Criminal legal involvement among recently separated veterans: Findings from the LIMBIC study.

OBJECTIVE: This study investigated individual-level and neighborhood-level predictors of criminal legal involvement of veterans during the critical transition period from military to civilian life. HYPOTHESES: We hypothesized that substance use, mental health, and personality disorders will increase the incidence of criminal legal involvement, which will be highest among veterans living in socioeconomically disadvantaged neighborhoods after military discharge. METHOD: We analyzed data from a longitudinal cohort study of 418,624 veterans who entered Department of Veterans Affairs (VA) health care after leaving the military. Department of Defense (DoD) data on clinical diagnoses, demographics, and military history were linked to VA data on neighborhood of residence and criminal legal involvement. RESULTS: Criminal legal involvement in the 2 years following military discharge was most strongly predicted by younger age, substance use disorder, and being male. Other predictors included the military branch in which veterans served, deployment history, traumatic brain injury, serious mental illness, personality disorder, having fewer physical health conditions, and living in socioeconomically disadvantaged neighborhoods. These factors combined in multivariable analysis yielded a very large effect size for predicting criminal legal involvement after military separation (area under the curve = .82). The incidence of criminal legal involvement was 10 times higher among veterans with co-occurring substance use disorder, serious mental illness, and personality disorder than among veterans with none of these diagnoses, and these rates were highest among veterans residing in more socioeconomically disadvantaged neighborhoods. CONCLUSIONS: To our knowledge, this is the largest longitudinal study of risk factors for criminal legal involvement in veterans following military discharge. The findings supported the hypothesis that veterans with co-occurring mental disorders living in socioeconomically disadvantaged neighborhoods were at higher risk of criminal legal involvement, underscoring the complex interplay of individual-level and neighborhood-level risk factors for criminal legal involvement after veterans leave the military. These results can inform policy and programs, such as the DoD Transition Assistance Program (TAP) and the VA Military to Civilian Readiness Pathway program (M2C Ready), to enhance community reintegration and prevent criminal legal involvement among veterans transitioning from military to civilian life. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Examination of PTSD symptom networks over the course of cognitive processing therapy.

OBJECTIVES: Cognitive processing therapy (CPT) is an evidence-based psychotherapy for posttraumatic stress disorder (PTSD); however, little is known about how interrelationships between PTSD symptoms change over the course of treatment. The current study examined baseline, midtreatment, and posttreatment PTSD symptom networks during CPT for PTSD. METHOD: Adults with PTSD (n = 107) received 12 sessions of CPT as part of a randomized trial. Self-reported PTSD symptoms were assessed at pretreatment, midtreatment, and posttreatment, and network analysis was used to examine the interrelationships between symptoms at these three timepoints. Linear regression was conducted to examine whether any baseline symptoms or midpoint symptoms predicted overall treatment change. RESULTS: In the baseline PTSD network, feelings of detachment and feeling upset at reminders of the trauma were central to the symptom network. These symptoms were no longer central at midtreatment, possibly suggesting that CPT quickly reduces the importance of these symptoms. These findings were consistent with regression results that, after accounting for multiple comparisons, high baseline scores of feeling upset at trauma reminders predicted later treatment change. At the conclusion of treatment, strong negative emotions were the most central symptom and may be most important in maintaining or lowering other PTSD symptoms at the conclusion of treatment. CONCLUSIONS: Though replication is necessary, these findings offer insights into identifying which symptoms may be most predictive of treatment outcomes and the course by which CPT reduces PTSD symptoms. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Posttraumatic stress symptoms, posttraumatic growth, and personality factors: A network analysis.

BACKGROUND: After experiencing a traumatic event, two possible outcomes are experiencing positive changes, such as posttraumatic growth (PTG), and/or experiencing distress in the form of posttraumatic stress symptoms (PTSS). These constructs are not mutually exclusive; those who experience PTSS may concurrently or at a later date likewise undergo PTG. Pretrauma factors, such as personality as measured by the Big Five Inventory (BFI), can interact with both PTSS and PTG. METHODS: The present study utilized Network theory to examine the interactions between PTSS, PTG, and personality in 1310 participants. Three networks were computed (PTSS, PTSS/BFI, PTSS/PTG/BFI). RESULTS: Within the PTSS network, strong negative emotions emerged as the strongest influence on the network. Again, in the PTSS and BFI network, strong negative emotions exerted the strongest overall influence in addition to bridging the PTSS and personality domains. In the network with all variables of interest, the PTG domain of new possibilities was the strongest overall influence on the network. Specific relationships between constructs were identified. LIMITATIONS: Limitations of this study include the cross-sectional design and utilization of a sub-threshold PTSD, non-treatment seeking sample. CONCLUSIONS: Overall, nuanced relationships between variables of interest were identified, informing personalized treatment and furthers our understanding of both positive and negative responses to trauma. As the primary influence across two networks, the experience of strong negative emotions appears to be central to the subjective experience of PTSD. This may indicate a need to modify present treatments for PTSD, which conceptualize PTSD as a primarily fear-based disorder.

Food Insecurity and Suicidal Ideation: Results from a National Longitudinal Study of Military Veterans.

