Longitudinal changes in the PTSD symptom network following trauma-focused treatment in military populations: Identifying central symptoms and the role of military sexual trauma.

Posttraumatic stress disorder (PTSD) is a debilitating condition affecting military populations, with a higher prevalence compared to the general population. Despite the development of first-line trauma-focused treatments such as Cognitive Processing Therapy (CPT) and Prolonged Exposure Therapy (PE), a significant proportion of patients continue to experience persistent PTSD symptoms following treatment. This study utilized network analysis to explore the PTSD symptom network's dynamics pre- and post- trauma-focused treatment and investigated the role of military sexual trauma (MST) history in shaping the network. Network analysis is a novel approach that can guide treatment target areas. The sample was comprised of 1648 service members and veterans who participated in a two-week intensive PTSD treatment program, which included completion of evidenced-based individual therapy as well as skill-building focused group therapy. PTSD severity was assessed using the PTSD Checklist for DSM-5 at baseline and post-treatment. Network analyses revealed strong connections within symptom clusters, with negative emotions emerging as one of the most central symptoms. Interestingly, the symptom network's overall structure remained stable following treatment, whereas global strength significantly increased. MST history did not significantly impact the network's structure or its change relative to treatment. Future research should further examine whether targeting negative emotions optimizes PTSD treatment outcomes for military populations.

Male sex and hazardous alcohol use following military sexual assault increase suicide risk among US service members and veterans.

Background: Higher alcohol use and military sexual assault (MSA) are associated with increased risk of death by suicide. Risk for death by suicide is rapidly increasing among females, who report higher rates of MSA, yet actual death by suicide and alcohol use are higher among males. It is not well understood whether higher alcohol use confers greater suicide risk in male or female service members and veterans who have experienced MSA.Objective: To determine whether the association between alcohol misuse and suicide risk was moderated by biological sex in a sample of male and female service members (N = 400, 50% female) who reported MSA.Method: Participants completed surveys of alcohol use and suicide risk as well as a demographic inventory. Linear regression with an interaction term was used to determine if suicide risk differed by sex and alcohol use severity after accounting for discharge status, sexual orientation, and age.Results: Average scores on the suicide risk measure were consistent with an inpatient psychiatric sample and scores on the AUDIT-C were indicative of a probable positive screen for alcohol misuse. Suicide risk was most pronounced among males who reported higher levels of hazardous alcohol use. A sensitivity analysis examining suicide risk by sex and screening results for alcohol misuse (positive/negative) showed that men with a probable positive screen had higher suicide risk.Discussion: The current study provides novel findings on suicide risk among survivors of military sexual violence by including both male and female survivors. Interventions to decrease suicide risk following MSA may consider alcohol reduction strategies, and optimizing these interventions in males. Engaging military culture at both the US Departments of Defense and Veterans Affairs to encourage more healthy alcohol consumption may mitigate this public health concern. Future research may consider how country of origin relates to these associations.

Average scores for the suicide risk measure and alcohol use were high among a sample of male and female survivors of military sexual assault.Suicide risk was most pronounced among males who reported higher levels of hazardous alcohol use.A sensitivity analysis examining suicide risk by sex and screening results for alcohol misuse (positive/negative) showed that men with a probable positive screen had higher suicide risk.

Negative posttraumatic cognitions about self potentially mediate the relation between sexual revictimization and suicide risk in a sample of military sexual assault survivors.

OBJECTIVE: Military sexual trauma (MST) is a risk factor for suicide among service members/veterans. Research reported that around half of MST survivors were exposed to pre-MST, making MST a revictimization experience. Unfortunately, little is known about mechanisms of the association between revictimization and suicide risk among MST survivors. One possible mechanism is posttraumatic cognitions (PTCs), which include the survivor's (a) negative cognitions about themselves, (b) negative cognitions about the world, and (c) self-blame. The current study examined each of the PTC subscales as potential mediators of the association between sexual revictimization and suicide risk. METHOD: Participants were 383 service members/veterans reporting a history of MST that involved assault (50.65% female). Participants completed self-report questionnaires assessing demographics, suicide risk, history of sexual victimization (MST and premilitary sexual victimization), and PTCs. Of these, 340 (88.8%) reported a history of MST and premilitary victimization and comprised the revictimization group. RESULTS: Parallel mediation analysis with suicide risk regressed on each of the PTCs subscales and covariates revealed that negative cognitions about self had a significant indirect effect on the association between revictimization and higher suicide risk, above and beyond negative cognitions about the world and self-blame. CONCLUSIONS: Targeting negative cognitions about self among sexual revictimization survivors may be a therapeutic strategy to reduce suicide risk most effectively. Cognitive processing therapy may be particularly useful given the focus on altering PTCs. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Using Military Screening Questions to Anonymously Recruit Post-9/11 Era Service Members and Veterans Using Online Survey Methods.

