Sleep disturbances and suicide—New battles for veterans of U.S. wars in Afghanistan and Iraq: A retrospective review

In this article, we systematically reviewed 116 veterans’ medical records to explore the mitigating factors in sleep disturbance, polytrauma clinical triad (PCT), and suicide. We discovered that a particular nonaction (i.e., no standardized completion of sleep-disturbance screenings) had strong implications for resulting suicides among veterans with reported sleep disturbances, PCT, and suicidal ideations. This study provides strong propositions for the further study of this veteran cohort—Operations Enduring Freedom (OEF), Iraqi Freedom (OIF), and New Dawn (OND)—with regard to the impact of sleep disturbance on PCT and its relationship with suicide symptoms, ideation, and completion. The purpose of this study was to examine the outcomes of sleep disturbances on complex relationships among the three primary diagnoses—posttraumatic stress disorder (PTSD), traumatic brain injury (TBI), and chronic pain—that establish the PCT cluster. We identified that those diagnosed with sleep disturbances had increased suicidal ideations and rates of completed suicides. We analyzed these factors in veterans returning from the current wars in Afghanistan and Iraq. We hypothesized that (a) clinicians were not completing sleep-disturbance screenings as a standard practice for the OEF/OIF/OND veterans diagnosed with PCT who reported sleep disturbance concerns within the U.S. Department of Veterans Affairs; (b) if no sleep-disturbance screening instruments were used by clinicians, veterans would be at a greater risk of suicide completion.     

Rates and Correlates of Pathological Gambling Among VA Mental Health Service Users

The rate and correlates of diagnosed pathological gambling (PG) among mental health patients in the Veterans Health Administration, the only national system of mental health care, have not been studied. Using fiscal year 2009 (FY2009) VA administrative data, a case–control study compared those with an ICD code of 312.31 (PG) versus those without. The analytic group was limited to 1,102,846 Veterans Affairs (VA) specialty mental health (MH) services users because 94.5% of all those diagnosed with PG in the U.S. VA health system received such services. Chi-square tests and logistic regression assessed associations between demographic and clinical factors and PG diagnosis. The past-year rate of PG diagnosis among veterans treated in specialty MH program was 0.2%, significantly lower than prevalence rates in other treatment samples and the general U.S population, suggesting under-diagnosis and/or a low-income sample. Being female, ages 40–74, and higher income increased the risk of PG diagnosis, as did past-year homelessness (Odds Ratio (OR) = 2.2), alcohol use disorders (OR = 2.8), bipolar disorder (OR = 2.1) and personality disorders (OR = 2.1). Depression, schizophrenia, and anxiety disorders other than PTSD, were also positively associated with PG diagnosis. Drug use disorder had no significant independent association with PG. PTSD, dementia, and living in isolated rural areas conferred reduced risk. More systematic screening and surveillance of PG among MH service users generally, and veterans with heavy alcohol use, severe mental illness, and homelessness specifically, appears warranted.     

Secondary Traumatization Among Adult Children of PTSD Veterans: The Role of Mother–Child Relationships

The study examined the level of secondary traumatization among adult children of Israeli war veterans with post-traumatic stress disorder (PTSD) as manifested in emotional distress, stress resulting from terrorist attacks, and capacity for intimacy. In addition, the role of the mother–child relationship as a moderator of these manifestations of distress was examined. Forty-six adult children of fathers with chronic PTSD, and 46 adult children of fathers who had participated in a war but did not have PTSD participated. Findings revealed that adult children of PTSD veterans showed higher levels of psychological distress, greater terror-related stress, and a lower capacity for intimacy than children of non-PTSD veterans. Positive relationship with the mother was found to moderate the level of participants' capacity for intimacy and their levels of psychiatric symptoms.     

Associations Between Psychological,Physical, and Sexual Intimate Partner Violence and Health Outcomes Among Women Veteran VA Patients

Women veterans experience high rates of lifetime intimate partner violence (IPV) and suffer a variety of trauma-related health conditions. The purpose of this study was to identify health status and health risk behaviors associated with experiences of psychological, physical, or sexual IPV among women veterans receiving care at a Veterans Affairs (VA) medical center. We conducted surveys with 249 women veteran patients and examined health factors associated with each form of violence. Sexual IPV victimization had the most pronounced associations with adverse health. In multivariate analysis, controlling for age, race, and income, women veterans who experienced sexual violence victimization were close to or more than three times as likely as those who experienced no IPV to report poor or fair overall health, a diagnosis of post-traumatic stress disorder or depression, bipolar disorder, or anxiety, difficulty sleeping, cigarette smoking, and problem drinking. Those who reported psychological violence only (without physical or sexual violence) also reported greater odds of self-rated poor or fair health. These findings are consistent with findings from studies with non-veteran populations and serve to further identify the unique contributions of sexual IPV to health outcomes. The integrated VA health care system offers opportunities for IPV identification and response including a coordinated team-based care model with social work integrated within primary care.     

