Military-related experiences and late-life depressive symptomatology among Japanese-American world war II veterans.

Objectives: To examine military service-related variables and late-life depressive symptomatology among older Japanese-American males.Method: This study is a secondary data analysis of a longitudinal, community-based study. A sample of 2669 participants (771 World War II veterans, 1898 civilians) was drawn from the Honolulu-Asia Aging Study. Depressive symptoms were assessed twice across a 9-year period with the Center for Epidemiologic Studies-Depression scale. Covariates included sociodemographic, physical health, health behavior, and psychosocial variables. Combat exposure and symptomatology were examined among a subset of 426 veterans. Cross-sectional and longitudinal designs were analyzed with linear regression.Results: Veterans and civilians did not differ in depression scores. Baseline depression scores significantly predicted follow-up depression scores. For the full sample, lower ratings of quality of life satisfaction, daily activity control and general health were associated with higher depression scores both cross-sectionally and longitudinally. Among veterans, light combat exposure was marginally associated with lower depression scores and longitudinally, previous depression scores and poorer health ratings were significant predictors of depression scores.Conclusion: Results suggest that military service does not affect late-life depressive symptomatology. However, combat exposure may play a marginal role in increased symptoms. Reasons for results include the possibility that other factors are more relevant to late-life depression, symptomatology naturally decreasing over time, or type of combat exposure measurement. Results expand literature by examination of an ethnoracial group not studied often and longitudinal examination of late-life depressive symptoms within a military-related context. Stakeholders should be knowledgeable of the distinct issues presented when serving aging veterans.

TELEMEDICINE VERSUS IN-PERSON DELIVERY OF COGNITIVE PROCESSING THERAPY FOR WOMEN WITH POSTTRAUMATIC STRESS DISORDER: A RANDOMIZED NONINFERIORITY TRIAL.

BACKGROUND: This study examined the effectiveness of telemedicine to provide psychotherapy to women with posttraumatic stress disorder (PTSD) who might be unable to access treatment. Objectives were to compare clinical and process outcomes of PTSD treatment delivered via videoteleconferencing (VTC) and in-person (NP) in an ethnically diverse sample of veteran and civilian women with PTSD. METHODS: A randomized controlled trial of Cognitive Processing Therapy, an evidence-based intervention for PTSD, was conducted through a noninferiority design to compare delivery modalities on difference in posttreatment PTSD symptoms. Women with PTSD, including 21 veterans and 105 civilians, were assigned to receive psychotherapy delivered via VTC or NP. Primary treatment outcomes were changes in PTSD symptoms in the completer sample. RESULTS: Improvements in PTSD symptoms in the VTC condition (n = 63) were noninferior to outcomes in the NP condition (n = 63). Clinical outcomes obtained when both conditions were pooled together (N = 126) demonstrated that PTSD symptoms declined substantially posttreatment (mean = -20.5, 95% CI -29.6 to -11.4) and gains were maintained at 3- (mean = -20.8, 95% CI -30.1 to -11.5) and 6-month followup (mean = -22.0, 95% CI -33.1 to -10.9. Veterans demonstrated smaller symptom reductions posttreatment (mean = -9.4, 95% CI -22.5 to 3.7) than civilian women (mean = -22.7, 95% CI -29.9 to -15.5. CONCLUSIONS: Providing psychotherapy to women with PTSD via VTC produced outcomes comparable to NP treatment. VTC can increase access to specialty mental health care for women in rural or remote areas.

Psychopathy and Protective Behavioral Strategies: PBS Mediates the Relationships between Primary and Secondary Psychopathy and Alcohol Consumption and Problems.

Objective: The most common conceptualization of psychopathy is a two-factor model of primary psychopathy and secondary psychopathy. Primary psychopathy consists of interpersonally abusive behavior, and callousness. Secondary psychopathy includes impulsive and risky decision making. Past research has found that psychopathy is related to negative outcomes, including increased alcohol consumption and problems, and is inversely related to harm reduction behaviors. Protective behavioral strategies (PBS), behaviors designed to reduce alcohol consumption and associated problems, may mediate the relationship between psychopathy and alcohol pathology. The current study examined the relationship between psychopathy, each subtype of PBS use (serious harm reduction (SHR), manner of drinking (MD) and stopping/limiting drinking (SLD)), alcohol consumption, and alcohol problems.Method: Participants were n = 967 (61.22% female) college students. Participants completed measures assessing psychopathy, PBS use, alcohol consumption, and alcohol problems. A path analysis was conducted to examine the relationships between psychopathy, subtypes of PBS, and alcohol consumption and problems.Results: Results indicated an inverse relationship between primary psychopathy and both SHR PBS and MD PBS, while secondary psychopathy was inversely associated with all three PBS subtypes. SHR PBS was inversely associated with alcohol problems while MD PBS was inversely associated with alcohol consumption.Conclusion: These findings suggest specific PBS subtypes mediate the relationship between primary and secondary psychopathy and alcohol consumption and problems. It may be clinically pertinent to consider targeting PBS use, such as with motivational interviewing, when working with patients exhibiting psychopathy traits. Future research should consider these findings when examining alcohol use.

Effective prevention programming for reducing alcohol-related harms experienced by first year college students: Evaluation of the expectancy challenge alcohol literacy curriculum (ECALC).