INTRODUCTION: The ability to collect data on posttraumatic reactions following military sexual trauma is impacted by data collection methods, such that under-reporting can occur when data are believed to be identifiable. This may be especially true for topics that are sensitive, including sexual trauma. Ensuring participation from service members using non-identifiable methods is challenging when service history cannot be confirmed. The COVID-19 pandemic complicated data collection due to contact and social distancing requirements and limitations. To attempt to overcome these challenges, this study utilized an anonymous survey delivered by Qualtrics, Inc. with military validation checks that served as a screening mechanism. The purpose of the current report is to describe the development and use of military validation questions to recruit a sample of military sexual assault survivors using an anonymous survey. MATERIALS AND METHODS: Qualtrics, Inc., a data collection software company, was contracted to collect data on military service members and veterans who reported military sexual assault. We developed and piloted four validation checks regarding military knowledge, which had to be answered correctly before participants could engage in the survey. This information was common to those who have served but uncommon to civilians, ensuring, to the best of our ability, that those responding were or had been service members. An incorrect response to any of the validation checks resulted in termination from the study. The probability of guessing correctly all four items was 0.16%. RESULTS: The current study collected data on 200 women and 200 men, all of whom reported military sexual assault. Data collection took approximately 6 weeks to complete. The validation checks resulted in screening out 1,450 potential participants who provided fraudulent responses. The average cost per participant, which included recruitment costs and participant payment, was $20. Given the histories of military sexual assault, the cohort reported high rates of probable positive screens for posttraumatic stress disorder (PTSD), suicide risk, and moderately severe depression, as well as other interpersonal challenges that are typically reported by those exposed to sexual assault, suggesting our validation checks were effective in recruiting the desired sample. Though not an original goal of our recruitment efforts, 9.75% (n = 39) of our sample identified as a sexual orientation other than heterosexual, including gay, bisexual, questioning, or "other." CONCLUSIONS: Use of Qualtrics, Inc. to incorporate validation checks helped us to be more reasonably confident that we were collecting data from military service members who reported military sexual assault. While the probability of a person without current or past military service passing the validation checks was low, it was not impossible. An unanticipated benefit of this platform was the short duration of time it took to complete data collection; the sample was collected within about 6 weeks. This platform may be a good option for investigators who cannot collect face-to-face data.

Suicide Ideation, Plans, and Attempts Among Military Veterans vs Nonveterans With Disability.

Importance: People with disability are at heightened risk for suicide ideation, planning, and attempt, with risk growing as the number of disabling limitations increases. Military veterans have higher rates of suicide deaths and disability relative to nonveterans. Objective: To evaluate whether veteran status is associated with greater risk for suicide in those with disability. Design, Setting, and Participants: This survey study used cross-sectional self-reported data from US adults who participated in the 2015-2020 National Survey on Drug Use and Health. Data were weighted to represent the population. Data analysis was conducted from July to August 2022. Main Outcomes and Measures: Suicide ideation, planning, and attempt served as primary outcomes. Disability status (present or absent) and number of disabling limitations (1, 2, or ≥3) served as factors. Veteran status was determined based on self-report (veteran or nonveteran). Multivariable logistic regression examined suicide ideation, planning, and attempt as a function of veteran status and disability variables. Results: Participants included 231 099 US veterans and nonveterans, representing 236 551 727 US adults, of whom 20.03% (weighted n = 47 397 876) reported a disabling limitation, 8.92% were veterans (weighted n = 21 111 727; 16.0% aged 35-49 years; 91.0% men; 6.7% Hispanic; 10.9% non-Hispanic Black; and 78.4% non-Hispanic White) and 91.08% were nonveterans (weighted n = 215 440 000; 25.4% aged 35-49 years; 44.0% male; 16.5% Hispanic; 11.7% non-Hispanic Black; and 63.3% non-Hispanic White). Overall, 4.39% reported suicide ideation, planning, or attempt (weighted n = 10 401 065). Among those with no disability, veteran status was associated with higher risk of suicide planning (adjusted odds ratio [AOR], 1.71; 95% CI, 1.17-2.49). Among those with 1 or 2 disabling limitations, being a veteran was associated with a lower risk of suicide planning (AOR, 0.57; 95% CI, 0.34-0.95) and history of attempt (AOR, 0.46; 95% CI, 0.24-0.88). Conclusions and Relevance: In this study of how suicide risk differs as a function of disability and veteran status, risk for death by suicide was lower among veterans with disability relative to nonveterans with disability. Veteran status may mitigate risk for suicide given increased receipt of more disability-related care through the Department of Veterans Affairs. Further research would extend this line of inquiry by examining the cause and type of disability as well as perceptions of disability on self-worth. It is possible that physical wounds of war are protective because of the meaning and value of service to one's country.

Posttraumatic Cognitions Differ Between Men and Women after Military Sexual Assault Revictimization in Their Contribution to PTSD Symptoms.

