Impact of Combat on the Mental Health and Well‐Being of Soldiers and Marines

This presentation introduces a summary of leading edge research and recommendations for a number of changes regarding mental health needs and services for Veterans. Those Veterans who experienced combat exposure and those who have perceived their leadership negatively have greater risks for developing subsequent PTSD. Research data provide support for the use of Battlemind Training as a useful approach to prevent mental health issues at all phases of the deployment cycle. The author also challenges the current use of DSM–IVTR diagnoses with combat Veterans.     

Surviving Critical Illness: New Insights From Mixed-Methods Research

Current advanced medical technology allows survival of critical illness. However, the patient's psychological response to survival is relatively unexplored. Interviews with 32 older adult survivors, using the Hospital Anxiety and Depression Scale (HADS) and the Experience after Treatment in Intensive Care (ETIC-7) scale, Miller's Q-sort, and social work clinical wisdom, yielded unique and unexpected research results. Four response types were identified: avoiding, depressed, denial, and coping. Psychological agency during illness was found to be important. Participants did not reveal posttraumatic stress disorder–related phenomena predicted in previous literature but instead experienced posttraumatic growth. Hallucinatory experiences during illness were not traumatic, whereas social support emerged as a complicated concept. Participants unexpectedly revealed that childhood trauma was an important factor. Implications for clinical social work practice and research are outlined following the discussion of findings.     

HIV and PTSD: A Confirmatory Factor Analysis of the PCL Screening Instrument

ABSTRACT

The findings are reported from a confirmatory factor analysis (CFA) of the posttraumatic screening checklist (PCL) created by Weathers et al. (1993) Weathers, F. W., Litz, B. T., Herman, D. S., Huska, J. A. and Keane, T. M. 1993. The PTSD Checklist (PCL): Reliability, validity, and diagnostic utility, Presented at Annual Meeting of the International Society for Traumatic Stress Studies, San Antonio, TX. [Google Scholar]. One hundred and eighty-six individuals receiving either preventive HIV information or ongoing HIV counseling from community-based AIDS organizations in the New York City area completed the PCL checklist. To identify a model relevant to screening posttraumatic stress disorder (PTSD) within the HIV/AIDS community, six CFAs were conducted. Results indicated that the PTSD scale should include attention to four general areas: a) reexperiencing the traumatic event; b) avoidance of anything associated with the traumatic event; c) a sense of numbing; and d) a hyperarousal state. The CFA produced a more concise model of 12 items, relevant to the HIV community. Future research suggests that the relationships between different components of trauma exposure and different manifestations of PTSD should be examined further.     

Aging,Depression, and Wisdom: A Pilot Study of Life-Review Intervention and PTSD Treatment With Two Groups of Vietnam Veterans

Vietnam War veterans are a sometimes overlooked subgroup of the aging baby boomer generation. Forty years after the war ended, war veterans still seek out VA or Vet Center counselors to assist with traumatic stress symptoms. However, there currently are no specific age-related protocols for treating older war veterans suffering from posttraumatic stress disorder (PTSD), nor have established PTSD interventions incorporated gerontology content for these older trauma survivors. This pilot study juxtaposed life review within regular PTSD group counseling for 12 Vietnam veterans at a community-based Vet Center using a partial crossover design. The Life Review and Experiencing Form (LREF) structured the delivery of the life review component. T-tests and repeated measures ANOVA were used to examine depression and self-assessed wisdom outcomes using measures previously tested with older adults. Findings suggest that life review prior to PTSD group therapy has clinical benefits for reducing symptoms of depression and increasing self-assessed wisdom. The study illuminates the possible relationship of traumatic stress symptom effects on the natural reminiscing process for older veterans and provides insights into methods for more age-appropriate treatment for trauma survivors participating in Vet Center and VA programs nationwide.     

PTSD Symptoms in Abused Latino Children

This exploratory study looks at a sample of abused Latino children and evaluates the relationship of PTSD symptoms to other symptoms, characteristics of the abuse, and demographics. The results indicate that Latino children have a wide range of distress, with some children being highly symptomatic and others with few symptoms. The scores on the PTSD Inventory were related to scores on measures of anxiety, behavior problems, dissociation, and verbal IQ. They were not related to the scores on depression, performance or full scale IQ, gender, or age. The relationship of PTSD symptoms to language of the child and abuse type are equivocal. A discussion of the practice implications is included.     

