From posttraumatic stress symptoms to suicidal ideation among military veterans: Pathways founded on meaning in life and gratitude.

Military veterans experience higher rates of suicidal ideation compared to nonveteran populations. Importantly, suicidal ideation often precedes and predicts fatal and nonfatal suicide attempts, and thus it is critical to better understand factors that increase risk for suicidal ideation to inform suicide prevention efforts in this population. One key predictor of suicidal ideation is exposure to traumatic experiences and their sequelae, particularly posttraumatic stress symptoms (PTSS). However, little work has explored how deficits in well-being contribute to this association among veterans. We tested two aspects of well-being-meaning in life and gratitude-as potential mechanisms underlying the pathway from PTSS to suicidal ideation among 7,388 men and women veterans who recently separated from service. A parallel mediation analysis revealed significant paths from more severe PTSS to more frequent suicidal ideation through diminished meaning in life, B = 0.005, SE = 0.001, 95% CI [0.004, 0.007], and gratitude, B = 0.001, SE = 0.001, 95% CI [< 0.001, 0.002]. Gender differences were also observed. Although the results related to meaning in life appeared to replicate across gender, pathways involving gratitude differed among men and women. Overall, our findings suggest that helping veterans build meaning and appreciation in everyday life may be a proactive and holistic approach to suicide prevention.

How well can U.S. military veterans' suicidal ideation be predicted from static and change-based indicators of their psychosocial well-being as they adapt to civilian life?

BACKGROUND: Identifying predictors of suicidal ideation (SI) is important to inform suicide prevention efforts, particularly among high-risk populations like military veterans. Although many studies have examined the contribution of psychopathology to veterans' SI, fewer studies have examined whether experiencing good psychosocial well-being with regard to multiple aspects of life can protect veterans from SI or evaluated whether SI risk prediction can be enhanced by considering change in life circumstances along with static factors. METHODS: The study drew from a longitudinal population-based sample of 7141 U.S. veterans assessed throughout the first three years after leaving military service. Machine learning methods (cross-validated random forests) were applied to examine the predictive utility of static and change-based well-being indicators to veterans' SI, as compared to psychopathology predictors. RESULTS: Although psychopathology models performed better, the full set of well-being predictors demonstrated acceptable discrimination in predicting new-onset SI and accounted for approximately two-thirds of cases of SI in the top strata (quintile) of predicted risk. Greater engagement in health promoting behavior and social well-being were most important in predicting reduced SI risk, with several change-based predictors of SI identified but stronger associations observed for static as compared to change-based indicator sets as a whole. CONCLUSIONS: Findings support the value of considering veterans' broader well-being in identifying individuals at risk for suicidal ideation and suggest the possibility that well-being promotion efforts may be useful in reducing suicide risk. Findings also highlight the need for additional attention to change-based predictors to better understand their potential value in identifying individuals at risk for SI.

Meaning in life following service among post-9/11 military veterans: A latent growth mixture model analysis.

Meaning in life refers to the "sense made of, and significance felt regarding, the nature of one's being and existence." Meaningful living promotes well-being, resilience, and personal growth. Yet, much remains unknown about how meaning changes over time and determinants of meaning, particularly during major life transitions. We identified distinct trajectories of meaning using latent growth mixture models and examined prospective predictors of class membership in a military veteran cohort assessed at multiple time points throughout the first 3 years after leaving service. Three trajectories were identified: consistently high meaning (89.5%; n = 7025), diminishing meaning (6.1%; n = 479), and strengthening meaning (4.4%; n = 348). Veterans with greater posttraumatic stress symptoms, depression symptoms, and moral injury experienced increased odds of a less adaptive trajectory (i.e. diminishing and/or strengthening vs. consistently high meaning), whereas veterans who reported greater psychological resilience, community relationship satisfaction, and intimate relationship satisfaction experienced lower odds of a less adaptive trajectory. Several gender differences were also observed. Results provide insight into veteran subgroups that are more likely to experience lower meaning after leaving military service and thus may benefit from additional support to reduce their risk for poor longer-term health and well-being outcomes.

Contribution of veterans' initial post-separation vocational, financial, and social experiences to their suicidal ideation trajectories following military service.