Sexual revictimization is heightened among military service members and veterans and is associated with greater posttraumatic stress symptoms (PTSS) and severity. The heightened distress following revictimization may be due to posttraumatic cognitions (PTC), which include negative beliefs about the self and world, and self-blame. Moreover, it is unclear whether men and women experience different levels of PTC. The current study tested PTC (overall and subdomains) as a possible mediator between sexual revictimization and PTSS severity, and gender as a possible moderator of these associations. Revictimization was defined across time periods (military sexual assault [MSA] only vs. premilitary sexual trauma + MSA) and in military rape frequency (0, 1, 2+). Participants were 400 (n = 200 [50%] male) service members/veterans with a history of MSA and completed online, anonymous, self-report questionnaires. PTC mediated the association between revictimization and PTSS severity. A significant interaction of gender suggested that men reported high overall PTC and PTC about the self regardless of revictimization; by contrast, overall PTC and PTC about the self were lower for women in response to MSA only and increased with revictimization. Results also showed men were more sensitive to PTC about self-blame as it pertains to more severe PTSS compared to women. There were no unique gender interactions when assessing revictimization by rape frequency, although PTC (overall, all subdomains) significantly mediated the association between rape frequency and PTSS severity. PTC may be a beneficial target when treating PTSS in men, and may be especially heightened in women who have experienced revictimization.

The Association of Military Sexual Harassment/Assault With Suicide Ideation, Plans, Attempts, and Mortality Among US Service Members/Veterans: A Meta-Analysis.

Suicide rates continue to increase among service members/veterans. Military sexual harassment/assault (MSH/A) may increase risk of suicide, but little is known about the collective magnitude of associations between MSH/A and suicide outcomes, including ideation, plan, attempt, and mortality. The current meta-analysis addressed this literature gap while testing potential moderators of gender, marital status, discharge status, and military branch. PsycINFO, PubMed, Dissertations/Theses, relevant citation lists, and conference brochures were reviewed for papers that included quantitative analyses in English, U.S. military samples, and measures of MSH/A and suicide ideation/plan/attempt/mortality. The search resulted in 22 studies (N = 10,898,875) measuring the association of MSH/A with suicide ideation (k = 15), plans (k = 1), attempts (k = 14), and mortality (k = 2), with papers published from 2007-2021. MSH/A was associated with suicide ideation (r ¯ = .14) and attempts (r ¯ = .11, ps < .05). The association of MSH/A and suicide ideation and attempts was higher among women relative to men, those identifying as married versus not married, those actively serving compared to discharged, and those reporting service in the Air Force relative to all other branches. The association of MSH/A with suicide plans and mortality was not calculated due to the small number of studies reporting those effect sizes (ks = 1-2). The effect sizes observed suggest MSH/A is part of a larger network of risk factors for suicide. Moderators indicate that suicide risk is higher among specific groups, and prevention strategies would be most effective if they targeted these individuals. This research area would be strengthened by additional studies of plans and mortality.

Exploring how positive and negative social exchanges relate to posttraumatic stress disorder severity among previously deployed men service members/veterans.

OBJECTIVE: Research in civilians and women shows negative social support is more deleterious for posttraumatic stress disorder (PTSD) symptoms than are the buffering effects of positive social support. However, this is understudied in male military samples. Moreover, appraisals of social support appear to be the mechanism of the association of social support type and PTSD severity, but appraisals as mediators have not been explored in military samples. METHOD: Previously deployed male service members/veterans (SM/Vs; n = 333) completed a demographic inventory, the Positive and Negative Social Exchange Scale, which assesses positive and negative social support and their appraisals, and the PTSD Checklist-5. Path analyses examined associations of positive and negative social support with PTSD severity and whether appraisals mediated these associations. RESULTS: The magnitude of the association of negative social support and PTSD symptom severity (standardized estimate = .33; SE = .06, p < .001) was statistically greater than the association of positive social support and PTSD symptom severity (standardized estimate = -.26; SE = .06, p < .001). Higher positive support was associated with higher appraisals, and in turn, higher appraisals were associated with lower PTSD severity, suggesting mediation. In contrast, the association of negative social support with PTSD was direct. CONCLUSION: Causality cannot be inferred. Positive support exhibits a weaker relationship with PTSD because its effect is dependent on how an individual appraises the support whereas negative support has a direct relationship with PTSD regardless of appraisals. Findings suggest positive support interventions should focus on individual perceptions whereas negative support interventions should focus on decreasing how often these interactions occur. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Sexual Violence in Military Service Members/Veterans Individual and Interpersonal Outcomes Associated with Single and Multiple Exposures to Civilian and Military Sexual Violence.

Sexual harassment and violence is a grave public health concern and risk for revictimization increases following initial exposure. Studies of sexual revictimization in military samples are generally limited to women and are focused on rates of posttraumatic stress disorder (PTSD), with no examination of how revictimization relates to interpersonal outcomes, such as relationship or sexual satisfaction. The current study addressed these gaps in a sample of 833 women and 556 men service members/veterans. Self-reported outcomes of PTSD, depression, suicidal ideation, sexual function, and relationship satisfaction were compared across those reporting exposure to sexual harassment and violence before the military only (i.e., pre-military), during the military only (i.e., military sexual harassment and violence [MSV]), before and during the military (i.e., revictimization), and to no exposure. More than half of women (51.14%, n = 426) reported revictimization and only 5.79% (n = 28) of men reported revictimization. Among women, those reporting MSV or revictimization tended to report higher PTSD, depression, and suicidal ideation relative to pre-military sexual violence and no sexual violence exposure. No interpersonal outcomes were significantly different among these sexual violence groups. Among men, revictimization was associated with higher PTSD, depression, and sexual compulsivity. PTSD and depression were also higher among those reporting MSV only. No effects were found for premilitary sexual trauma exposure only or relationship satisfaction for either group. Findings highlight the particularly bothersome nature of MSV, whether it occurred alone or in tandem with premilitary sexual violence. Findings also show unique gender differences across outcomes, suggesting interventions following sexual harassment and violence may differ for men and women.

