Risk and protective factors associated with mental health among female military veterans: results from the veterans' health study.

BACKGROUND: This study focuses on factors that may disproportionately affect female veterans' mental health, compared to men, and is part of a larger study assessing the prevalence of mental health disorders and treatment seeking among formerly deployed US military service members. METHODS: We surveyed a random sample of 1,730 veterans who were patients in a large non-VA hospital system in the US. Based on previous research, women were hypothesized to be at higher risk for psychological problems. We adjusted our results for confounding factors, including history of trauma, childhood abuse, combat exposure, deployments, stressful life events, alcohol misuse, psychological resources, and social support. RESULTS: Among the veterans studied, 5% were female (n = 85), 96% were White (n = 1,161), 22.9% were Iraq/Afghanistan veterans (n = 398), and the mean age was 59 years old (SD = 12). Compared to males, female veterans were younger, unmarried, college graduates, had less combat exposure, but were more likely to have lifetime PTSD (29% vs. 12%.), depression (46% vs. 21%), suicidal ideation (27% vs. 11%), and lifetime mental health service use (67% vs. 47%). Females were also more likely to have low psychological resilience and to have used psychotropic medications in the past year. Using multivariate logistic regression analyses that controlled for risk and protective factors, female veterans had greater risk for lifetime PTSD, depression, suicidal thoughts, and for lifetime use of psychological services, compared to males. Since 95% of the population in this study were male and these results may have been statistically biased, we reran our analyses using propensity score matching. Results were consistent across these analyses. CONCLUSION: Using a sample of post-deployment veterans receiving healthcare services from a large non-VA health system, we find that female veterans are at greater risk for lifetime psychological problems, compared to male veterans. We discuss these findings and their implications for service providers.

The Family Resilience Inventory: A Culturally Grounded Measure of Current and Family-of-Origin Protective Processes in Native American Families.

The purpose of this article is to introduce the Family Resilience Inventory (FRI) and present findings on initial efforts to validate this measure. The FRI is designed to assess family resilience in one's current family and in one's family of origin, enabling the assessment of family protective factors across these generations. The development of the FRI was the result of many years of ethnographic research with Southeastern Native American tribes; yet, we believe that this scale is applicable to families of various backgrounds. Items for the FRI were derived directly from thematic analysis of qualitative data with 436 participants, resulting in two 20-item scales. Due to missing data, eight cases were removed from the 127 participants across two tribes, resulting in an analytic sample size of 119. Conceptually, the FRI is comprised of two factors or scales measuring distinct dimensions of family resilience (i.e., resilience in one's current family and resilience in one's family of origin). The results of the confirmatory factor analysis supported the hypothesized two-factor structure (X2 (644) = 814.14, p = .03, X2 /df = 1.10, RMSEA = .03, CFI = .97, TLI = .96). Both the subscales and the total FRI scale (α = .92) demonstrated excellent reliability. The results also provided preliminary evidence of convergent and discriminant validity. This measure fills a gap in the absence of community-based, culturally grounded, and empirical measures of family resilience. The examination of family resilience, which may occur across generations, is an exciting new contribution of the FRI.

El propósito de este artículo es presentar el "Inventario de Resiliencia Familiar" (FRI, por sus siglas en inglés) y los resultados actuales sobre los primeros esfuerzos para validar esta medición. El FRI está diseñado para evaluar la resiliencia familiar en la familia actual de una persona y en la familia de origen de una persona, lo cual permite la evaluación de los factores protectores familiares entre estas generaciones. El desarrollo del FRI fue el resultado de muchos años de investigación etnográfica con tribus amerindias del sudeste; sin embargo, creemos que esta escala puede aplicarse a familias de diferentes orígenes. Los puntos que componen el FRI se obtuvieron directamente de análisis temáticos de datos cualitativos con 436 participantes, cuyo resultado fueron dos escalas de 20 puntos. Debidos a datos faltantes, se extrajeron ocho casos de los 127 participantes entre dos tribus, lo cual resultó en un tamaño de la muestra análitica de 119. Conceptualmente, el FRI está compuesto por dos factores o escalas que miden diferentes dimensiones de resiliencia familiar (p. ej.: la resiliencia en la familia actual de una persona y la resiliencia en la familia de origen de una persona). Los resultados del análisis factorial confirmatorio respaldaron la estructura de dos factores planteada como hipótesis (X2 (644) = 814.14, p = .03, X2 /df = 1.10, RMSEA = .03, CFI = .97, TLI = .96). Tanto las subescalas como la escala total del FRI (α = .92) demostraron una excelente fiabilidad. Los resultados también proporcionaron indicios preliminares de validez convergente y discriminante. Esta medición llena un vacío en ausencia de mediciones de resiliencia familiar comunitarias, basadas en la cultura y en la práctica. El análisis de la resiliencia familiar, que puede darse en distintas generaciones, es un nuevo y fascinante aporte del FRI.