BACKGROUND: Veterans' success with navigating the challenges of transition from military service may contribute to their risk for suicidal outcomes. The concept of well-being can help to conceptualize and assess successful navigation of reintegration challenges and may serve as an optimal target for public health-oriented suicide prevention. METHODS: The relationship between US veterans' psychosocial well-being and experiences of suicidal ideation (SI) during the first 3 years following military separation was evaluated using multinomial logistic regression predicting SI trajectories over time in a population-based, longitudinal, post-9/11 veteran cohort. At 3-months post-separation, veterans reported on their socio-material conditions, functioning, and satisfaction with respect to vocational, financial, and social domains. SI frequency was assessed at 3-, 9-, 15-, 21-, and 27-months post-separation using the Patient Health Questionnaire-9. RESULTS: Veterans' vocational, financial, and social well-being were associated with their SI trajectories, even after accounting for mental health. Socio-material conditions, functioning, and satisfaction all emerged as important predictors of SI trajectories, although results varied across domains. Effects were largest for social well-being. CONCLUSIONS: Suicide prevention efforts may benefit from a holistic approach that considers veterans' needs for support across their vocational, financial, and social well-being, inclusive of their socio-material conditions, functioning, and satisfaction within each domain.

The transition to civilian life: Impact of comorbid PTSD, chronic pain, and sleep disturbance on veterans' social functioning and suicidal ideation.

OBJECTIVE: Trauma-exposed veterans may be more likely to experience posttraumatic stress disorder (PTSD), chronic pain, and sleep disturbance together rather than in isolation. Although these conditions are independently associated with distress and impairment, how they relate to social functioning and suicidal ideation (SI) when experienced comorbidly is not clear. METHOD: Using longitudinal data on 5,461 trauma-exposed U.S. veterans from The Veterans Metrics Initiative study and self-reported disorders, we assessed (a) the extent to which PTSD co-occurs with sleep disturbance and chronic pain (CP); (b) the relationship of PTSD in conjunction with sleep disturbance and chronic pain with later social functioning and SI; and (c) the extent to which social functioning mediates the impact of multimorbidity on SI. RESULTS: At approximately 15 months postseparation, 90.5% of veterans with probable PTSD also reported sleep disturbance and/or CP. Relative to veterans without probable PTSD, veterans with all 3 conditions (n = 907) experienced the poorest social functioning (B = -.56, p < .001) and had greater risk for SI (OR = 3.78, p < .001); Social functioning partially mediated the relationship between multimorbidity and SI. However, relative to those with PTSD alone, sleep disturbance and CP did not confer greater risk for SI. CONCLUSIONS: Although these findings underscore the impact of PTSD on functioning and SI, they also highlight the complexity of multimorbidity and the importance of bolstering social functioning for veterans. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Veterinary medical student perceptions of companion animal primary care as a career choice over an academic year.

Despite companion animal primary care being the most common career choice for veterinarians, relatively little is known about students' perception of this career choice. In this study, the authors examined students' (233 at Time 1 and 119 at Time 2) perceptions of careers in companion animal primary care and whether perceptions changed over the course of an academic year or differed by year in veterinary school. The study was conducted by an online questionnaire sent to the student email listserv and the results analyzed by Mixed ANOVAs for each perception outcome. The study concluded that a majority of veterinary students have companion animal primary care as their preferred career choice and have a positive perception of it as a career choice. This positive perception increased over the course of an academic year, but did not differ significantly by year in school. First year students had a decrease in perception of level of training over time. This study sets a baseline for students' perceptions of companion animal primary care as a career choice at one college of veterinary medicine.

Strengths and vulnerabilities: Comparing post-9/11 U.S. veterans' and non-veterans' perceptions of health and broader well-being.