Sexual compulsivity, erectile dysfunction, and suicidality among male survivors of military sexual violence.

Although military sexual trauma (MST) is associated with an increased risk of suicide, suicide attempts, and suicidal ideation among service members and veterans, there is limited knowledge regarding the mechanisms of MST and suicidality among men. The current study examined whether MST was associated with sexual compulsivity and/or erectile dysfunction and if these, in turn, explained elevated suicidal thoughts and the likelihood of engaging in future suicidal behavior after accounting for mental health, military, and demographic characteristics. Service members and veterans who reported their gender as male (N = 508) were recruited via social media and completed online self-report measures assessing MST, erectile dysfunction, sexual compulsivity, suicidal ideation frequency, and the likelihood of engaging in future suicidal behavior. Path analysis was used to examine the study hypotheses. In total, 67 participants (13.2%) reported a history of MST; of these individuals, 27 (40.3%) reported suicidal ideation in the past 12 months, and 29 (43.9%) reported an increased likelihood of engaging in future suicidal behavior. MST was associated with increased sexual compulsivity, which, in turn, predicted more frequent suicidal ideation as well as a higher self-reported likelihood of engaging in future suicidal behavior. MST was associated with higher levels of erectile dysfunction, but erectile dysfunction was not associated with suicidal ideation in the adjusted model. Although the data were cross-sectional, precluding determinations of causality, the results support assessing and intervening with regard to sexual compulsivity to mitigate the risk for suicide-related outcomes among men who experience MST.

Mechanisms of the association between PTSD and sexual arousal and lubrication functioning among trauma-exposed female service members/veterans.

BACKGROUND: The presence of a post-traumatic stress disorder (PTSD) diagnosis or higher PTSD severity is associated with higher overall sexual dysfunction in female service members/veterans. However, the mechanisms linking PTSD to specific components of women's sexual arousal function, like lubrication and mental arousal, are unknown. METHODS: We conducted a survey among 464 women who reported probable Criterion A exposure for PTSD. Path analysis examined (1) the association of PTSD with sexual arousal, (2) whether specific PTSD symptom clusters were uniquely associated with sexual arousal, and (3) whether this association is indirect, through the effects of higher depression severity and lower romantic relationship satisfaction. Arousal was operationalized to measure both mental (subjective arousal) and physical (lubrication) experiences. RESULTS: Higher PTSD severity was associated with lower lubrication and arousal function. The association of PTSD severity with arousal was indirect, through lower romantic relationship satisfaction (estimate: -0.12; 95% CI: [-0.014, -0.007]) and higher depression (estimate: -0.08, 95% CI: [-0.012, -0.002]). The association of PTSD severity with lubrication was also indirect, but only through lower relationship satisfaction (estimate: -0.10, 95% CI: [-0.013, -0.006]). PTSD symptom clusters were not uniquely associated with arousal and lubrication through mediated pathways. LIMITATIONS: Data were from a cross-sectional study using a convenience sample. Criterion A exposure could not be confirmed. CONCLUSIONS: PTSD may lead to arousal and lubrication dysfunction by contributing to higher depression severity and strained romantic relationships. Interventions targeting reductions in depressive symptoms and bolstering relationship satisfaction may minimize the burden of PTSD on sexual arousal concerns.

The association of self-reported romantic relationship satisfaction and anhedonia symptoms secondary to posttraumatic stress among trauma-exposed male service members/veterans.

OBJECTIVE: Higher posttraumatic stress disorder (PTSD) symptoms are associated with poorer romantic relationship satisfaction in military samples. Studies have examined PTSD symptom clusters and their association with relationship satisfaction, but these studies are limited to the pre-Diagnostic and Statistical Manual (DSM)-5 PTSD models or samples of women. The current study explored the best fitting model of PTSD using contemporary symptoms and examined the association of symptom clusters and relationship satisfaction in a sample of partnered male service members/veterans who reported exposure to a probable Criterion A event. METHOD: Factor analyses of 6 competing PTSD models were compared using confirmatory factor analysis in a sample of 499 men. Path analysis was then used to examine which symptom clusters were uniquely associated with relationship satisfaction after accounting for covariates in a subsample of 217 men who reported probable Criterion A exposure. RESULTS: The Anhedonia and Hybrid Models had the best fit to the data in both the larger sample and subsample of men reporting probable trauma exposure. Models had comparable model fit, thus symptom clusters from both models were examined as predictors of relationship satisfaction in 2 separate analyses adjusted for covariates. In both analyses, only higher anhedonia symptoms were associated with lower romantic relationship satisfaction. CONCLUSIONS: Data was cross-sectional so causality cannot be inferred, but it appears that poorer relationship satisfaction is more common when symptoms of anhedonia are high. Interventions to improve relationship satisfaction among those reporting posttraumatic stress symptoms may be most effective if they focus on reducing anhedonia. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Depression symptoms as a potential mediator of the association between disordered eating symptoms and sexual function in women service members and veterans.