OBJECTIVE: Research examining social determinants of suicide risk in veterans suggests a potential link between food insecurity and subsequent suicidal ideation in military veterans. The objective of this study is to investigate, if and how, food insecurity predicts subsequent suicidal ideation in a nationally representative longitudinal survey of veterans. METHODS: A national longitudinal survey was analyzed of participants randomly drawn from over one million U.S. military service members who served after September 11, 2001. N = 1,090 veterans provided two waves of data one year apart (79% retention rate); the final sample was representative of post-9/11 veterans in all 50 states and all military branches. RESULTS: Veterans with food insecurity had nearly four times higher suicidal ideation one year later compared to veterans not reporting food insecurity (39% vs 10%). In multivariable analyses controlling for demographic, military, and clinical covariates, food insecurity (OR = 2.37, p =.0165) predicted suicidal ideation one year later, as did mental health disorders (OR = 2.12, p = .0097). Veterans with both food insecurity and mental health disorders had a more than nine-fold increase in predicted probability of suicidal ideation in the subsequent year compared to veterans with neither food insecurity nor mental health disorders (48.5% vs. 5.5%). CONCLUSION: These findings identify food insecurity as an independent risk marker for suicidal ideation in military veterans in addition to mental disorders. Food insecurity is both an indicator of and an intervention point for subsequent suicide risk. Regularly assessing for food insecurity, and intervening accordingly, can provide upstream opportunities to reduce odds of suicide among veterans.HIGHLIGHTSMilitary veterans with food insecurity were at elevated risk of suicidal ideation.Veterans with mental health disorders had higher odds of suicidal ideation one year later.Food insecurity plus mental health disorders led to a substantial increase in suicidal ideation.

Treatment outcome of posttraumatic stress disorder: A white matter tract analysis.

Despite the development of empirically supported treatments for posttraumatic stress disorder (PTSD), many individuals remain symptomatic following therapy or dropout prematurely. Neuroimaging studies examining PTSD treatment outcome may offer valuable insights into possible mechanisms that may impact treatment efficacy. To date, few studies of PTSD have used neuroimaging to examine symptom change following completed treatment, and most have focused on gray matter. Studies of white matter are equally important, as changes in white matter integrity (WMI) are connected to a host of detrimental outcomes. The current study examined symptom change of 21 women with PTSD as a result of interpersonal violence who received baseline diffusion tensor imaging (DTI) scans and completed 12 weeks of Cognitive Processing Therapy (CPT). After controlling for baseline PTSD severity, fractional anisotropy (FA) in the left internal capsule, posterior limb of the internal capsule, left cingulate gyrus, superior longitudinal fasciculus, and splenium of the corpus callosum was predicted by PTSD symptom change. Results contribute to understanding neural changes within therapy and may assist in predicting individual treatment response. Namely, by identifying areas potentially impacted by PTSD treatment, future studies may be able to connect the function of these white matter areas to better predict patient PTSD treatment outcome.

A network analysis of risk factors for suicide in Iraq/Afghanistan-era veterans.

Suicidal ideation (SI) is a prevalent issue in the veteran population. A number of factors have been identified as risk factors for suicidal ideation (SI) in veterans, including suicide attempts, depression, posttraumatic stress disorder (PTSD), and drug use. However, clinicians' ability to predict suicide is poor, particularly given the interplay between various factors such as previous suicide attempts. As such, there is a gap in our knowledge of which factors most saliently predict suicide risk and which should be targets for interventions designed to lower SI. Network analysis, a method allowing for an examination of how variables relate within the context of a network of factors, may bridge this gap by simultaneously evaluating the interrelationships between risk factors for suicide in veterans. Current study used network analysis and data from 2268 Iraq/Afghanistan-era military veterans to examine the relationships between suicidal ideation and several factors related to suicide risk, such as past suicide attempts, PTSD symptoms, depression, drug use, trauma exposure. Partial correlation network results showed suicidal ideation to be strongly related to depression, with smaller connections to past suicide attempts and anger. Additionally, past suicide attempts was strongly related to history of childhood trauma and weakly related to problematic drug use and PTSD symptoms. These results offer valuable information for both predicting suicide risk and differentiating targets for interventions lowering suicide risk in veterans.

The effects of bullying in depression on white matter integrity.

Individuals with elevated symptoms of depression exhibit alterations in white matter integrity, including lower fractional anisotropy (FA) evident on diffusion tensor imaging (DTI). Similarly, individuals with a history of early life stress (ELS) exhibit lower FA in the white matter independent of concurrent depression. Prior studies have not determined whether the neuroimaging signature of comorbid ELS and adult depression differs from the pattern of brain white matter changes associated with depression in the absence of self-reported ELS. The current study examined FA in multiple white matter tracts in 186 adults (93 males; 93 females) with a current diagnosis of major depressive disorder, including 88 who reported a history of bullying before the age of 18 (43 males; 45 females). All patients were antidepressant medication free at the time of testing. After adjusting for demographics and other ELS subtypes, participants with a history of bullying exhibited increased FA in the right medial lemniscus (p =.039) and left posterior corona radiata (p =.008) compared to participants with depression but no self-reported history of bullying. Both groups endorsed similar levels of depression. Group differences were most pronounced among individuals who endorsed bullying in late adolescence (14-17 years of age). Results suggest bullying in late adolescence is uniquely related to abnormal brain microstructure among individuals with current diagnoses of depression, possibly due to an overactive fear response. Further work is needed to differentiate why ELS within bullying is associated with higher FA.