Background: Prior research has examined how the post-military health and well-being of both the larger veteran population and earlier veteran cohorts differs from non-veterans. However, no study has yet to provide a holistic examination of how the health, vocational, financial, and social well-being of the newest generation of post-9/11 U.S. military veterans compares with their non-veteran peers. This is a significant oversight, as accurate knowledge of the strengths and vulnerabilities of post-9/11 veterans is required to ensure that the needs of this population are adequately addressed, as well as to counter inaccurate veteran stereotypes. Methods: Post-9/11 U.S. veterans' (N = 15,160) and non-veterans' (N = 4,533) reported on their health and broader well-being as part of a confidential web-based survey in 2018. Participants were drawn from probability-based sampling frames, and sex-stratified weighted logistic regressions were conducted to examine differences in veterans' and non-veterans' reports of health, vocational, financial, and social outcomes. Results: Although both men and women post-9/11 veterans endorsed poorer health status than non-veterans, they reported greater engagement in a number of positive health behaviors (healthy eating and exercise) and were more likely to indicate having access to health care. Veterans also endorsed greater social well-being than non-veterans on several outcomes, whereas few differences were observed in vocational and financial well-being. Conclusion: Despite their greater vulnerability to experiencing health conditions, the newest generation of post-9/11 U.S. veterans report experiencing similar or better outcomes than non-veterans in many aspects of their lives. Findings underscore the value of examining a wider range of health and well-being outcomes in veteran research and highlight a number of important directions for intervention, public health education, policy, and research related to the reintegration of military veterans within broader civilian society.

The First Year After Military Service: Predictors of U.S. Veterans' Suicidal Ideation.

INTRODUCTION: Little is known about predictors of military veterans' suicidal ideation as they transition from service to civilian life, a potentially high-risk period that represents a critical time for intervention. This study examined factors associated with veterans' suicidal ideation in the first year after military separation. METHODS: A national sample of U.S. veterans (N=7,383) from The Veterans Metrics Initiative Study reported on their mental health, psychosocial well-being, and demographic/military characteristics in an online survey at 3 and 9 months after separation. Cross-validated random forest models and mean decrease in accuracy values were used to identify key predictors of suicidal ideation. Bivariate ORs were calculated to examine the magnitude and direction of main effects associations between predictors and suicidal ideation. Data were collected in 2016/2017 and analyzed in 2021. RESULTS: In the first year after separation, 15.1% of veterans reported suicidal ideation. Endorsing depression symptoms and, to a lesser extent, identifying oneself as experiencing depression, were most predictive of suicidal ideation. Other psychopathology predictors included higher anxiety and posttraumatic stress disorder symptoms. Psychosocial well-being predictors included higher health satisfaction and functioning, community satisfaction and functioning, and psychological resilience. Logistic models performed similarly to random forest models, suggesting that relationships between predictors and suicidal ideation were better represented as main effects than interactions. CONCLUSIONS: Results highlight the potential value of bolstering key aspects of military veterans' mental health and psychosocial well-being to reduce their risk for suicidal ideation in the first year after separation. Findings can inform interventions aimed at helping veterans acclimate to civilian life.

Trajectories of suicidal ideation following separation from military service: Overall trends and group differences.

BACKGROUND: Although the transition out of military service is a high-risk time for suicidal ideation (SI), a paucity of research examines the development of SI during this transition process and veteran subgroups at risk for SI as they readjust to civilian life. METHODS: A population-based, longitudinal post-9/11 veteran cohort reported SI frequency at 3, 9, 15, 21, and 27 months post-separation using the Patient Health Questionnaire-9. We identified distinct trajectories of SI over time (i.e., classes) using latent class growth analysis and examined demographic and military service predictors of class membership overall and by gender using multinomial logistic regression. RESULTS: Four SI trajectories that were similar across genders were identified: resilient (90.1%), delayed onset (5.0%), remitting (2.7%), and chronic (2.2%). Younger age, minority race/ethnicity, medical and other (vs. honorable) separation types, and Veterans Health Administration service utilization were associated with increased odds of assignment to a higher-risk trajectory (delayed onset, remitting, and/or chronic vs. resilient), whereas continued service in the National Guard/Reserves and officer rank was associated with lower odds of assignment to a higher-risk trajectory. CONCLUSIONS: Findings regarding veterans at greatest risk for SI following military separation can inform targeted assessment and early intervention efforts.

Changes in the health and broader well-being of U.S. veterans in the first three years after leaving military service: Overall trends and group differences.