Time and support do not heal all wounds: Mental health correlates of past bullying among college students

Abstract

Objective: We examined whether perceptions of being bullied during middle and high school were associated with depressive, anxiety, and posttraumatic stress disorder (PTSD) symptoms during college. We also examined whether perceived social support (PSS) mediated the association between bullying and symptoms, and explored whether parental, peer, or other sources of support was most beneficial. Participants: Undergraduates (N?=?270) from an urban commuter college in the Northeast participated during Spring 2013 or Fall 2015. Methods: Psychometrically sound self-report measures were used to assess symptoms and perceptions of bullying and social support. Results: As hypothesized, bullying was associated with more symptoms, and PSS significantly mediated the associations between bullying and symptoms of PTSD and depression. Conclusion: The college years provide another opportunity to address the effects of middle and high school bullying. Receiving current support for past bullying is beneficial but is not enough, college counseling services are needed to reduce symptoms.     

Compassion Fatigue in the Treatment of Combat-Related Trauma During Wartime

This article utilizes relevant data on the troops serving in Iraq and Afghanistan, and a composite case of a clinician working with combat survivors, in order to illustrate the potential for compassion fatigue in clinicians treating this cohort. Review of the literature on the effects of compassion fatigue related to combat trauma and the impact of collective shared trauma is presented. This is done in order to emphasize the complexity of the provision of war trauma treatment post 9/11 in the context of the ongoing wars. There is an urgent need for the mental health field to continue to develop interventions and educational programs that will help mitigate the deleterious effects of compassion fatigue in clinicians working with this population.     

Positive Reaction to Disclosure and Recovery from Child Sexual Abuse

ABSTRACT

Factors associated with improvement in the behavioral-emotional functioning of sexually abused children, from 6 to 18 years of age, were investigated. Children were classified by their therapist according to current level of disclosure regarding past abuse. Ratings of degree of support offered by significant people in the children's lives were also made. Findings showed children who were in an actively disclosing stage to be exhibiting significantly less externalizing behavior problems than non-disclosing children. Children who were fully disclosing without recantation showed significantly lower dissociation than did all other subjects. Children who recanted with or without re-disclosure showed significantly more post-traumatic stress symptomatology. As all the subjects were in foster care, the reactions to disclosure of foster parents proved to be most salient with respect to current functioning. Children who received full support from foster parents showed significantly lower depression scores than did children who received only partial support.

Other significant findings pertain to the effects of time since initial disclosure, age of subjects, and type of sexual abuse on behavioral-emotional functioning. Implications for developing structured training programs for foster parents and their caseworkers are discussed. Recommendations are made for future study using the present design with a non-foster care population and investigating the effect that the timing of supportive reactions to disclosure has.     

The Effects of Childhood Sexual Abuse and Other Trauma on Drug Court Participants

Within the context of a larger study of drug court participants, this study examined the impact of traumatic experiences on psychiatric distress and on court outcomes. In the analyses, the participants (n = 229) were separated into 3 groups: childhood sexual abuse (CSA; n = 18), other trauma (n = 134), and no trauma (n = 77). The CSA group had higher mean scores on depression, anxiety, panic disorder, social phobia, somatization, and posttraumatic stress disorder than the other trauma group. Path analyses suggest that a history of trauma is a positive predictor of psychiatric distress and negative court events (positive urine screens, sanctions, etc.), with indirect effects on substance abuse severity, and failure in the drug court. These results suggest a need for the initial assessment procedure in drug courts to include a screening for trauma history, including CSA. They also suggest a need for trauma-informed care within drug courts.     

Subjective distress from trauma in older clients with severe mental illness

There is little research on older persons with severe mental illness (SMI) who have experienced trauma. We conducted an exploratory study with 174 community mental health clients with SMI who were 50 years of age or older (range 50–87; mean age 58) to examine the relationship between subjective distress related to six common traumas and post-traumatic stress symptoms while controlling for gender and other key psychiatric symptoms. With regression analysis, we found that of the six common traumas, only distress from unexpected loss of a loved one was significant. That factor accounted for the most variance in post-traumatic stress symptoms than all other factors in the model including gender, psychiatric symptoms of SMI, and other trauma. Gender and symptoms of psychosis were also significant in the model. Unexpected losses, particularly in older persons with SMI, can cause considerable emotional distress and could be related to post-traumatic stress symptoms. Practitioners should be vigilant in regularly screening older people with SMI for recent loss of loved ones and be prepared to address their distress with grief/bereavement counseling.