Mental, Physical and Social Dimensions of Health Equity and Wellness among U.S. Indigenous Peoples: What is Known and Next Steps.

This special issue and introduction focuses on promoting health equity and addressing health disparities among Indigenous peoples of the United States (U.S.) and associated Territories in the Pacific Islands and Caribbean. We provide an overview of the current state of health equity across social, physical, and mental health domains. In Part 1 of the special issue, we trace promotive, protective, and risk factors related to Indigenous health equity. Part 2 of the special issue describes interventions that address and promote wellness, providing promising pathways to achieving and transcending health equity.

Grapheme-Color Synesthesia is Associated with PTSD Among Deployed Veterans: Confirmation of Previous Findings and Need for Additional Research.

Post-traumatic stress disorder (PTSD) is related to alteration in neuropsychological functioning, including visual and other cognitive processes. Grapheme-color synesthesia is a phenomenon in which a letter or number elicits response of a concurrent image or color perception. Since we earlier reported an association between grapheme-color synesthesia and PTSD, our objective in the current study was to validate this association among a new study group and assess risk factors. For this, we surveyed 1,730 military veterans who have been outpatients in the Geisinger Clinic, a multi-hospital system in Pennsylvania, USA. All the study veterans served in a warzone deployment. The association between PTSD and Grapheme-color synesthesia was evaluated. The average age of veterans was 59.6 years among whom 95.1% were male. Current PTSD prevalence rate was observed to be 7.6% (95% C.I. = 6.5-9.0) and in 3.4% of veterans (95% C.I. = 2.7-4.4) grapheme-color synesthesia was found to be positive. Initial bivariate analyses suggested that synesthesia was associated with current PTSD [odds ratio (OR) = 3.3, p<0.001]. Multivariable stepwise logistic regression evaluating the age, sex, education, trauma exposure, current psychological stress, psychotropic medication use, combat exposure, history of concussion, and current depression, confirmed this association (OR = 2.33, p = 0.019). The present study corroborated that Grapheme-color synesthesia was linked to PTSD among a second cohort of deployed military veterans. Further research is recommended in order to validate this observation and to determine whether synesthesia is a risk factor for PTSD.

Mental Health Impact of Homecoming Experience Among 1730 Formerly Deployed Veterans From the Vietnam War to Current Conflicts: Results From the Veterans' Health Study.

We examined the effects of homecoming support on current mental health among 1730 deployed veterans from Vietnam, Iraq/Afghanistan, Persian Gulf, and other conflicts. The prevalence of current posttraumatic stress disorder (PTSD) was 5.4%, current depression was 8.3%, and 5.4% had suicidal thoughts in the past month. Overall, 26% of veterans had low homecoming support, which was more prevalent among Vietnam veterans (44.3%, p < 0.001). In multivariable logistic regressions, controlling for demographics, combat exposure, number of deployments, trauma history, and operational theater, low postdeployment support was associated with PTSD (odds ratio, 2.13; p = 0.032) and suicidality (odds ratio, 1.91; p < 0.030), but not depression. For suicidality, an interaction was detected for homecoming by theater status, whereby Iraq/Afghanistan veterans with lower homecoming support had a higher probability of suicidal thoughts (p = 0.002). Thus, years after deployment, lower homecoming support was associated with current PTSD and suicidality, regardless of theater and warzone exposures. For suicidality, lower support had a greater impact on Iraq/Afghanistan veterans.

Mental health outcomes at the Jersey Shore after Hurricane Sandy.

