Purpose in Life and Conscientiousness Protect Against the Development of Suicidal Ideation in U.S. Military Veterans With PTSD and MDD: Results From the National Health and Resilience in Veterans Study.

Background:Although several studies have examined risk factors for suicidal ideation among veterans, little is known about risk and protective factors for suicidal ideation in high-risk veteran samples. Thus, this study examined a broad range of risk and protective factors associated with the development of suicidal ideation in a high-risk sample of U.S. veterans who screened positive for current posttraumatic stress disorder (PTSD) and/or major depressive disorder (MDD). Methods:Data were analyzed from the National Health and Resilience in Veterans Study, a nationally representative, prospective cohort study of U.S. veterans. Veterans completed self-report measures to screen for PTSD and MDD and to assess for risk and protective factors. The sample included 222 veterans with PTSD and/or MDD who did not endorse suicidal ideation at baseline and completed at least one assessment over a seven-year follow-up period. A multivariable binary logistic regression analysis was conducted to examine baseline factors associated with incident suicidal ideation. Results:Nearly one in three (27.1%) of veterans with PTSD and/or MDD developed suicidal ideation over the seven-year follow-up period. Non-Caucasian race and lower scores on measures of purpose in life, conscientiousness, and frequency of religious service attendance were independently associated with incident suicidal ideation. Lower purpose in life (52.3%) and conscientiousness (33.2%) explained the vast majority of variance in incident suicidal ideation. Conclusion:Nearly 30% of veterans with PTSD and/or MDD who did not endorse suicidal ideation at baseline developed suicidal ideation over a seven-year period. Prevention and treatment efforts designed to bolster purpose in life and conscientiousness may help mitigate risk for suicidal ideation in this high-risk population

Military Sexual Trauma in Veterans: Consequences, Treatment, and Therapeutic Implications

Amongst Veterans served within the Veterans Affairs healthcare system, approximately 1 in 50 men and 1 in 3 women have experienced military sexual trauma (MST). While every individual is different, a common characteristic or identity amongst those who have served is that of a warrior – someone perceived as strong and ready to defend both their country and fellow soldier. Experiencing military sexual trauma can create a painful and discrepant identity as well as impact almost all domains of functioning. Unfortunately, trauma is an all too common occurrence in the lives of many service members and the multifinality of trauma can lead to complex, harmful consequences ranging from mental health issues, physical health conditions, and an increased risk of suicide. This clinical research project explores the prevalence of MST in Veterans, its consequences, treatment approaches found to be most effective for MST-related PTSD, and clinical implications for working with MST survivors. At this time, Cognitive Processing Therapy, Prolonged Exposure, and Eye Movement Desensitization and Reprocessing are considered by Veterans Affairs to be the “gold standard” evidence-based PTSD treatments. Suggestions for clinical practice and recommendations for future research are provided

PTSD AND THE WARFIGHTER: A TECHNOLOGY-BASED APPROACH TO THERAPY

The missions in support of Global War on Terrorism may have concluded throughout the Middle East, but the residual effects of the sustained combat operations remain present and continue to influence the lives of so many combat Veterans. Advances in technology, such as health monitoring and wearable devices, could improve the treatment of the warfighters and the approach adopted by the Defense Health Agency and the U.S. Department of Veterans Affairs. The U.S. Navy and U.S. Marine Corps have policies established to remove their respective Sailors and Marines from their standard deployable status to a Limited Duty (LIMDU) position, which are limited to six-month periods and two concurrent periods before personnel must go before a Medical Review Board, where they are susceptible to medical separation or medical retirement. It is important to explore additional treatment options so the victims can obtain a renewed sense of purpose, eliminate suicidal thoughts and ideations, and if preferred, continue their military service and share their valued experiences with the next generation. This research explores nontraditional methods of PTSD treatment, to include technology, mood tracking, and sleep data, and how these data points influence one another.Approved for public release. Distribution is unlimited.Lieutenant, United States NavyLieutenant, United States Nav