OBJECTIVES: Scholars have theorized that the initial period after military discharge may be a particularly vulnerable time for veterans. Yet, several recent studies raise the prospect that risk for poor adjustment may actually increase rather than decrease over time. The current study examined whether the U.S. military veteran population experiences improvements or declines in their health and broader well-being during the first three years after leaving military service and documented differences based on gender, military rank, and warzone deployment history. METHODS: A population-based sample of 3733 newly separated veterans completed a survey within three months of separation (Fall 2016), followed by five additional surveys at six-month intervals. Weighted multilevel logistic regressions were conducted to examine changes in the proportion of veterans reporting good health and broader well-being over time. RESULTS: Most aspects of veterans' health and broader well-being worsened over time, with a noteworthy increase in reporting of mental health conditions and a decline in veterans' community involvement. Declines in the proportion of veterans reporting good health and well-being were most notable for women, with smaller differences observed for other subgroups. CONCLUSIONS: The finding that veterans experienced worsening health and broader well-being over time highlights the need for enhanced prevention and early intervention efforts to mitigate these declines. Findings also point to the importance of attending to the unique readjustment concerns of female veterans and other at-risk subgroups.

Implementation and outcomes of the Balanced Living with Diabetes program conducted by Cooperative Extension in rural communities in Virginia.

INTRODUCTION: Adult onset diabetes is a significant health issue in rural communities that are disproportionately suffering from the health, social and financial costs of the disease. Despite this, over half of rural counties in the USA lack access to diabetes self-management programs, which are effective at improving diabetes management. The Cooperative Extension System (CES) is a nationwide education network that provides research-based information and programs in nearly 3000 counties in the USA to improve the health and wellbeing of rural and urban communities. This study evaluated the implementation and outcomes of a lifestyle management program, Balanced Living with Diabetes (BLD) conducted by community-based educators who are part of the CES in rural Virginia, to address the gap in diabetes education in these communities. BLD is grounded in social cognitive theory and has shown efficacy to modify dietary and physical activity behaviors resulting in improved glycemic control in people with type 2 diabetes. METHODS: The study evaluated the implementation and effectiveness of BLD programs conducted by the CES in 16 rural counties over 2 years. Program adoption, reach, context, and barriers and facilitators to implementation were evaluated through program outcome data and extension educator interviews. Program outcomes included change in weight, glycosylated hemoglobin (A1C), diabetes knowledge, self-management practices, diet and physical activity behaviors, and self-efficacy from baseline to 12-week assessment. RESULTS: Extension educators conducted 30 programs, reaching 290 residents, with a 58% mean retention rate. The program resulted in a significant increase in diabetes and food knowledge, fruit, vegetable, and whole grain intake, use of the plate method, exercise, and diabetes management self-efficacy. A1C decreased significantly in participants with diabetes (mean reduction=0.345±1.013; p=0.001). The program was conducted twice in 11 counties, and once in five counties. Barriers to program adoption in the five counties included limited community interest, competing program priorities of the extension educator, and loss of extension personnel to conduct the program. Participant communication materials and systems to enhance program sustainability were developed in response to educator feedback. Process evaluation indicated that the program was highly acceptable to extension educators and program participants. CONCLUSION: The CES is an effective network for implementation of diabetes lifestyle-management programs in underserved communities, and the BLD program is effective at increasing lifestyle behaviors and self-efficacy that improve glycemic control in people with type 2 diabetes. Collaboration by Virginia's CES with a variety of community partners, including healthcare and social service providers, increases the reach and sustainability of extension diabetes programs. The CES in the USA is well positioned to fill the gap in diabetes education in rural communities as part of a chronic care model.

Contraceptive Needs Among Women Recently Incarcerated at a Rural Appalachian Jail.

Background: Incarceration is associated with negative sexual and reproductive health outcomes. We examined contraceptive needs among women incarcerated at a rural Appalachian jail with emphasis on pregnancy history, recent contraceptive use, and current and near-future contraceptive needs. Materials and Methods: A survey was administered to newly incarcerated women at a jail in Southwest Virginia. It included questions about (1) prior pregnancies; (2) pregnancy intentions, contraceptive use, and sexual activity in the 3 months before jail; (3) unprotected sex in the 5 days before jail; (4) interest in contraceptive education and access during incarceration; and (5) post-release sexual activity, pregnancy, and contraceptive plans. Results: One hundred ninety-three women completed surveys. Analyses focused on the 95 at risk for pregnancy. Fifty-eight percent of prior pregnancies on which women provided intention information were unintended, with 74% of respondents reporting at least 1 such pregnancy. Ninety-four percent of women reported vaginal intercourse during the 3 months before jail. Only 46% of those who did not want to get pregnant reported consistent contraceptive use. Condoms and withdrawal were the most common methods used. Forty percent of women were eligible for emergency contraception (EC). Most (78%) participants anticipated sex with a man within 6 months of release, and most (63%) did not want to become pregnant within a year of release. Almost half (47%) expressed interest in receiving birth control while in jail. Conclusions: Results support the need to offer women EC on incarceration, family planning education during confinement, and effective birth control before release.

