Toward an Integrated Theoretical Model of Risk Factors for Post-Deployment PTSD and its Implications for Justice-Involved Veterans

At present, very little knowledge exists about individual differences in susceptibility to posttraumatic stress disorder (PTSD) after combat trauma. Two differing perspectives have emerged. Some researchers maintain that a distinct linear dose-response relationship exists between the severity of combat trauma and the later development of PTSD. Conversely, others have questioned whether differential exposure to combat alone is sufficient to explain differences in the prevalence of post-deployment PTSD. This debate has implications for military veteran offenders who suffer from PTSD. In this paper, I propose a cumulative stress model that posits that it is the particular combination of psychosocial factors and combat exposure that interact to predict the likelihood of developing and maintaining PTSD after deployment. Therefore, PTSD influences post-deployment offending and antisocial behavior through this mechanism. Finally, this paper will discuss implications for criminal justice policy and practice.     

Snug Harbor

No abstract available for this article.     

Child Sexual Abuse,Post-Traumatic Stress Disorder,and Substance Use: Predictors of Revictimization in Adult Sexual Assault Survivors

This study examined the unique effects of child sexual abuse simultaneously with post-traumatic stress disorder symptom clusters, problem drinking, and illicit drug use in relation to sexual revictimization in a community sample of female adult sexual assault victims. Participants (N?=?555) completed two surveys a year apart. Child sexual abuse predicted more post-traumatic stress disorder symptoms in adult sexual assault victims. Post-traumatic stress disorder numbing symptoms directly predicted revictimization, whereas other post-traumatic stress disorder symptoms (reexperiencing, avoidance, and arousal) were related to problem drinking, which in turn predicted revictimization. Thus, numbing symptoms and problem drinking may be independent risk factors for sexual revictimization in adult sexual assault victims, particularly for women with a history of childhood sexual abuse.     

A National Survey of Child Advocacy Center Directors Regarding Knowledge of Assessment,Treatment Referral,and Training Needs in Physical and Sexual Abuse

Mental health services are a core component of child advocacy centers in the United States. Child advocacy center directors were surveyed about (a) trauma and posttraumatic stress disorder; (b) referral criteria for treatment of abuse victims; (c) evidence-based treatments for abused children; (d) reliable, valid, and normed measures helpful in assessment; and (e) training needs. Directors accurately identified posttraumatic stress disorder symptoms, but additional symptoms were misidentified. Directors identified best practices for assessment and treatment, but they misidentified non-evidence-based practices. Primary reasons for referral for services included severity of abuse and emotional response of the child. However, referrals based on assessment findings were not a high priority. Directors expressed some training needs for staff consistent with issues identified in the study.     

The Clinical Correlates of Reported Childhood Sexual Abuse: An Association Between Age at Trauma Onset and Severity of Depression and PTSD in Adults

This study investigated the relationship between the age of -self‐reported sexual abuse occurrence and the development of post-traumatic stress disorder and/or depressive symptoms in adulthood. Subjects were evaluated for the presence of post-traumatic stress disorder and/or depressive symptoms as well as for a self-reported history of sexual abuse before the age of 18. Results found that relative risk of having severe post-traumatic stress disorder symptoms was 10 times higher in patients reporting sexual abuse after age 12 than in those reporting sexual abuse before age 12. Relative risk of having severe depressive symptoms was higher for those abused before the age of 12 than for those abused after the age of 12. Findings suggest that the impact of reported sexual abuse at different stages of development may lead to distinct psychiatric symptoms in adulthood.     