Treating intimate partner violence within intact couple relationships: outcomes of multi-couple versus individual couple therapy

An experimental design was used to determine outcomes of a domestic violence-focused treatment program for couples that choose to stay together after mild-to-moderate violence has occurred. Forty-two couples were randomly assigned to either individual couple or multi-couple group treatment. Nine couples served as the comparison group. Male violence recidivism rates 6 months after treatment were significantly lower for the multi-couple group (25%) than for the comparison group (66%). In contrast, men in the individual couple condition were not significantly less likely to recidivate (43%) than those in the comparison group. In addition, marital satisfaction increased significantly, and both marital aggression and acceptance of wife battering decreased significantly among individuals who participated in multi-couple group therapy, but not among those who participated in individual couple therapy or the comparison group.     

Intimate partner violence and PTSD: the moderating role of emotion-focused coping

Intimate partner violence (IPV) affects millions of women every year, often resulting in posttraumatic stress disorder (PTSD). The strength of the relationship between IPV and PTSD has been shown to be affected by factors such as the amount of violence exposure and the style of coping in which the individual engages. For example, emotion-focused coping has been shown to be strongly related to IPV exposure and the expression of PTSD symptoms. This topic was explored in IPV survivors, with the finding that more frequent use of emotion-focused coping was associated with both higher violence exposure and heightened PTSD symptoms. Regression analyses revealed that emotion-focused coping moderated the relationship between IPV exposure and PTSD symptoms. More specifically, the results suggest that while individuals low on emotion-focused coping had fewer PTSD symptoms than women who frequently used emotion-focused coping, these individuals reported higher PTSD symptoms in the presence of frequent violence exposure. For individuals who frequently engaged in emotion-focused coping, violence exposure was less strongly associated with symptoms of PTSD.     

Posttraumatic stress disorder symptomatology and comorbid depressive symptoms among abused women referred from emergency department care

Posttraumatic stress disorder (PTSD) is common among victims of intimate partner violence (IPV) as is comorbid depression. Comorbid depression may exacerbate PTSD severity and chronicity. This study sampled female IPV victims from an urban emergency department to assess the relationship between PTSD symptomatology in the previous 12 months and current depressive symptomatology and to evaluate independent predictors of PTSD symptomatology. Half of respondents had symptoms consistent with PTSD. Those with PTSD symptomatology had significantly higher mean total depression scores and mean scores on 3 of 4 depression subscales than those without PTSD. Depressive symptomatology, being married, sexual IPV, severity of physical IPV, and partner's consumption of 5 or more alcoholic drinks per occasion at least once a month independently predicted PTSD symptomatology. Our findings underscore the important roles these factors play in IPV-related PTSD and the need for prompt identification and intervention of those at risk.     

Effects of trauma exposure on anger, aggression, and violence in a nonclinical sample of men

This study assessed the impact of traumatic exposure and posttraumatic stress disorder (PTSD) symptoms on anger, aggression, and violence among civilian male college students. Results suggest that civilian men who have been exposed to a potentially traumatic event (PTE) and report symptoms of PTSD indicate more trait anger, more internal anger and hostility, and more aggression and violence than men who do not report symptoms of PTSD. Results are contrasted to those found in clinical samples of male veterans with PTSD and discussed in terms of understanding and treating anger and aggression in non-clinical, trauma-exposed populations.     

Patterns of intimate partner violence in young adult couples: nonviolent, unilaterally violent, and mutually violent couples

This study examined nonviolent (NV), unilaterally violent (UV), and mutually violent (MV) patterns of perpetrated intimate partner violence in relation to dyadic relationship quality and partner injury. The respondents were 1,294 young adult, Add Health partners (AHP) and their non-Add Health partners (NAHP), in dating, engaged, or in marital relationships, who were participants in Wave III of the National Longitudinal Study of Adolescent Health (Add Health). Using both partner reports of perpetration to classify intimate partner violence (IPV) patterns resulted in 25% of couples with a MV pattern, and 75% of couples with a UV pattern; among those couples (41%) reporting any perpetrated IPV. Results also showed poorer relationship quality and higher partner sensation-seeking scores among MV and UV couples when contrasted with NV couples. Those couples with MV patterns were more likely to contain partner injury than those with UV patterns.     