On October 29, 2012, Hurricane Sandy made landfall in the most densely populated region in the US. In New Jersey, thousands of families were made homeless and entire communities were destroyed in the worst disaster in the history of the state. The economic impact of Sandy was huge, comparable to Hurricane Katrina. The areas that sustained the most damage were the small- to medium-sized beach communities along New Jersey's Atlantic coastline. Six months following the hurricane, we conducted a random telephone survey of 200 adults residing in 18 beach communities located in Monmouth County. We found that 14.5% (95% CI = 9.9-20.2) of these residents screened positive for PTSD and 6.0% (95% CI = 3.1-10.2) met criteria for major depression. Altogether 13.5% (95% CI = 9.1-19.0) received mental health counseling and 20.5% (95% CI = 15.1-26.8) sought some type of mental health support in person or online, rates similar to those reported in New York after the World Trade Center disaster In multivariate analyses, the best predictors of mental health status and service use were having high hurricane exposure levels, having physical health limitations, and having environmental health concerns. Research is needed to assess the mental health status and service use of Jersey Shore residents over time, to evaluate environmental health concerns, and to better understand the storm's impact among those with physical health limitations.

Is Self-Care a Stand-In for Feminized Social Privilege? A Systematic Review of Self-Care Facilitators and Barriers to Self-Care Practices in Social Work.

PURPOSE: The purpose of this systematic review is to fill the gap in a critical understanding of peer-reviewed empirical research on self-care practices to identify structural, relational, and individual-level facilitators and barriers to self-care practices in social work. METHOD: We followed the preferred reporting items for systematic reviews and meta-analysis for this systematic review of peer-reviewed quantitative and qualitative empirical research articles focusing on self-care in social work among adult social work practitioners and students. RESULTS: Twenty-one articles related to empirical studies of self-care were identified in the systematic review process with samples of social work practitioners (n = 15), social work students (n = 3), and social work educators (n = 3). DISCUSSION: Social workers engaged in self-care practices are more likely to be healthy, work less, be White, and have higher socioeconomic professional status and privilege, indicating current conceptualizations of self-care may not be accessible and contextually and culturally relevant for many social workers. CONCLUSION: Overwhelmingly, results indicated social workers reporting greater sociostructural, economic, professional, and physical health privilege engaged in more self-care. No articles directly assessed institutional factors that may drive distress among social workers and clients. Rather, self-care was framed as a personal responsibility without integration of feminized and racialized inequities in a sociopolitical and historical context. Such framings may replicate rather than redress unsustainable inequities experienced by social workers and clients.

Shared trauma, resilience, and growth: A roadmap toward transcultural conceptualization.

Objective: Countless communities worldwide are exposed directly and subsequently to the effects of massive-scale collective stressors, from natural disasters to human-caused. In contexts of collective adversity, health care providers who are also members of these communities share and interdependently affect the range of responses their patients have. We aim to conceptualize this spectrum, termed shared trauma, shared resilience, and shared growth. Method: In this metasynthesis, we review the literature on these underacknowledged dynamics globally. We include prior conceptualizations of direct and indirect trauma, collective trauma, cultural context, and the COVID-19 pandemic toward clearer conceptualization of shared mental health in global collective stressor contexts. Results: Most trauma and resilience research focuses on prevailing concepts and measures with questionable cross-cultural applicability. These works usually center on acute, highly distressing threats to physical safety at the individual level. The scarce literature on shared trauma describes it as a rare phenomenon, entailing conflicting messages of narrative accounts within contexts of few cultures with medium to high degrees of individualism. There has been little consideration of other non-Western and indigenous communities with more collectivist values and collective trauma histories. There is limited understanding of these concepts as they pertain to the vast majority of cultures. As a result, shared trauma, resilience, and growth have been poorly conceptualized, differentiated, or empirically researched. Conclusions: We propose uniquely inclusive models of shared trauma, resilience, and growth. These models reflect the cumulative effects and interplay of direct to indirect, acute to chronic, individual to collective, and historic to transgenerational factors influenced by cultural context. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Understanding the neurobiology of fear conditioning and emergence of posttraumatic stress disorder psychobiology: commentary on Blanchard et al.

In this article, we discuss the historical evolution of posttraumatic stress disorder (PTSD) after the Vietnam War, with a focus on an article by Blanchard, Kolb, Prins, Gates, and McCoy (J Nerv Ment Dis 179:371-373, 1991) published in this Journal in 1991 entitled Changes in Plasma Norepinephrine to Combat-Related Stimuli Among Vietnam Veterans With Posttraumatic Stress Disorder. In this commentary, we discuss the significance of this brief article and the developments in the PTSD field before, during, and after the Blanchard publication. Within this context, we discuss the eventual recognition in both the clinical and scientific fields that PTSD had a major neurobiological foundation. Finally, we examine the key implication of these discoveries from an epidemiological, a clinical, and a public health perspective.