Impact of Flexible Work Arrangements, Self-Efficacy, and Barriers on Daily Physical Activity Among University Staff.

BACKGROUND: Little is known about the link between flexible work arrangements and health behaviors, such as physical activity. This study aimed to explore how self-efficacy and daily barriers to physical activity influence daily levels of physical activity on workdays when university staff members used a flexible work arrangement (flextime or telework). METHODS: Full-time university staff employees (N = 61, mean age = 41; 89% female) participated in this daily diary study. Participants completed an initial survey followed by daily surveys over the course of one workweek, resulting in 281 diary days. RESULTS: The most frequently reported barriers to physical activity were as follows: lack of time, feeling tired, and not enough motivation. Multilevel models revealed that as the number of barriers increased, minutes of physical activity significantly decreased. Self-efficacy was not significantly related to daily physical activity. Participants reported fewer minutes of physical activity on flextime workdays compared to days when a flexible work arrangement was not used (ie, traditional workday). Daily use of a flexible work arrangement did not moderate the association between barriers and physical activity. CONCLUSIONS: This study illustrated the influence of daily barriers and flextime workdays on physical activity levels, which can inform workplace health programs for university staff.

Identifying factors that contribute to military veterans' post-military well-being.

Prior research has examined the independent effects of demographic and military characteristics, trauma history, and coping resources on military veterans' health. However, there is limited knowledge of how these factors intersect with one another and with veterans' health to impact their broader well-being as they readjust to civilian life. Data for this study were drawn from a longitudinal investigation of the health and broader well-being of U.S. veterans (N = 7150) who had recently left military service. Machine learning analyses (random forests of regression trees) were used to examine how factors assessed shortly after military separation were associated with veterans' well-being approximately a year later. Veterans who endorsed the combination of low depression, high social support, and high psychological resilience were most likely to report high well-being a year later. Neither demographic and military characteristics nor trauma history emerged as strong predictors of veterans' well-being when considered in the context of other factors. Although most predictors were similar for women and men, depression was a stronger predictor of women's well-being. Results highlight the importance of screening for and intervening with veterans who report high depression, low social support, and low psychological resilience when leaving military service. These findings can inform efforts to promote veterans' post-military well-being.

Sleep Quality and Sleepiness Among Veterinary Medical Students Over an Academic Year.

Good sleep health is a key component to good personal well-being. It has been postulated that veterinary students have poor sleep health, but few measurements have been undertaken. This study measured Pittsburgh Sleep Quality Index and Epworth Sleepiness Scale values at multiple points throughout an academic year for students in a veterinary medical curriculum. Students were found to have overall poor sleep quality and above average to excessive daytime sleepiness. Further investigation is necessary to determine specific causes as well as what action can be taken to improve student sleep health.

Implications of parents' work travel on youth adjustment.

Guided by ecological, work-family spillover and crossover frameworks, this study examined mechanisms linking parental work travel (i.e., nights per year) to youth adjustment (i.e., externalizing and internalizing behaviours) through youth's perceptions of parenting (i.e., knowledge, solicitation) with traveller and youth gender as moderators in a sample of 78 children in 44 two-parent families residing in the United States. The findings from multilevel analyses suggested that mothers' travel nights predicted lower levels of maternal knowledge, with variation by traveller and youth gender. Mothers' and fathers' work travel and perceived parenting were predictors of youth's externalizing behaviours, whereas only fathers' work travel and perceived parenting were predictors of youth's internalizing behaviours. Tests of indirect effects indicated that maternal work travel linked to youth's externalizing behaviours through youth's perceptions of maternal knowledge. These findings add to our limited understanding of work-family issues for parents who have the unique work demand of frequently travelling.