Sexual dysfunction is associated with disorders commonly diagnosed in service members/veterans (SM/Vs; e.g., depression, posttraumatic stress disorder) and increased risk for suicide in service women. Theory indicates depression may play an important role in predicting sexual dysfunction in the presence of certain mental health challenges, such as disordered eating symptoms. Given the risk for depression and incidence of eating disorders in women SM/Vs, the current study examined whether depressive symptoms mediated the association of disordered eating symptoms and sexual dysfunction in women SM/Vs. Participants (n = 494) were recruited via social media and completed measures of sexual function, disordered eating symptoms, depressive symptom severity, a demographic inventory, and measures of relationship satisfaction and trauma exposure (covariates). Based on self-report measures, probable sexual dysfunction, eating disorder, and depressive disorders were found among 58.70%, 38.5%, and 44.13% of participants, respectively. The relationship of higher disordered eating symptoms and lower sexual function was indirect, through higher depressive symptoms (indirect effect: -0.57, 95% confidence interval: -0.82, -0.34). Findings underscore the importance of screening for sexual function, particularly when disordered eating behavior or depression is present. Integrating treatment for sexual function into existing treatments for women SM/Vs with disordered eating and depression symptoms may be valuable.

The association of assault military sexual trauma and sexual function among partnered female service members and veterans: the mediating roles of depression and sexual self-schemas.

Background: Military sexual trauma (MST) that involves assault is associated with poorer sexual function in U. S. women service members/veterans (SM/Vs). Theory of sexual function suggests that the presence of higher depression severity and more negative sexual self-schemas may contribute to sexual dysfunction. This has yet to be examined in partnered women SM/Vs who are survivors of MST. Objective: Using path analysis, the current study examined the associations of MST type, depression, sexual self-schemas, and sexual function in 818 partnered women SM/Vs. Method: Three separate mediation models were tested, all testing indirect effects of depression and sexual self-schemas on the association of MST type and sexual function. In Model 1, the mediation model assumed that exposure to MST predicted more severe depression, which then predicted more negative sexual self-schemas. More negative sexual self-schemas, in turn, predicted poorer sexual function. In Model 2, the mediation model assumed that exposure to MST predicted more negative sexual self-schemas, which then predicted more severe depression. More severe depression, in turn, predicted poorer sexual function. In Model 3, the mediation model assumed a parallel mediation in that exposure to MST predicted more severe depression and more negative sexual self-schemas, which in turn, predicted poorer sexual function. Results: The best fitting model suggested a parallel mediation of higher depression severity (estimate: -1.30, confidence interval: -1.91,-.69) and more negative sexual self-schemas (estimate: -2.09, confidence interval: -2.94,-1.24) on the association of assault MST and poorer sexual function (Model 3). Harassment-only MST was unrelated to sexual function through mediated pathways. Conclusions: Interventions to improve sexual function among MST survivors who experienced assault should address negative sexual self-schemas related to sexual performance and depressive symptoms. Cognitive behavioural interventions that include challenging maladaptive cognitions may be well suited to address this clinical need.

Antecedentes: El trauma sexual militar (MST por sus siglas en inglés) que involucra agresión sexual (a diferencia de una experiencia en la que únicamente hubo acoso) está asociado con una función sexual más pobre en las mujeres militares activas o veteranas de los EE. UU. (SM/Vs por sus siglas en inglés). La teoría de la función sexual sugiere que la presencia de una mayor severidad de la depresión y de autoesquemas sexuales más negativos pueden contribuir con la disfunción sexual. Esto aún tiene que ser examinado en mujeres SM/Vs que tengan parejas sobrevivientes a MST.Objetivo: Usando el análisis de ruta, el presente estudio examinó la asociación del tipo de MST (ej., ninguno, solo acoso, agresión), depresión, autoesquemas sexuales y función sexual en 818 mujeres SM/Vs con pareja.Método: Se evaluaron tres modelos de mediación distintos, todos probando efectos indirectos de la depresión y los autoesquemas sexuales en la asociación del tipo de MST y la función sexual. En el Modelo 1, el modelo de mediación asumía que la exposición al MST predecía una depresión más severa, lo que a su vez predecía autoesquemas sexuales más negativos. Los auto- esquemas sexuales más negativos, a su vez, predecian una función sexual más probre. En el Modelo 2, el modelo de mediación asumía que la exposición al MST predecía autoesquemas sexuales más negativos, lo cual entonces predecía una depresión más severa. La depresión más severa, a su vez, predecía una función sexual más pobre. En el Modelo 3, el modelo de mediación asumía una mediación paralela en que la exposición al MST predecía depresión más severa y autoesquemas sexuales más negativos, los que a su vez, predecían una funcion sexual más pobre.Resultados: El mejor modelo de ajuste sugirió una mediación de mayor severidad de la depresión (estimación:-1.30, intervalo de confianza: −1.91, −.69) y auto-esquemas sexuales más negativos (estimación: −2.09, intervalo de confianza: −2.94,-1.24) en la asociación de la agresión MST y función sexual más pobre (Modelo 3). El haber presentado una experiencia únicamente de acoso no tuvo relación con la función sexual a través de las vías mediadas.Conclusiones: Las intervenciones para mejorar la función sexual entre las sobrevivientes del MST que experimentaron agresión deberían abordar los autoesquemas sexuales negativos relacionados con el rendimiento sexual y los síntomas depresivos. Las intervenciones cognitivo-conductuales que incluyen el debate de cogniciones desadaptativas pueden ser adecuadas para abordar esta necesidad clínica.