Psychotherapeutic Treatment of Post-Traumatic Disorder in Rural Veterans

Post-traumatic stress disorder (PTSD) is a significant health issue among the veteran population. PTSD can lead to adverse outcomes such as suicide, violence, substance abuse, and an overall decreased quality of life. Psychotherapy has demonstrated effectiveness in treating PTSD. However, providers may not be aware which specific types of psychotherapy have achieved the strongest levels of evidence . Additional challenges exist in treating rural veterans because of barriers such as geographical distance and a shortage of mental health providers. These obstacles may place rural veterans at higher risk. The purpose of this project was to explore the current evidence that supports the use of psychotherapy in the treatment of PTSD and discuss how these strategies might be implemented for veterans in a rural setting. Shapiro\u27s Adaptive Information Processing Model served as a theoretical framework for this project . The methods used to conduct this project consisted of first performing a literature review of pertinent articles and current practice guidelines. Expert clinicians within the community were consulted to gain further insight and directly observe some clinical applications of these therapies. Collaborative efforts were made with contacts from the Department of Defense Centers of Excellence and an upper-Midwest rural health agency . A variety of web-based training modules related to the practice of psychotherapy for veterans with PTSD were also reviewed . The findings of this project revealed that cognitive behavioral-based therapies, such as Cognitive Processing Therapy (CPT) and Prolonged Exposure (PE) therapy as well as eye movement desensitization and reprocessing (EMDR) demonstrate the greatest level of efficacy in treating PTSD. Technological advances such as telemental health services or virtual reality-based interventions may improve accessibility to rural veterans . Integrating PTSD treatment options into primary care settings, such as community-based clinics may also improve barriers to seeking treatment. These results have been disseminated to local providers via informational pamphlets and poster presentations. Several accessible, online training websites have also been included as resources that can assist providers in gaining increased knowledge and understanding specific to the psychotherapies discussed as well as issues pertinent to military culture and programs. By increasing providers\u27 awareness of these evidence-based practices, it is hopeful that better care can be offered to rural veterans in treating their symptoms of PTSD and improving overall quality of life

Catecholamine responses to virtual combat: implications for post-traumatic stress and dimensions of functioning

PTSD symptoms can result in functional impairment among service members (SMs), even in those without a clinical diagnosis. The variability in outcomes may be related to underlying catecholamine mechanisms. Individuals with PTSD tend to have elevated basal catecholamine levels, though less is known regarding catecholamine responses to trauma-related stimuli. We assessed whether catecholamine responses to a virtual combat environment impact the relationship between PTSD symptom clusters and elements of functioning. Eighty-seven clinically healthy SMs, within 2 months after deployment to Iraq or Afghanistan, completed self-report measures, viewed virtual-reality (VR) combat sequences, and had sequential blood draws. Norepinephrine responses to VR combat exposure moderated the relationship between avoidance symptoms and scales of functioning including physical functioning, physical-role functioning, and vitality. Among those with high levels of avoidance, norepinephrine change was inversely associated with functional status, whereas a positive correlation was observed for those with low levels of avoidance. Our findings represent a novel use of a virtual environment to display combat-related stimuli to returning SMs to elucidate mind-body connections inherent in their responses. The insight gained improves our understanding of post-deployment symptoms and quality of life in SMs and may facilitate enhancements in treatment. Further research is needed to validate these findings in other populations and to define the implications for treatment effectiveness

Differences in Research on Post-Traumatic Stress Disorder: How Trauma-Type and Sex Contribute to the Published Research