Prevention programs may have contributed to modest declines in alcohol use among college students in recent years, but negative consequences continue to be pervasive. First year college students (FYCS) are particularly vulnerable, and there is clearly a need for more effective methods to reduce risk. Meta-analyses focused on expectancy challenge (EC) have found this approach to be effective, but "experiential" EC that includes a drinking exercise is not suitable for most FYCS, many of whom are underage. A non-experiential alternative, the Expectancy Challenge Alcohol Literacy Curriculum (ECALC), is practical for widespread implementation. ECALC has been effective with mandated students and members of fraternities, and in the present study, we focused on evaluating effects with FYCS. In a group randomized trial, 48 class sections of a course designed for FYCS received either ECALC or an attention-matched control presentation. ECALC was associated with significant changes on six expectancy subscales of the Comprehensive Effects of Alcohol Scale (CEOA). Structural equation modeling was used to examine the mediated effects of the intervention on alcohol-related harms via alcohol expectancies. There were significant indirect effects from condition to alcohol use (IND = -0.04, p <.001) and alcohol harms (IND = -0.07, p <.001). This model accounted for 54% of the variance in alcohol use and 46% of the variance in alcohol-related harms. These findings suggest ECALC is an effective, single session group-delivered program that can be incorporated into classroom curricula.

Effects of Military Service on Marital Stability Among World War II U.S. Veterans of Japanese Descent.

INTRODUCTION: This study had two goals. First, we investigated how World War II (WW II) military service impacted marital stability during men's young and middle adulthood in a large community sample of American men of Japanese descent. Second, within a subgroup of WW II veterans, we assessed how the level of combat exposure affected marital stability. MATERIAL AND METHODS: The Honolulu Heart Program and later Honolulu-Asia Aging Project were longitudinal, community-based studies of Japanese-American men living in Hawai'i. This study is a secondary data analysis of 1,249 male WW II veterans and 3,489 men of Japanese descent who were civilians during WW II, born 1910-1919, who completed interviews at the first (1965-1968) and third (1971-1975) exams. Data from a subsample of veterans who completed a military service interview during the sixth exam (1997-1999) also were used. In the first set of analyses, we compared veterans to civilians on three marital outcomes for ages 15-59: (1) likelihood of never marrying, (2) age at first marriage, and (3) likelihood of divorce. Next, we investigated the negative consequences of increasing combat exposure on the same marital outcomes. All analyses controlled for age in 1941 and occupation. RESULTS: Overall, 88% of the sample remained in their first marriage with no differences between veterans and civilians. We found no effects of military service on the timing of first marriages on the likelihood of divorce during young and middle adulthood. However, among those who had not married before WW II, veterans were significantly more likely to remain unmarried compared with civilians; odds ratio = 1.52 (1.10, 2.09). The level of combat exposure did not predict any of the three marital outcomes among WW II veterans. In fact, none of the other military service characteristics assessed (i.e., age of military induction, years of service, and service-connected disability) predicted marital outcomes. We found that age at the beginning of WW II impacted the timing and stability of marriage in both veterans and civilians. Finally, we identified cultural effects on the likelihood of marriage between Nisei and Kibei groups with Nisei men being less likely to marry. CONCLUSION: Similar to other groups in this era, long-term marriage with one partner was the norm for both veterans and civilians. For a small portion of American men of Japanese descent, military service seemed to impact the transition into marriage. However, we found no differences in the timing of marriage or the likelihood of divorce based on military service or level of combat exposure. While our findings are inconsistent with previous research on the impact of military service and combat exposure, much of that research was conducted with mainland veterans, usually of European descent. There appears to be little long-term disruption of life course events. Results highlight the importance of studying diverse groups of veterans to understand how experiences in the military interact with pre-military factors in defining long-term responses to military service.

Predictors of differential PTSD treatment outcomes between veteran and civilian women after cognitive processing therapy.

OBJECTIVE: This study used data from a recent randomized clinical trial (RCT) that found differences between women veterans and civilians in posttraumatic stress disorder (PTSD) treatment response, with civilians demonstrating greater improvement than did veterans. Despite having similar PTSD severity scores at baseline, veterans scored roughly 18 points higher than civilians did on the Clinician-Administered PTSD Scale (CAPS) at posttreatment (p < .01). This study sought to identify the clinical and treatment variables that were associated with the differential response to treatment demonstrated by the women in the RCT. METHOD: Veteran (n = 21) and civilian (n = 105) women with PTSD received cognitive processing therapy (CPT) for PTSD. These secondary data analyses used structural equation modeling to investigate the role of 7 clinical and treatment variables to explain the reduced treatment response to CPT in veterans compared to civilians. RESULTS: Using structural equation modeling, we found that differences in CAPS scores at posttreatment were largely mediated by negative posttraumatic cognitions, as measured by the Posttraumatic Cognition Inventory (PTCI). Although veterans and civilians had similar PTCI scores at baseline, civilians had significantly lower PTCI scores at posttreatment, which predicted lower CAPS scores at posttreatment. This mediation appeared to be at least in part explained by lower treatment expectancies by veterans compared to civilians. CONCLUSIONS: Future research should be focused on further understanding and addressing these 2 treatment outcome predictors in an effort to reduce the gap in PTSD treatment outcomes between veterans and civilians. (PsycINFO Database Record