Bryann B. DeBeer

Combined PTSD and depressive symptoms interact with post-deployment social support to predict suicidal ideation in Operation Enduring Freedom and Operation Iraqi Freedom veterans

Rates of suicide are alarmingly high in military and veteran samples. Suicide rates are particularly elevated among those with post-traumatic stress disorder (PTSD) and depression, which share overlapping symptoms and frequently co-occur. Identifying and confirming factors that reduce, suicide risk among veterans with PTSD and depression is imperative. The proposed study evaluated, whether post-deployment social support moderated the influence of PTSD-depression symptoms on, suicidal ideation among Veterans returning from Iraq and Afghanistan using state of the art clinical, diagnostic interviews and self-report measures. Operations Enduring and Iraqi Freedom (OEF/OIF) Veterans (n=145) were invited to, participate in a study evaluating returning Veterans׳ experiences. As predicted, PTSD-depression, symptoms had almost no effect on suicidal ideation (SI) when post-deployment social support was high; however, when, post-deployment social support was low, PTSD-depression symptoms were positively associated with, SI. Thus, social support may be an important factor for clinicians to assess in the context of PTSD and, depressive symptoms. Future research is needed to prospectively examine the inter-relationship, between PTSD/depression and social support on suicidal risk, as well as whether interventions to, improve social support result in decreased suicidality.

Self‐Compassion as a Prospective Predictor of PTSD Symptom Severity Among Trauma‐Exposed U.S. Iraq and Afghanistan War Veterans

U.S. combat veterans of the Iraq and Afghanistan wars have elevated rates of posttraumatic stress disorder (PTSD) compared to the general population. Self-compassion, characterized by self-kindness, a sense of common humanity when faced with suffering, and mindful awareness of suffering, is a potentially modifiable factor implicated in the development and maintenance of PTSD. We examined the concurrent and prospective relationship between self-compassion and PTSD symptom severity after accounting for level of combat exposure and baseline PTSD severity in 115 Iraq and Afghanistan war veterans exposed to 1 or more traumatic events during deployment. PTSD symptoms were assessed using the Clinician Administered PTSD Scale for DSM-IV (CAPS-IV) at baseline and 12 months (n =101). Self-compassion and combat exposure were assessed at baseline via self-report. Self-compassion was associated with baseline PTSD symptoms after accounting for combat exposure (β = -.59; p < .001; ΔR(2) = .34; f(2) = .67; large effect) and predicted 12-month PTSD symptom severity after accounting for combat exposure and baseline PTSD severity (β = -.24; p = .008; ΔR(2) = .03; f(2) = .08; small effect). Findings suggest that interventions that increase self-compassion may be beneficial for treating chronic PTSD symptoms among some Iraq and Afghanistan war veterans.

A 12-Month prospective study of the effects of PTSD-depression comorbidity on suicidal behavior in Iraq/Afghanistan-era veterans.

The present study used validated clinical interviews to assess the effect of comorbid PTSD-depression on suicidal behavior over the course of 12 months in 309 Iraq/Afghanistan-era veterans. Logistic regression models demonstrated that comorbid PTSD-depression was a statistically significant predictor of suicide attempts at the 12-month follow-up in both the total sample and in the subset of veterans with PTSD/depression (n=98). In contrast, gender, age, race, sexual orientation, and baseline history of suicide attempts did not have significant effects. These findings suggest that comorbid PTSD-depression may be a significant risk factor for future suicidal behavior in veterans.

Resilience, traumatic brain injury, depression, and posttraumatic stress among Iraq/Afghanistan War Veterans

OBJECTIVE We examined the prospective influence of the resilient, undercontrolled, and overcontrolled personality prototypes on depression and posttraumatic stress disorder (PTSD) symptoms among Iraq/Afghanistan war veterans. After accounting for the possible influence of combat exposure, we expected that the resilient prototype would predict lower depression and PTSD over time and would be associated with adaptive coping strategies, higher social support, lower psychological inflexibility, and higher self-reported resilience relative to overcontrolled and undercontrolled prototypes, independent of traumatic brain injury (TBI) status. METHOD One hundred twenty-seven veterans (107 men, 20 women; average age = 37) participated in the study. Personality was assessed at baseline, and PTSD and depression symptoms were assessed 8 months later. Path analysis was used to test the direct and indirect effects of personality on distress. RESULTS No direct effects were observed from personality to distress. The resilient prototype did have significant indirect effects on PTSD and depression through its beneficial effects on social support, coping and psychological inflexibility. TBI also had direct effects on PTSD. CONCLUSIONS A resilient personality prototype appears to influence veteran adjustment through its positive associations with greater social support and psychological flexibility, and lower use of avoidant coping. Low social support, avoidant coping, and psychological inflexibility are related to overcontrolled and undercontrolled personality prototypes, and these behaviors seem to characterize veterans who experience problems with depression and PTSD over time. A positive TBI status is directly and prospectively associated with PTSD symptomology independent of personality prototype. Implications for clinical interventions and future research are discussed.

Nonsuicidal self-injury and suicide attempts in Iraq/Afghanistan war veterans

The present study examined the association between history of nonsuicidal self-injury (NSSI) and history of suicide attempts (SA) among 292 Iraq/Afghanistan veterans, half of whom carried a lifetime diagnosis of posttraumatic stress disorder (PTSD). Consistent with hypotheses, veterans who reported a history of NSSI were significantly more likely to report a history of SA than veterans without a history of NSSI. In addition, logistic regression demonstrated that NSSI remained a significant predictor of SA even after a wide range of covariates (i.e., combat exposure, traumatic brain injury, PTSD, depression, alcohol dependence) were considered. Taken together, these findings suggest that clinicians working with veterans should include NSSI history as part of their standard risk assessment battery.