Posttraumatic Stress Disorder and Older Women

SUMMARY

This article examines the literature related to the identification and treatment of posttraumatic stress disorder in older women. From this review, several key findings emerge. Consistent in the research literature is the fact that American women are more at risk for PTSD than are men as a result of the high frequency of sexual and domestic physical abuse that women experience. Studies on older women and PTSD indicate that older women are under-diagnosed and are more typically perceived as suffering from depression, anxiety or poor physical health. It was found consistently that older women who present with age-related stressors may not be asked about earlier trauma history or it may not be understood within the context of trauma-related variables. In several research studies, trauma history was often not identified either as a result of current assessment practice or because women from certain age cohorts did not disclose trauma-related data to health professionals. Key researchers emphasize the necessity of clinicians, staff and medical personnel to attend to the historical variables present in trauma histories of older women. Researchers underscore the importance of understanding the impact of early and repeated trauma, especially interpersonal trauma, on the physical health and social functioning of older women–even though a significant amount of time may have elapsed since exposure. These findings indicate that further study of PTSD in older women is warranted. The paper concludes with a discussion of assessment and treatment options.     

Experiences of student veterans with social anxiety and avoidance: A qualitative study

Eight-to-ten percent of returning combat veterans report symptoms of Posttraumatic Stress Disorder (PTSD), of which 7–13% also report symptoms of Social Anxiety Disorder. Both disorders are characterized by maladaptive patterns of social functioning, which can have significant effects on the lives of returning combat veterans and increase suicidal risk. The objective of the present study was to identify elements of the lived experience of college student veterans experiencing social anxiety and avoidance. Twelve student veterans with post-9/11 active duty service were interviewed about their lived experiences with social anxiety/avoidance within the framework of phenomenological theory. Data was analyzed using multilevel coding and theme analysis. Analysis of interview themes (n = 12) clarified university campus environments that induce social anxiety/avoidance and the impact on personal and professional relationships, learning, and navigation of physical space. Implications of this study include addressing student veterans’ needs through clinical intervention and further representative research on prevalence rates of these risk factors in various university and community college settings.     

Helping the helpers: Post‐traumatic distress and need for help among Israeli social workers in foster care agencies following armed conflict

This study examined the associations between exposure to armed conflict, perceived support, work experience, needing help, and post‐traumatic distress among Israeli social workers in foster care agencies based on Conservation of Resources theory. The study used a mixed‐methods design. Six months after the end of an armed conflict, 82 social workers responded to a web‐based questionnaire with closed‐ and open‐ended questions. Results showed that exposure to the armed conflict was moderately associated with post‐traumatic stress symptoms and functional impairment. Only the workers' perceived need for personal help (but not help for professional matters) was positively associated with their psychological distress. The qualitative analysis suggests that social workers showed strengths and wanted help mainly to improve their professional skills. Yet they also elaborated on the complexities involved in conducting their professional work, especially home visits, because such visits put their own lives in danger and meant deserting their own families. Practice implications are as follows: Foster care agencies should make greater efforts to provide knowledge and skills, support, supervision, and a “safe haven” for their workers, in the context of armed conflict.     

Adverse Childhood Experiences and Gambling: Results From a National Survey

Pathological gambling disorder and problem gambling are addictive disorders with severe consequences for individuals, families, and society. Knowledge about associations between childhood adverse experiences (i.e., physical, sexual, and emotional abuse) and gambling pathology in adulthood is limited. Using data from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), associations between adverse childhood experiences and lifetime gambling status were tested. Strong bivariate associations between adverse childhood experiences and gambling status were found, which were attenuated with the inclusion of clinical covariates. Adverse childhood experiences might be related to pathological gambling in adulthood, but this relationship might not be gambling-specific.     

Cultural adaptations in psychosocial interventions for post-traumatic stress disorder among refugees: A systematic review

ABSTRACT

The aim of this study was to systematically review randomized controlled trials on non-pharmaceutical interventions for post-traumatic stress disorder (PTSD) among adult refugees with a focus on identifying common cultural adaptations and reviewing possible effects of such adaptations on outcomes. The conducted systematic search yielded 11 studies. The strongest support was for eye movement desensitization and reprocessing (EMDR). Commonly used cultural adaptations in the reviewed studies included modifications in personnel and setting context, changes in content, and translation or adaptation of evaluation tools.