Gender, partner violence, and perceived family functioning among a sample of Vietnam veterans

This study examined partner violence and perceived family functioning among a sample of 298 male veterans and their female partners. Partner violent men were higher than partner violent women on measures of partner violence severity, although differences did not reach statistical significance. Among couples experiencing unidirectional violence, female victims of partner violence reported significantly poorer family functioning than male victims of partner violence. Data appear to suggest that the effects of male-perpetrated partner violence on perceived family functioning may be larger than that of female-perpetrated partner violence.     

Military‐Related Posttraumatic Stress Disorder and Intimate Relationship Behaviors: A Developing Dyadic Relationship Model

The protracted conflict in Iraq and Afghanistan and an all‐volunteer military has resulted in multiple war zone deployments for many service members. While quick redeployment turnaround has left little time for readjustment for either the service member or family, dealing with the long‐term sequelae of combat exposure often leaves families and intimate partners ill‐prepared for years after deployments. Using a modified grounded theory approach, digitally recorded couple interviews of 23 couples were purposefully selected from a larger sample of 441 couples to better understand the impact of war zone deployment on the couple. The veteran sample was recruited from a randomly selected cohort of men in treatment for posttraumatic stress disorder (PTSD). Overall, it was found when veterans experiencing deployment‐related PTSD reenter or start new intimate relationships they may bring with them a unique cluster of interrelated issues which include PTSD symptoms, physical impairment, high rates of alcohol and/or drug abuse, and psychological and physical aggression. These factors contributed to a dynamic of exacerbating conflict. How these couples approached relationship qualities of mutuality, balanced locus of control and weakness tolerance across six axes of caregiving, disability, responsibility, trauma, communication, and community impacted the couple's capacity to communicate and resolve conflict. This dyadic relationship model is used to help inform implications for clinical practice.     

PTSD symptoms among men and women survivors of intimate partner violence: the role of risk and protective factors

The purpose of this cross-sectional analysis of the National Violence Against Women Survey was to characterize current symptoms of posttraumatic stress disorder (PTSD) among 185 men and 369 women survivors of intimate partner violence (IPV). In this subsample, 24% of women and 20% of men had current moderate-to-severe PTSD symptoms. PTSD scores were higher for women than men. Protective factors that appear to increase resiliency of survivors were higher education and income, being currently married, and reporting that IPV had stopped. Higher physical or psychological IPV scores, current depressive symptoms, and the survivor having left the relationship at least once were associated with risk of moderate-to-severe symptoms of PTSD. Protective factors may be used to boost resiliency of IPV survivors and reduce PTSD symptoms.     

Relationship Quality and Stability in Couples When One Partner Suffers From Borderline Personality Disorder

The main goal of the present study was to examine and compare the psychosocial functioning of 35 couples including a woman diagnosed with borderline personality disorder (BPD) to that of a nonclinical control sample of 35 couples. The BPD status of women from the clinical group and the prevalence of personality disorder in their partner were ascertained through the SCID-II. Participants completed self-report measures of couple functioning. A majority of couples in which the woman suffered from BPD (68.7%) evidenced frequent episodes of breakups and reconciliations and, over an 18-month period, nearly 30% of these couples dissolved their relationship. Nearly half of the men involved in a romantic relationship with a woman suffering from BPD met criteria for one personality disorder or more. As compared with nonclinical couples, clinical couples showed lower marital satisfaction, higher attachment insecurity, more demand/withdraw communication problems, and higher levels of violence.     

Health disparities in military veterans with PTSD: influential sociocultural factors

Health disparities based on sociocultural factors such as gender, race and ethnicity, socioeconomic status, culture, and access to health care can potentially complicate the early diagnosis and effective management of posttraumatic stress disorder (PTSD). Research indicates that among those individuals affected by health disparities, there is a greater burden of illness and disability, higher morbidity and mortality rates, and increased behavioral risk factors. The purpose of this article is to highlight the sociocultural factors that affect the development of PTSD and to publicize health disparities in military combat veterans.     

Violence and hostility among families of Vietnam veterans with combat-related posttraumatic stress disorder

The current study provides a portrait of emotional-behavioral functioning within a small sample of Vietnam veterans with combat-related posttraumatic stress disorder (PTSD), their partners, and older adolescent and adult children. Veterans, their partners and children reported moderate-low to moderate-high levels of violent behavior. In addition, partner and veteran hostility scores were elevated relative to gender and age matched norms. Partners also reported heightened levels of psychological maltreatment by veterans. Veterans' combat exposure was positively correlated with hostility and violent behavior among children but unrelated to partner variables. Veterans' reports of PTSD symptoms were positively associated with reports of hostility and violence among children, and hostility and general psychological distress among partners. Veterans' violent behavior was also positively correlated with children's violent behavior, but did not yield significant correlations with other child or partner variables. Findings are discussed in relation to prior work and directions for future research are addressed.     