Non-suicidal self-injury as a predictor of active and passive suicidal ideation among Iraq/Afghanistan war veterans

The present study examined the association between lifetime non-suicidal self-injury (NSSI) and current suicidal ideation among Iraq/Afghanistan veterans. NSSI was positively associated with passive, active, and concurrent active-passive suicidal ideation at the bivariate level. NSSI remained a predictor of active, OR=5.15, and concurrent active-passive suicidal ideation, OR=7.01, when other risk factors were considered. These findings suggest that NSSI may be a particularly useful marker of active suicidal ideation among veterans.

ADHD and nonsuicidal self-injury in male veterans with and without PTSD

The objective of the present research was to examine the association between ADHD symptoms and nonsuicidal self-injury (NSSI) in male Iraq/Afghanistan-era veterans with and without PTSD. Approximately 25% of veterans screened positive for clinically-significant levels of ADHD. Male veterans with PTSD were significantly more likely to report ADHD symptoms than male veterans without PTSD. In addition, as expected, ADHD was strongly associated with NSSI, even after accounting for the effects of demographic variables, PTSD, depression, and alcohol use disorder. Future work aimed at replicating and extending these findings in longitudinal studies of veterans is needed.

Resilience and Traumatic Brain Injury Among Iraq/Afghanistan War Veterans: Differential Patterns of Adjustment and Quality of Life

OBJECTIVE We examined the degree to which a resilient personality prototype predicted adjustment among war Veterans with and without a traumatic brain injury (TBI) while covarying the level of combat exposure. METHOD A total of 127 war Veterans (107 men, 20 women; average age = 37 years) participated. Personality prototypes were derived from the Multidimensional Personality Questionnaire (Patrick, Curtain, & Tellegen, 2002). Measures were administered at baseline, and a subset was administered at 4- and 8-month follow-ups. RESULTS Veterans with resilient personalities reported less sleep disturbance, more health-promoting behaviors, psychological flexibility, and emotional distress tolerance than Veterans with undercontrolled or overcontrolled prototypes. Path models revealed that resilience significantly predicted posttraumatic stress disorder (PTSD), depression, quality of life, and social support over time. TBI had unique and consistent effects only on PTSD. CONCLUSION Personality characteristics influence distress and quality of life among war Veterans with and without TBI. Implications for assessment, interventions, and research are discussed.

Psychological inflexibility predicts PTSD symptom severity in war veterans after accounting for established PTSD risk factors and personality.

Objective and method: Numerous risk factors for posttraumatic stress disorder (PTSD) have been identified; however, many do not inform treatment. Psychological inflexibility is a modifiable factor that can be targeted in psychological treatment. This study examined whether higher levels of psychological inflexibility predicted unique variance in PTSD symptom severity at 1-year follow-up in 236 U.S. veterans of the wars in Iraq in Afghanistan after accounting for the strongest known risk factors for PTSD. PTSD symptom severity was assessed using the Clinician Administered PTSD Scale. Results: In hierarchical regression analyses, higher baseline psychological inflexibility predicted unique variance in 1-year PTSD symptom severity (p < .001, medium effect) after accounting for the strongest predictors, including: serving in the Army, rank, trauma severity, perceived threat, peritraumatic dissociation, recent life stress, and social support. Psychological inflexibility remained a significant predictor of unique variance in 1-year PTSD symptom severity after accounting for all other predictors and personality factors (neuroticism, extroversion, openness to experience, agreeableness, and conscientiousness; p < .001, small effect) and after accounting for all other predictors, personality factors, and baseline PTSD avoidance symptoms (p < .001; small effect). Conclusions: Findings indicate a key unique association between psychological inflexibility and PTSD symptom severity over time that is not attributable to overlap with personality or PTSD avoidance symptoms. Additional research on psychological inflexibility in the development and maintenance of PTSD is warranted, as well as whether increasing psychological flexibility leads to reductions in PTSD symptoms and improved psychosocial functioning.

Gender differences in associations between DSM–5 posttraumatic stress disorder symptom clusters and functional impairment in war veterans.

Understanding the links between posttraumatic stress disorder (PTSD) symptoms and functional impairment is essential for assisting veterans in transitioning to civilian life. Moreover, there may be differences between men and women in the relationships between PTSD symptoms and functional impairment. However, no prior studies have examined the links between functional impairment and the revised symptom clusters as defined in the Diagnostic and Statistical Manual of Mental Disorders, 5th ed. (DSM–5; American Psychiatric Association, 2013) or whether the associations between PTSD symptom clusters and functional impairment differ by gender. We examined the associations between the DSM–5 PTSD symptom clusters and functional impairment in 252 trauma-exposed Iraq and Afghanistan war veterans (79 females). Regression analyses included demographic factors and exposure to both combat and military sexual trauma as covariates. In the total sample, both the intrusions cluster (&bgr; = .18, p = .045) and the negative alterations in cognition and mood cluster (&bgr; = .45, p < .001) were associated with global functional impairment. Among male veterans, global functional impairment was associated only with negative alterations in cognition and mood (&bgr; = .52, p < .001). However, by contrast, among female veterans, only marked alterations in arousal and reactivity were associated with global functional impairment (&bgr; = .35, p = .027). These findings suggest that there may be important gender differences with respect to the relationship between PTSD symptoms and functional impairment.