Impact and Risk of Moral Injury Among Deployed Veterans: Implications for Veterans and Mental Health.

The impact of "moral injury" (MI) among deployed veterans, defined as actions in combat that violate a veteran's moral beliefs and result in psychological distress, has increasingly become a significant clinical concern separate from other trauma- and stressor-related disorders. MI involves severe distress over violations of core beliefs often followed by feelings of guilt and conflict and is common among veterans with PTSD. While the psychological impact of PTSD is well-documented among veterans, this has been done less so with respect to MI. We studied MI among 1,032 deployed veterans who were outpatients in a large non-profit multi-hospital system in central Pennsylvania. The study included active duty and Guard/Reserve members, as well as veterans who were not Department of Veterans Affairs (VA) service users. Our hypothesis was that, controlling for other risk factors, veterans with high MI would have current mental disorders. Our secondary hypothesis was that MI would be associated with other psychopathologies, including chronic pain, sleep disorders, fear of death, anomie, and use of alcohol/drugs to cope post deployment. Most veterans studied were deployed to Vietnam (64.1%), while others were deployed to post-Vietnam conflicts in Iraq and Afghanistan and elsewhere. Altogether, 95.1% of the veterans were male and their mean age was 61.6 years (SD = 11.8). Among the veterans, 24.4% had high combat exposure, 10.9% had PTSD, 19.8% had major depressive disorder, and 11.7% had a history of suicidal thoughts. Based on the Moral Injury Events Scale (MIES), 25.8% had high MI post deployment, defined as a score above the 75th percentile. Results show that high MI among veterans was associated with current global mental health severity and recent mental health service use, but not suicidal thoughts. In addition, as hypothesized, MI was also associated with pain, sleep disorders, fear of death, anomie, use of alcohol/drugs to cope post-deployment, and poor unit support/morale during deployment. Deployed veterans with MI are more likely to have current mental health disorders and other psychological problems years after deployment. Further research is advised related to the screening, assessment, treatment, and prevention of MI among veterans and others after trauma exposures.

Psychological well-being and alcohol misuse among community-based veterans: results from the Veterans' Health Study.

BACKGROUND: Maladaptive drinking is an increasing concern among military policy makers and healthcare providers. The goal of this study was to assess how social and psychological factors relate to alcohol problems among post-deployed US veterans and how problematic drinking is associated with well-being. METHODS: Data were collected via a telephone survey from a random sample of veterans receiving their healthcare from a large non-VA hospital system in central Pennsylvania (N = 1730). Interviewers inquired about participants' current alcohol consumption, using the CAGE and AUDIT-C scales, and health-related outcomes (general psychological distress, major depression, and self-reported health status). Analyses included demographic, military and nonmilitary stressful events, use of alcohol or drugs to cope post-deployment, use of psychiatric services, and personality characteristics as independent variables. Our sample was 95% male, 96% White, and had a mean age of 59 years old (SD = 12 years). RESULTS: Analyses included demographic, military and nonmilitary stressful events, use of alcohol or drugs to cope post-deployment, use of psychiatric services, and personality characteristics as independent variables. Our sample was 95% male, 96% White, and had a mean age of 59 years old (SD = 12 years). Analyses for our drinking measures show that those who used drugs or alcohol to cope post-deployment were more likely to be problematic drinkers, while positive personality characteristics such as agreeableness and conscientiousness were related to fewer drinking problems. Multivariate logistic regressions for our well-being measures found that alcohol misuse was not related to distress or depression, but that a positive score on the AUDIT-C was associated with a lower likelihood of poor self-rated health. Using alcohol or drugs to cope was related to higher distress. DISCUSSION: We conclude that service providers might consider using post-deployment AUDIT-C and the drugs and alcohol coping questions when screening for possible alcohol and mental health problems among veterans.

Genetic and Psychosocial Risk Factors Associated with Suicide Among Community Veterans: Implications for Screening, Treatment and Precision Medicine.