There is a pervasive and comprehensive history of sexism in the pursuit of scientific truth, extending back beyond the days of “hysteria” and continuing still. Herein, we discuss a disparity in scientific research on a disorder thought to affect less than 8% of the adult population in the USA with the number of women diagnosed with the disorder estimated to be two to three times higher than that of men. While post-traumatic stress disorder (PTSD) is more likely to be experienced by women, we find that the overwhelming majority of published scientific literature on PTSD involves male combat veterans. For example, since March 2019, according to a widely used medical research search engine, specifically the electronic database PubMed (https://www.ncbi.nlm.nih.gov/pubmed/), over 1,100 articles can be found with the keywords, “veteran and PTSD” while using the keywords, “sexual assault and PTSD” yields a little over 100 total articles. While not all victims of sexual assault are female and not all combat veterans are male, the majority sex in each category is such that much of the research on “veteran” was specifically carried out with male veterans and much of the work on “sexual abuse” was carried out exclusively with females. This creates a perception that both overinflates the incidence of PTSD experienced by male combat veterans and underemphasizes the experience of PTSD in female victims of sexual assault. Differences in symptoms of PTSD do vary by war and what little research exists on PTSD after sexual assault suggests that it is likely that symptoms as well as associated comorbidities will vary depending on the cause, type, number, and age at first trauma, among other factors. This study focuses on the specific comorbidities of pain, addiction, and immune function in those who experience PTSD following war-based or sexually-based traumas. It is our hope that in reviewing the currently available research, we spotlight the need for research focused on PTSD experienced after sexual assault. Doing so has the potential to lead to better and more tailored treatments for PTSD, thus enriching outcomes for all sufferers of PTSD

Self-Compassion and Suicide Risk in Veterans: Serial Effects of Shame, Guilt, and PTSD

Suicide is a significant public health concern and ranks as the 10th leading cause of death in the U.S. Veterans are at a disproportionately higher risk for suicide, due to risk factors such as exposure to trauma and its negative cognitive-emotional sequalae, such as PTSD, shame, and guilt. However, not all veterans exposed to traumatic events, or who experience shame and guilt, die by suicide, perhaps as a result of the presence of individual-level protective factors such as self-compassion. Conceptualized as self-kindness, mindfulness and common humanity, self-compassion is beneficially associated with mental and physical health, including reduced suicide risk. We examined the potential serial mediating effects of shame/guilt, separated into two models, and PTSD in the relation between self-compassion and suicide risk in a sample of U.S. veterans (N = 317). Participants in our IRB-approved study provided informed consent and completed the Self-Compassion Scale - Short Form, Differential Emotions Scale-IV, PTSD Checklist-Military Version (PCL-M) for DSM-IV, and Suicidal Behaviors Questionnaire - Revised (SBQ-R). Supporting hypotheses, shame/guilt and PTSD, and PTSD alone, mediated the relation between self-compassion and suicide risk, but shame/guilt alone did not. Our results remained significant when covarying depressive symptoms. Therapeutic interventions such as Mindful Self-Compassion and Compassion-Focused Therapy may increase self-compassion and ameliorate negative cognitive-emotional sequelae, including suicide risk, in veterans

Therapeutic treatments for PTSD : does type of treatment impact help seeking behaviors in a military sample?

There are several known barriers that people face that decrease the likelihood of seeking professional psychological help. The present study sought to identify whether certain treatment types for PTSD serve as barriers to seeking psychological help. It specifically sought to identify trauma-focused treatments as potential barriers due to their perception of being emotionally challenging. A survey was administered to 84 respondents. Of the respondents, 41 were randomly assigned to read a treatment protocol for an exposure-based, trauma-focused psychotherapy for PTSD, which 43 were randomly assigned to read a protocol for a trauma-avoidant psychotherapy for PTSD. Measures of attitudes toward seeking help and mental health stigma were then administered, with treatment type serving as two levels of an independent variable. We hypothesized that participants in the trauma-focused condition would subsequently report higher levels of stigma and more negative attitudes toward seeking help. MANCOVA results did not support our hypothesis as both groups were shown to have equal reactions to the protocols. This held true when controlling for four potential covariates: PTSD symptoms, avoidant coping styles, conformity to masculine gender norms, and previous PTSD treatment history. Treatment implications and future directions were discussed