seeking and aggression risk behaviors should be included in risk assessments and prevention efforts along with substance use and risky sexual practices to reduce veterans' risk of becoming homeless and reducing risk of chronic homelessness. Further research is needed to understand the trajectory of these risk behaviors and the mechanisms that underlie the association between these risk behaviors and homelessness for veterans.

Civilian Unemployment and Mental Health: The Moderating Impact of Alcohol Misuse in Returning National Guard.

Postdeployment civilian unemployment has become a common problem and source of additional stress for National Guard (NG) personnel. This study evaluated 126 California NG members, exploring the relationship between immediate postdeployment employment status and self-reported mental health symptoms, including evidence of alcohol misuse. Participants were recruited from a NG unit within the first 3 months after returning home in August 2011. Over one-third of participants reported being unemployed beyond the part-time NG commitment. Mental health symptoms were greater in those participants without civilian employment. Additionally, those participants with comorbid alcohol misuse with either depression or post-traumatic stress disorder were significantly more likely to lack civilian employment. Interaction testing revealed a significant interaction between employment status and alcohol misuse for both depression and post-traumatic stress disorder. Alcohol use was concluded to moderate the relationship between civilian unemployment and mental health symptoms. Results suggest that the part-time employment provided through NG service may serve as a protective factor in the development of negative psychological outcomes, except for cases where alcohol misuse is present.

Sexual trauma in the military: Exploring PTSD and mental health care utilization in female veterans.

Sexual trauma remains a pervasive problem in the military. The deleterious mental health outcomes related to incidents of sexual assault have been well-documented in the literature, with particular attention given to the development of posttraumatic stress disorder (PTSD) and utilization of mental health services. Much effort has focused on addressing issues of sexual trauma in the military. The purpose of this study was to examine the incidences of sexual assault in female veterans, the relationship to PTSD and mental health care utilization. The research explored differences in pre- and post-9/11 veterans. Data were collected using a 6-prong recruitment strategy to reach veterans living in Southern California. A total of 2,583 veterans completed online and in-person surveys, of which 325 female veterans were identified for inclusion in the analysis. Forty percent of the sample reported experiencing sexual assault during their military service. A history of military sexual trauma was found to be a substantial contributor to symptoms of PTSD. A majority of female veterans who indicated being sexually assaulted during their military service met the cutoff for a diagnosis of PTSD. Although only a minority of participants who indicated being a victim of sexual assault reported receiving immediate care after the incident, most had received mental health counseling within the past 12 months. Findings point to the need for additional prevention programs within the military and opportunities for care for victims of military sexual assault.

Secondary traumatic stress in military primary and mental health care providers.

The purpose of this study was to explore rates of secondary traumatic stress (STS) in a sample of 70 military primary and mental health care providers. The sample included working professionals within two military hospitals. Participants completed surveys containing a demographic questionnaire and the Secondary Traumatic Stress Scale. Results of data analysis found military participants in the sample to be experiencing relatively low rates of STS. Over half of the sample reported endorsing at least one symptom of STS occurring within the last week, whereas 8% of participants indicated moderate to high symptomatology. The most frequently reported symptoms were feeling emotionally numb and trouble sleeping followed by the intrusive thoughts about clients. The least frequently reported symptom was feeling jumpy. Implications of study findings and recommendations for future research are outlined.

Counselor attitudes toward and use of evidence-based practices in private substance use disorder treatment centers: a comparison of social workers and non-social workers.

The purpose of this study was to examine factors that may be associated with variation in social workers' perceptions of effectiveness, perceptions of acceptability, and use of psychosocial evidence-based practices (EBPs) for the treatment of substance use disorders (SUD) in comparison to other SUD counselors who are nonsocial workers. A national sample of 1,140 counselors in private SUD treatment settings completed a mailed survey. Overall, counselors perceive both motivational interviewing (MI) and contingency management (CM) to be effective and acceptable interventions, with MI perceived to be both more effective and more acceptable than CM. The results of this study also shed light on the factors associated with perceptions of effectiveness and acceptability of MI and CM. The results of this study underscore the importance of exposure to EBPs in the development of positive attitudes toward and use of EBPs. In particular, professional networks are an important route to introduce social workers to EBPs, as is professional training on specific EBPs. Efforts to increase the uptake of evidence-based SUD interventions should not be limited to dissemination of information regarding effectiveness; rather, efforts should also be expended to expose social workers to EBPs.

Intervention following a sudden death: the social work-medical examiner model.

The suddenly bereaved are faced with not only a very difficult grief experience, but also a lack of access to supportive services to assist them in working through that grief. The social work-medical examiner model was developed in an effort to address the challenge of reaching this population. The model provides a connection between social work practice and families experiencing sudden death. The model is rooted in services embedded within social work practice--crisis intervention, grief support, and referral assessment. In addition, the model demonstrates a mutually beneficial relationship between the social worker and the ME--each benefiting from the intricacies of the model process. Social work has had a prominent voice in the advancement of end-of-life care as it relates to families grieving long-term illness. The intervention described in this model expands this care, showing how social work practice can reach the suddenly bereaved population. The implementation of this model provides the field of social work a rare opportunity to reach a vulnerable population in need of support.