INTRODUCTION: Since veteran suicide is a concern and our knowledge of predictive factors is still limited, our objective was to assess risk factors for suicide, including genetic factors, among deployed veterans. METHODS: For this study, we surveyed 1730 veterans who were outpatients in a multi-hospital system in Pennsylvania. Altogether, 1041 veterans (60%) provided a DNA sample. The genetic risk variants investigated were within loci previously associated with PTSD and substance misuse, including CRHR1, CHRNA5, RORA, and FKBP5 genetic variations, which were used to calculate a polygenic risk score (range=0-8, mean=3.6, SD=1.4). RESULTS: Most veterans (56.2%) were deployed to Vietnam while significant numbers were deployed to Iraq, Afghanistan, and other post-Vietnam conflicts. Overall, 95.1% of the veterans were male, their mean age was 56.2 (SD=12), and 95.6% were Caucasian. Among the veterans, 24% had high combat exposure. The prevalence of lifetime suicidal thoughts was 11.3%. Additionally, 5.7% ever developed a suicide plan or attempted suicide in their lifetimes. Among those with a history of a lifetime suicide attempt or suicide plan, the PTSD genetic risk score was significantly higher (OR=3.96 vs 3.55, p=0.033), but for suicidal thoughts, this association was not significant (p=0.717). In multivariable analysis (MVA) logistic regression, significant predictors of attempting suicide or having a suicide plan were history of depression (OR=5.04, p<0.001), PTSD genetic risk score (OR=1.25, p=0.036), history of childhood abuse/neglect (OR=2.24, p=0.009), and lifetime marijuana use (OR= 1.56, p=0.020). Conversely, rural residence was protective for suicide risk (OR=0.49; p=0.031). For suicidal thoughts, in the MVA genetic risk score was not significant (p=0.697), but history of child abuse/neglect (p<0.001), history of depression (p>0.001), low psychological resilience (p=0.004), and lifetime marijuana use (p=0.022) were significant. DISCUSSION: In this study, we identified genetic risk variants and other predictors for suicide among veterans that may have implications for future screening and clinical care. Further research is advised.

Mental health service use after the World Trade Center disaster: utilization trends and comparative effectiveness.

Previous research suggested that community-level mental health service use was low following the World Trade Center Disaster (WTCD) and that brief interventions were effective. In the current study, we assess service use during a longer follow-up period and compare the effectiveness of brief versus multisession interventions. To assess these, we conducted baseline diagnostic interviews among New York City residents 1 year after the WTCD (N = 2368) and follow-up interviews 2 years afterward (N = 1681). At follow-up, there was an increase in mental health utilization, especially for psychotropic medication use, and a decrease in use of physicians for mental health treatment. The best predictor of service use at follow-up was higher WTCD exposure. Using propensity score matching to control for selection bias, brief mental health interventions appeared more effective than multisession interventions. These intervention findings held even after matching on demographic, stress exposure, mental health history, treatment history, access to care, other key variables. Our study suggested that community-level mental health service use increased in the follow-up period and that brief interventions were more effective than conventional multisession interventions. Since this study was designed to assess treatment outcomes, our findings raise clinical questions.

Risk and protective factors for symptoms of depression and anxiety among American Indians: Understanding the roles of resilience and trauma.

OBJECTIVE: Depression and anxiety are comorbid conditions that are disproportionately high among American Indians (AIs) or Alaska Natives. The purpose of this study was to identify potential risk (e.g., low income, intimate partner violence [IPV], adverse childhood experiences [ACEs]) and protective factors (e.g., family resilience, social and community support) related to symptoms of depression and anxiety among AI adults. METHOD: As part of larger exploratory sequential mixed-methods research, the study focused on survey data with 127 AI adults from two Southeastern tribes (n = 117 when missing data were removed). We used the following three-stage hierarchical regression to understand factors related to depressive and anxiety symptoms: (a) demographics, including income; (b) ACEs and IPV; and (c) family resilience, along with family and community support. RESULTS: Many participants experienced elevated levels of clinically significant symptoms of depression and anxiety (15% and 20%, respectively). Results indicated lower income was associated with higher depressive and anxiety symptoms. IPV and ACE variables were positively associated with depressive and anxiety symptoms. Family resilience was negatively associated with symptoms of anxiety and depression. Social and community support were associated with symptoms of anxiety. CONCLUSIONS: The findings provide strong preliminary support for the role of family protective and promotive factors in offsetting symptoms of anxiety and depression. This is contrary to most models of interventions for anxiety and depression focusing on individual psychotherapy rather than promoting family resilience or involvement. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Mental health status in veterans residing in rural versus non-rural areas: results from the veterans' health study.