The buffering role of higher romantic relationship satisfaction on the association of hazardous drinking with PTSD and depression symptoms among female military service members/veterans.

Studies show that more positive relationship satisfaction can mitigate the effects of posttraumatic stress disorder (PTSD) and depression severity on hazardous drinking in military samples. However, past studies were not circumscribed to female service members/veterans (SM/V), who represent the fastest growing demographic in the military. Moreover, studies did not examine moderators of specific symptom clusters of PTSD and depression with hazardous drinking. Indeed, recent studies have shown that the more depressive and cognitive clusters are associated with greater dysfunction. The current study extended this literature in a convenience sample of 584 female SM/V who completed self-report measures of hazardous drinking, PTSD, depression, and relationship satisfaction. PTSD or depression severity, relationship satisfaction, and their interaction, were examined as correlates of hazardous drinking after accounting for relationship, demographic, and military characteristics. For both overall PTSD and depression severity, higher relationship satisfaction weakened their association with hazardous drinking. Such results were consistent when global scores were replaced with PTSD-related negative alterations in cognitions and mood and somatic depression symptom clusters, but not for PTSD-related dysphoric arousal, anhedonia, or non-somatic depression symptom clusters. Findings suggest that to lessen the association of PTSD or depressive symptoms with problematic drinking, interventions aimed at improving relationship satisfaction may be worth considering among women in relationships. Moreover, symptom cluster analyses show that the cognitive and depressive components of PTSD, as well as the physical symptoms of depression, are most problematic, pinpointing specific areas of function on which to intervene.

The association between social support and posttraumatic stress symptoms among survivors of betrayal trauma: a meta-analysis.

Background: Betrayal traumas have a particularly deleterious effect on mental health. Although social support is a robust predictor of posttraumatic stress disorder (PTSD) symptom severity, it is not clear what factors may impact this relationship among betrayal trauma survivors. Objective: This study sought to describe the association between social support and PTSD symptom severity among survivors of betrayal trauma and examine whether methodological, sample, trauma, and social support characteristics moderated this association. Method: A comprehensive search identified 29 studies that assessed the cross-sectional association between PTSD symptom severity and social support among 6,510 adult betrayal trauma survivors. Results: The average effect size (r = -.25; 95% CI: -.30, -.20) was small to medium, with significant heterogeneity between studies (I2 = 71.86). The association between PTSD and social support was stronger when the trauma was perpetrated by a romantic partner compared to mixed perpetrators, even after accounting for covariates. There was also a significant effect of support type depending on whether the support was provided in the context of trauma disclosure. Specifically, positive reactions to trauma disclosure were not associated with PTSD symptoms whereas general positive social support (not disclosure focused) was associated with fewer PTSD symptoms. Negative reactions to trauma disclosure were associated with more PTSD symptoms. None of the included studies measured general negative social support outside of trauma disclosure. Conclusions: Our findings suggest that social support may be a particularly important buffer against PTSD symptoms when experiencing traumatic betrayal by an intimate partner. Additionally, our results suggest that social support interventions for those experiencing betrayal trauma should focus on reducing negative responses to disclosure and bolstering general satisfaction with social support.

Antecedentes: Los traumas de traición tienen un efecto particularmente perjudicial sobre la salud mental. Aunque el apoyo social es un fuerte predictor de la severidad de los síntomas del trastorno de estrés postraumático (TEPT), no está claro qué factores pueden afectar esta relación entre los sobrevivientes de traumas de traición.Objetivo: Este estudio buscó describir la asociación entre el apoyo social y la severidad de los síntomas del TEPT entre los sobrevivientes de trauma de traición y examinar si las características metodológicas, muestrales, de trauma y de apoyo social moderaron esta asociación.Método: Una búsqueda exhaustiva identificó 29 estudios que evaluaron la asociación transversal entre la gravedad de los síntomas de TEPT y el apoyo social entre 6.510 adultos sobrevivientes de trauma de traición.Resultados: El tamaño del efecto promedio (r = −.25; IC del 95%: −.30, −.20) fue de pequeño a mediano, con heterogeneidad significativa entre los estudios (I2 = 71.86). La asociación entre el TEPT y el apoyo social fue más fuerte cuando el trauma fue perpetrado por una pareja romántica en comparación con perpetradores mixtos, incluso después de tener en cuenta las covariables. También hubo un efecto significativo del tipo de apoyo dependiendo de si el apoyo se proporcionó en el contexto de la revelación del trauma. Específicamente, las reacciones positivas a la revelación del trauma no se asociaron con síntomas de TEPT, mientras que el apoyo social positivo general (no enfocado en la revelación) se asoció con menos síntomas de TEPT. Las reacciones negativas a la revelación del trauma se asociaron con más síntomas de TEPT. Ninguno de los estudios incluidos midió el apoyo social negativo general fuera de la revelación del trauma.Conclusiones: Nuestros hallazgos sugieren que el apoyo social puede ser un amortiguador particularmente importante contra los síntomas del TEPT cuando se experimenta una traición traumática por un compañero íntimo. Además, nuestros resultados sugieren que las intervenciones de apoyo social para quienes experimentan el trauma de traición deben centrarse en reducir las respuestas negativas a la revelación y reforzar la satisfacción general con el apoyo social.