Meeting the mental health needs of the aging veteran population

The growth in the veterans population parallels the graying of America, accompanied by an increasing need for health care and mental health services from the U.S. Department of Veterans Affairs (VA) health care system. With the incidence of posttraumatic stress disorder (PTSD) rising in veterans of the wars in Iraq and Afghanistan and the already strained mental health resources in use by veterans with persistent PTSD from previous wars, the VA mental health system is and will continue to be in overload. In addition, recent research has noted an increased incidence of dementia in veterans with PTSD. The VA's long-term care facilities cannot meet their current demands, nevermind provide support for veterans with cognitive deficits who can no longer be cared for at home. It is imperative that immediate measures be taken to strengthen resources for research, manpower, and training to accommodate the future mental health needs of our aging veterans.     

Differentiation of the Self and Posttraumatic Symptomatology Among ex-POWs and Their Wives

War captivity is a highly traumatic experience which sometimes has deleterious effects on both ex-POWs and their wives. This study examined the relationships between posttraumatic stress disorder (PTSD) symptoms and differentiation among male ex-prisoners of war (ex-POWs; n  = 103), their wives ( n  = 82), and comparable controls. Results show that ex-POWs and their wives endorsed more PTSD symptoms than controls. Ex-POWs endorsed more cut-off and fusion than controls, while their wives endorsed only more fusion than control wives. Finally, the relationship between differentiation and PTSD was found to be stronger among ex-POW couples than among control couples. The unique characteristics of war captivity and the relationships between avoidance symptoms and cut-off were suggested as possible explanations .     

Factors associated with relationship dissolution and post-dissolution adjustment among lesbian adoptive couples

ABSTRACT

Same-sex adoptive couples are increasingly visible, yet few studies have addressed relationship stability and dissolution among these couples. In this study, using a theoretical framework based on Investment Models and Vulnerability-Stress-Adaptation Theory, factors associated with dissolution and post-dissolution adjustment among 27 lesbian adoptive couples were examined across two points. At Wave 1, all 27 couples were together; children were on average 3 years old. Results revealed that nearly one third broke up over 5 years (between Waves 1 and 2). Factors related to shorter relationship length and undermining coparenting at Wave 1 distinguished women who later broke up versus stayed together. Worse mental health at Wave 2 characterized women in dissolved rather than sustained relationships, even with comparable individual adjustment at Wave 1. Weaker parenting alliance and greater dissatisfaction with childcare divisions were reported by women no longer with their partners at Wave 2 as compared with those in enduring partnerships. This research has implications for understanding lesbian relationship dynamics and associations with individual adjustment.     

Distal and Proximal Factors in Domestic Violence: A Test of an Integrated Model

We employed 4,095 couples from both waves of the National Survey of Families and Households (NSFH) to test a model of couple violence drawn from several theoretical perspectives. The outcome distinguishes among nonviolent couples and those experiencing either physical aggression or intense male violence. According to the model, background characteristics of couples are related to relationship stressors, which affect the risk of violence via their tendency to promote verbal conflict. Considerable support for the model was found. Couples were at higher risk for one or both forms of violence if they were younger at union inception, had been together for less time, were both in their first union, had only one partner who was employed, had a nontraditional woman paired with a traditional man, had at least one partner who abused substances, had more children, had more frequent disagreements, exhibited a more hostile disagreement style, or lived in an economically disadvantaged neighborhood. Moreover, the effects of stressors such as the number of children and couples' employment status disparities appear to be mediated by disagreement frequency and disagreement style.     

Pathological Gambling and Posttraumatic Stress Disorder: A Study of the Co-Morbidity versus Each Alone

This report is the first empirical study to compare pathological gambling (PG), posttraumatic stress disorder (PTSD), and their co-occurrence. The sample was 106 adults recruited from the community (35 with current PG; 36 with current PTSD, and 35 with BOTH). Using a cross-sectional design, the three groups were rigorously diagnosed and compared on various measures including sociodemographics, psychopathology (e.g., dissociation, suicidality, comorbid Axis I and II disorders), functioning, cognition, life history, and severity of gambling and PTSD. Overall, the PG group reported better psychological health and higher functioning than PTSD or BOTH; and there were virtually no differences between PTSD and BOTH. This suggests that it is the impact of PTSD, rather than comorbidity per se, that appears to drive a substantial increase in symptoms. We also found high rates of additional co-occurring disorders and suicidality in PTSD and BOTH, which warrants further clinical attention. Across the total sample, many reported a family history of substance use disorder (59%) and gambling problems (34%), highlighting the intergenerational impact of these. We also found notable subthreshold PTSD and gambling symptoms even among those not diagnosed with the disorders, suggesting a need for preventive care. Dissociation measures had mixed results. Discussion includes methodology considerations and future research areas.