BACKGROUND: The majority of Veterans Affair (VA) hospitals are in urban areas. We examined whether veterans residing in rural areas have lower mental health service use and poorer mental health status. METHODS: Veterans with at least 1 warzone deployment in central and northeastern Pennsylvania were randomly selected for an interview. Mental health status, including PTSD, major depression, alcohol abuse and mental health global severity, were assessed using structured interviews. Psychiatric service use was based on self-reported utilization in the past 12 months. Results were compared between veterans residing in rural and non-rural areas. Data were also analyzed using multivariate logistic regression to minimize the influence by confounding factors. RESULTS: A total of 1730 subjects (55% of the eligible veterans) responded to the survey and 1692 of them had complete geocode information. Those that did not have this information (n = 38), were excluded from some analyses. Veterans residing in rural areas were older, more often of the white race, married, and experienced fewer stressful events. In comparison to those residing in non-rural areas, veterans residing in rural areas had lower global mental health severity scores; they also had fewer mental health visits. In multivariate logistic regression, rural residence was associated with lower service use, but not with PTSD, major depression, alcohol abuse, and global mental health severity score after adjusting confounding factors (e.g., age, gender, marital status and education). CONCLUSIONS: Rural residence is associated with lower mental health service use, but not with poor mental health in veterans with former warzone deployment, suggesting rural residence is possibly protective.

The Historical Oppression Scale: Preliminary conceptualization and measurement of historical oppression among Indigenous peoples of the United States.

Indigenous peoples of the United States are distinct from other ethnic minorities because they have experienced colonization as the original inhabitants. Social and health disparities are connected to a context of historical oppression-the chronic, pervasive, and intergenerational experiences of oppression that, over time, may be normalized, imposed, and internalized into the daily lives of many Indigenous peoples (including individuals, families, and communities). As part of the critical Framework of Historical Oppression, Resilience, and Transcendence (FHORT), in this article, we introduce the Historical Oppression Scale (HOS), a scale assessing internalized and externalized oppression. Our study reports on survey data (N = 127) from a larger convergent mixed-methodology study with scale items derived from thematic analysis of qualitative data (N = 436), which informed the resultant 10-item scale. After six cases were removed from the 127 participants who participated in the quantitative component to the study due to missing data across two tribes, the sample size for analysis was 121. Confirmatory factor analysis testing of the hypothesized unidimensional construct indicated acceptable model fit (X2 = 58.10, X2/df= 1.94, CFI = .98, TLI = .97, RMSEA = .088, 90% CI = .05, .12). Reliability of the 10-item scale was excellent (α = .97) and convergent and discriminant validity were established. The HOS explicates complex associations between historical oppression and health and social disparities and may be an important clinical and research tool in an understudied area.

Predictors of Current DSM-5 PTSD Diagnosis and Symptom Severity Among Deployed Veterans: Significance of Predisposition, Stress Exposure, and Genetics.

BACKGROUND: Previously we reported a genetic risk score significantly improved PTSD prediction among a trauma-exposed civilian population. In the current study, we sought to assess this prediction among a trauma-exposed military population. METHODS: We examined current PTSD diagnosis and PTSD symptom severity among a random sample of 1042 community-based US military veterans. Main effects and interaction effects were assessed for PTSD genetic risk by trauma exposure using cross-product terms for PTSD x trauma exposures, including combat, lifetime trauma, and adverse childhood exposures. The PTSD risk variants studied were within genetic loci previously associated with PTSD, including CRHR1, CHRNA5, RORA, and FKBP5 genetic variants, which were used to calculate a total PTSD genetic risk score (range=0-8, mean=3.6, SD=1.4). RESULTS: Based on DSM-5 PTSD criteria, 7.1% of veterans (95% CI=5.6-8.8) met criteria for current PTSD. The PTSD genetic risk count was significantly higher among PTSD cases vs non-cases (3.92 vs 3.55, p=0.027). Since the PTSD genetic risk score was not significant in the PTSD diagnosis model, we assessed this association using PTSD symptom severity. Because these symptom data were skewed (mean=9.54, SD=12.71, range=0-76), we used negative binomial regression to assess this outcome. This symptom model included a PTSD genetic risk score, demographic factors, trauma exposures, current insomnia, current depression, concussion history, and attention-deficit disorder, expressed as incident rate ratios (IRR), which is an estimate of one-unit increase in PTSD severity, given other variables are held constant. Variables in the final model included age and sex (both p<0.001), PTSD genetic risk (IRR=1.02, p=0.028), warzone tours (IRR=0.94, p=0.003), childhood abuse (IRR=1.50, p<0.0001), current depression (IRR=1.89, p<0.0001), current insomnia (IRR=2.58, p<0.0001), low social support (IRR=1.19, p<0.0001), attention-deficit disorder (IRR=1.51, p<0.0001), agreeable personality (IRR=0.77, p<0.0001), and concussion (IRR=1.38, p<0.0001). Significant interactions were detected for combat and lifetime trauma exposure by PTSD genetic risk (both p<0.0001), suggesting that the impact of trauma exposures on PTSD severity was lower when the PTSD genetic risk was higher. CONCLUSION: Both warzone and non-warzone factors predicted current PTSD symptoms among veterans, including a PTSD genetic risk score. Interaction effects were detected for combat exposure and lifetime trauma by genetic risk score for PTSD symptoms, suggesting that PTSD symptom manifestation was more dependent on PTSD risk variants than the level of trauma or combat exposure. This suggests that controlling for other factors, the absence of genetic risk variants may confer PTSD resilience. Further research is planned.