Gender as a moderator of the association of military sexual trauma and posttraumatic stress symptoms.

OBJECTIVE: The current study examined the moderating role of gender on the association of military sexual trauma (MST) type (harassment-only vs. assault) and posttraumatic stress symptoms (PTSS) using the 6-factor Anhedonia Model. METHODS: Participants were 1321 service members/veterans. Two-part hurdle models assessed the moderating role of gender on the association of MST type with the presence (at least "moderate" symptoms endorsed within each cluster) or severity of PTSS and symptom clusters. RESULTS: Among those who experienced assault MST, women were at higher risk for the presence of intrusive, avoidance, negative affect, and anhedonia symptoms, and higher risk for more severe negative affect symptoms. Among those who experienced harassment-only MST, men were at higher risk of more severe PTSS symptoms overall and in the intrusive and dysphoric arousal symptom clusters. No other significant differences were observed. CONCLUSIONS: Gathering information on MST type may be helpful in treatment planning.

More frequent negative social exchanges are associated with higher suicide ideation and risk in men service members/veterans.

INTRODUCTION: Suicide is a leading cause of death in military service members/veterans (SM/Vs). Positive social exchanges (e.g., emotional support) buffer against suicide risk but the influence of negative social exchanges (e.g., unwanted advice) is understudied. METHOD: The current study explored (1) the contributions of positive and negative social exchanges as simultaneous correlates of suicide ideation and risk, (2) whether positive social exchanges mitigated the association of negative social exchanges and suicide ideation and risk, and (3) if facets of social exchanges were uniquely related to suicide ideation and risk. SM/Vs men (N = 508) completed self-report questionnaires. RESULTS: Roughly 27% endorsed suicide ideation. Between 23.62 and 41.14% reported elevated suicide risk. Adjusted analyses revealed higher negative social exchanges, particularly insensitive behaviors, and lower positive social exchanges were associated with higher suicide ideation and risk. The magnitude of positive and negative social exchanges with suicide ideation or risk was statistically similar. Higher positive social exchanges did not attenuate the association of negative social exchanges and suicide ideation or risk (p > 0.05). CONCLUSION: Higher negative social exchanges are equally strong correlates of suicide ideation and risk as positive social exchanges. Decreasing insensitive behaviors may reduce suicide ideation and risk in men SM/Vs.

The Association of Exposure to Military Sexual Trauma and Romantic Relationship Satisfaction Among Partnered Men Service Members/Veterans: The Influence of Compulsive Sexual Behavior.

Civilian literature shows a strong, consistent association between exposure to sexual violence and poor romantic relationship satisfaction. The impact of sexual violence that occurred during military service, or military sexual trauma (MST), on romantic relationship satisfaction among partnered men service members/veterans (SM/Vs) is understudied. However, a recent study conducted in women observed that MST that involved an assault was associated with poorer relationship satisfaction through higher sexual dysfunction and lower sexual satisfaction. The current study extended the literature by examining sexual function as a mediator of the association of exposure to MST and romantic relationship satisfaction among partnered men SM/Vs (N = 499). Participants completed self-report measures of MST exposure, romantic relationship satisfaction, erectile dysfunction, and compulsive sexual behavior, as well as a demographic inventory. The average score on relationship satisfaction was in the distressed range. Sixty-four participants (12.83%) reported MST exposure. MST exposure was related to lower relationship satisfaction through higher compulsive sexual behavior. The model explained 16% of the variance in relationship satisfaction. The indirect effect of erectile dysfunction was nonsignificant. Current findings are consistent with research in women SM/Vs: the association of MST and romantic relationship satisfaction appears to be indirect, through the effects of sexual function. Couples' therapy may be most effective if it addresses sexual health concerns among men MST survivors, particularly engagement in compulsive sexual behaviors. Due to low endorsement of MST that involved assault, the impact of MST severity could not be examined.