The impact of repression, hostility, and post-traumatic stress disorder on all-cause mortality: a prospective 16-year follow-up study.

A common assumption is that repression of traumatic memories is harmful to health. To assess this, we examined all-cause mortality among a national random sample of 4462 male US Army veterans evaluated in 1985 and followed up in 2000. Our hypothesis was that repression on the Welsh R scale would be associated with increased future mortality. We also expected to find a repression x post-traumatic stress disorder (PTSD) interaction effect. Multivariate Cox regression results for all veterans and for theater veterans (Vietnam service) and era veterans (no Vietnam service) separately, revealed that while PTSD was significant in all models, no main or interaction effect was found for repression. In addition, for era veterans, higher repression symptoms were protective for future mortality (HR = 0.95, p = 0.03). For hostility symptoms, although no interaction effect was found by PTSD, a positive main effect was detected for hostility, but only for theater veterans (HR = 1.04, p = 0.034). Disease-specific results were nonsignificant. Similar to a recent study, we also found that repression symptoms were negatively correlated with PTSD symptoms (r = -0.109, p < 0.001), suggesting repression might be protective. Our study found no evidence that repression had an adverse health impact on men exposed to psychological trauma.

Measuring mental health following traumatization: psychometric analysis of the Kuwait Raha Scale using a random national household data set.

The authors report on the psychometric properties of the Kuwait Raha Scale (KRS), a measure developed to assess well-being among Kuwaitis. Specific aims of the study were to (a) evaluate competing models of the latent structure of the KRS using exploratory factor analysis and identify the best model, (b) compare the model developed from a nationally representative sample with the initial model reported with Kuwaiti undergraduate students, and (c) assess the discriminant validity of the KRS with the General Health Questionnaire (GHQ). Factor analysis suggested that a 5-factor model best suited the data, whereas the development of the KRS indicated a 4-factor model. Differences in the latent structure found between the current study and the original examination of the KRS factor structure may be attributed to the demographics of the samples used in the 2 studies. Whereas the earlier study used a sample of undergraduate college students, the current study acquired a nationally representative sample of the Kuwaiti population. Discriminant validity of the KRS with the GHQ indicated that the KRS and the GHQ measure different dimensions of health. Implications for theory and research are discussed, with particular attention to overcoming the challenges confronting the meaning and measurement of well-being in developing countries and stimulating interdisciplinary research.

The Framework of Historical Oppression, Resilience and Transcendence to Understand Disparities in Depression Amongst Indigenous Peoples.

Given chronic experiences of historical oppression, Indigenous peoples tend to experience much higher rates of depression than the general US population, which then, drives disproportionately high rates of suicide and other health disparities. The purpose of this research was to examine the core components of the culturally grounded Framework of Historical Oppression, Resilience, and Transcendence as they relate to depressive symptoms experienced by Indigenous peoples. As part of a larger convergent mixed-methods study, in this quantitative survey component, we utilised data from a sample of 127 Indigenous adults across two Southeastern US tribes. Regression analysis results signified support for the framework, indicating that historical oppression and proximal stress (daily stressors and lower incomes) were risk factors, whereas family resilience and life satisfaction (a measure of transcendence) were protective factors related to depressive symptoms. The results provide a foundation for future research to build upon in identifying culturally relevant risk and protective factors to ameliorate depression and other health disparities.