La bibliografía sobre los civiles indica una asociación fuerte y constante entre la exposición a la violencia sexual y la insatisfacción con la relación amorosa. El efecto de la violencia sexual sufrida durante el servicio militar, o el trauma sexual militar, en la satisfacción con la relación amorosa entre miembros o veteranos masculinos del servicio militar se ha estudiado muy poco. Sin embargo, en un estudio reciente realizado en mujeres se observó que el trauma sexual militar que implicó abuso estuvo asociado con una peor satisfacción con la relación mediante una mayor disfunción sexual y una menor satisfacción sexual. El presente estudio amplió la bibliografía analizando la función sexual como mediadora de la asociación de la exposición al trauma sexual militar y la satisfacción con la relación amorosa entre miembros o veteranos masculinos del servicio militar que están en pareja (N=499). Los participantes completaron medidas de autoinforme sobre la exposición al trauma sexual militar, la satisfacción con la relación amorosa, la disfunción eréctil y el comportamiento sexual compulsivo, así como un inventario demográfico. El puntaje promedio de la satisfacción con la relación estuvo en el rango de riesgo. Sesenta y cuatro participantes (el 12.83 %) informaron exposición al trauma sexual militar. La exposición al trauma sexual militar estuvo relacionada con una menor satisfacción con la relación mediante un mayor comportamiento sexual compulsivo. El modelo explicó el 16 % de la varianza en la satisfacción con la relación. El efecto indirecto de la disfunción eréctil no fue significativo. Los resultados actuales coinciden con la investigación sobre las mujeres integrantes o veteranas del servicio militar: la asociación del trauma sexual militar y la satisfacción con la relación amorosa parece ser indirecta, mediante los efectos de la función sexual. La terapia de pareja puede ser más eficaz si aborda las preocupaciones sobre la salud sexual entre los hombres sobrevivientes al trauma sexual militar, particularmente la práctica de comportamientos sexuales compulsivos. Debido a un bajo informe de trauma sexual militar que haya implicado abuso, no se pudo analizar el efecto de la intensidad del trauma sexual militar.

Self-reported PTSD symptoms and social support in U.S. military service members and veterans: a meta-analysis.

Background: The mental health burden of posttraumatic stress disorder (PTSD) is high in U.S. military samples. Social support is one of the most robust protective factors against PTSD and a recent meta-analysis indicates that this relationship is even stronger in military samples compared to civilian samples. Yet no meta-analyses have explored factors impacting this association in veterans and military service members (VSMs). Objective: The current meta-analysis examined demographic, social support, and military characteristics that may moderate the relationship of PTSD severity and social support among U.S. VSMs. Method: A search identified 37 cross-sectional studies, representing 38 unique samples with a total of 18,766 individuals. Results: The overall random effects estimate was -.33 (95% CI: -.38, -.27, Z = -10.19, p <.001), indicating that lower levels of social support were associated with more severe PTSD symptoms. PTSD measures based on the Diagnostic and Statistical Manual (DSM)-III had a larger effect size than measures based on DSM-IV or DSM-5. The social support source was a significant moderator such that support perceived from non-military sources was associated with a larger effect size than support perceived from military sources. This finding held after accounting for covariates. Deployment-era, timing of social support, and age were also significant moderators, but were no longer significantly associated with effect size after adjusting for covariates. Although previous meta-analyses have shown social negativity to be more impactful than positive forms of social support, there were too few studies conducted to evaluate social negativity in moderator analyses. Conclusion: Results suggest that social support received from civilians and in the home environment may play a greater protective role than social support received from military sources on long-term PTSD symptom severity. The literature on social support and PTSD in U.S. VSMs would be strengthened by studies examining the association of social negativity and PTSD symptoms.

Antecedentes: La carga en salud mental del trastorno de estrés post-traumático (TEPT) es alta en muestras militares estadounidenses. El apoyo social es uno de los factores protectores más robustos contra el TEPT, y un meta-análisis reciente indica que esta relación es incluso más fuerte en muestras militares comparada con muestras de civiles. Aunque, ningún meta-análisis ha explorado los factores que impactan esta asociación en veteranos y miembros militares en servicio (VMS).Objetivo: El presente meta-análisis examinó características demográficas, de apoyo social, y militares que puedan moderar la relación de severidad de TEPT y apoyo social en VMS estadounidenses.Método: Una búsqueda identificó 37 estudios transversales, representando 38 muestras únicas con un total de 18.766 individuos.Resultados: La estimación general de efectos aleatorios fue −.33 (95% CI: −.38, −.27, Z=−10.19, p<.001), indicando que niveles más bajos de apoyo social estaban asociados a mayor severidad de síntomas TEPT. Los instrumentos de TEPT basados en el Manual diagnóstico y estadístico de los trastornos mentales (DSM) ­III obtuvieron un tamaño de efecto mayor que los instrumentos basados en DSM-IV o DSM-5. La fuente de apoyo social fue un moderador significativo, de tal forma que el apoyo percibido de fuentes no militares estuvo asociado a un tamaño de efecto más grande que el percibido de fuentes militares. Este efecto se mantuvo luego de controlar covariables. La era de despliegue militar, temporalidad del apoyo social, y edad también fueron moderadores significativos, pero no se mantuvieron significativamente asociados al tamaño de efecto luego de controlar covariables. Aunque meta-análisis previos han demostrado que la negatividad social ha tenido más impacto que las formas positivas de apoyo social, existían muy pocos estudios como para evaluar negatividad social en un análisis de moderación.Conclusión: Los resultados sugieren que el apoyo social recibido de civiles y en el ambiente familiar puede tener un rol protector más relevante que el recibido de fuentes militares en la severidad de síntomas TEPT en el largo plazo. La literatura sobre apoyo social y TEPT en VMS estadounidenses se vería enriquecida por estudios que examinen la asociación de la negatividad social y síntomas TEPT.