Dawne Vogt

Deployment Risk and Resilience Inventory: A Collection of Measures for Studying Deployment-Related Experiences of Military Personnel and Veterans

This article describes the development of an inventory to assess key psychosocial risk and resilience factors for military personnel and veterans deployed to war zones or other hazardous environments. Part 1 details the definition and operationalization of the 14 constructs: 2 predeployment factors (e.g., childhood family environment), 10 deployment or war-zone factors (e.g., concerns about life and family disruptions, deployment social support, combat experiences), and 2 postdeployment factors (e.g., postdeployment stressors). In Parts 2 and 3, data from 2 separate national samples of Gulf War veterans were used to refine item sets and establish estimates of internal consistency reliability. Part 4 employed a 3rd new national sample of Gulf War veterans to document evidence for validity in terms of relations with mental and physical health.

Validation of Scales from the Deployment Risk and Resilience Inventory in a Sample of Operation Iraqi Freedom Veterans.

The Deployment Risk and Resilience Inventory (DRRI) is a suite of scales that can be used to assess deployment-related factors implicated in the health and well-being of military veterans. Although initial evidence for the reliability and validity of DRRI scales based on Gulf War veteran samples is encouraging, evidence with respect to a more contemporary cohort of Operation Iraqi Freedom (OIF) veterans is not available. Therefore, the primary goal of the present study was to validate scales from the DRRI in a large sample of OIF army personnel diversified in occupational and demographic characteristics. In general, results supported the use of these DRRI scales in this population. Internal consistency reliability estimates were quite strong. Additionally, support was obtained for criterion-related validity, as demonstrated by associations with mental and physical health measures, and discriminative validity, as demonstrated by differences between key military subgroups.

Cognitive and Affective Predictors of Treatment Outcome in Cognitive Processing Therapy and Prolonged Exposure for Posttraumatic Stress Disorder

This study examined cognitive and affective predictors of treatment dropout and treatment efficacy in Cognitive Processing Therapy (CPT) and Prolonged Exposure (PE) for PTSD. Study participants were women with PTSD from a sexual assault who received at least one session of either treatment (n = 145) as part of a randomized clinical trial. Results revealed that younger age, lower intelligence, and less education were associated with higher treatment dropout, whereas higher depression and guilt at pretreatment were associated with greater improvement in PTSD symptomatology. Results by treatment condition indicated that women with higher anger at pretreatment were more likely to dropout of PE and that older women in PE and younger women in CPT had the best overall outcomes. These findings have implications for efforts to enhance treatment efficacy and retention in CBT treatment protocols.

Mental and Physical Health Status and Alcohol and Drug Use Following Return From Deployment to Iraq or Afghanistan

OBJECTIVES We examined (1) mental and physical health symptoms and functioning in US veterans within 1 year of returning from deployment, and (2) differences by gender, service component (Active, National Guard, other Reserve), service branch (Army, Navy, Air Force, Marines), and deployment operation (Operation Enduring Freedom/Operation Iraqi Freedom [OEF/OIF]). METHODS We surveyed a national sample of 596 OEF/OIF veterans, oversampling women to make up 50% of the total, and National Guard and Reserve components to each make up 25%. Weights were applied to account for stratification and nonresponse bias. RESULTS Mental health functioning was significantly worse compared with the general population; 13.9% screened positive for probable posttraumatic stress disorder, 39% for probable alcohol abuse, and 3% for probable drug abuse. Men reported more alcohol and drug use than did women, but there were no gender differences in posttraumatic stress disorder or other mental health domains. OIF veterans reported more depression or functioning problems and alcohol and drug use than did OEF veterans. Army and Marine veterans reported worse mental and physical health than did Air Force or Navy veterans. CONCLUSIONS Continuing identification of veterans at risk for mental health and substance use problems is important for evidence-based interventions intended to increase resilience and enhance treatment.

Gender differences among veterans deployed in support of the wars in Afghanistan and Iraq.

ABSTRACTBACKGROUNDThe changing scope of women’s roles in combat operations has led to growing interest in women’s deployment experiences and post-deployment adjustment.OBJECTIVESTo quantify the gender-specific frequency of deployment stressors, including sexual and non-sexual harassment, lack of social support and combat exposure. To quantify gender-specific post-deployment mental health conditions and associations between deployment stressors and posttraumatic stress disorder (PTSD), to inform the care of Veterans returning from the current conflicts.DESIGNNational mail survey of OEF/OIF Veterans randomly sampled within gender, with women oversampled.SETTINGThe community.PARTICIPANTSIn total, 1,207 female and 1,137 male Veterans from a roster of all Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF) Veterans. Response rate was 48.6 %.MAIN MEASURESDeployment stressors (including combat and harassment stress), PTSD, depression, anxiety and alcohol use, all measured via self-report.KEY RESULTSWomen were more likely to report sexual harassment (OR = 8.7, 95% CI: 6.9, 11) but less likely to report combat (OR = 0 .62, 95 % CI: 0.50, 0.76). Women and men were equally likely to report symptoms consistent with probable PTSD (OR = 0 .87, 95 % CI: 0.70, 1.1) and symptomatic anxiety (OR  =  1.1, 9 5% CI: 0.86, 1.3). Women were more likely to report probable depression (OR = 1.3, 95 % CI: 1.1, 1.6) and less likely to report problematic alcohol use (OR  = 0 .59, 9 5% CI: 0.47, 0.72). With a five-point change in harassment stress, adjusted odds ratios for PTSD were 1.36 (95 % CI: 1.23, 1.52) for women and 1.38 (95 % CI: 1.19, 1.61) for men. The analogous associations between combat stress and PTSD were 1.31 (95 % CI: 1.24, 1.39) and 1.31 (95 % CI: 1.26, 1.36), respectively.CONCLUSIONSAlthough there are important gender differences in deployment stressors—including women’s increased risk of interpersonal stressors—and post-deployment adjustment, there are also significant similarities. The post-deployment adjustment of our nation’s growing population of female Veterans seems comparable to that of our nation’s male Veterans.

Deployment stressors and posttraumatic stress symptomatology: Comparing active duty and National Guard/Reserve personnel from Gulf War I

The increased use of National Guard and Reserve (NG/R) military personnel in current conflicts raises the question of whether deployment experiences and their associations with posttraumatic stress symptomatology differ for active duty and NG/R military personnel. To date, very few studies are available on this topic. Moreover, it is unclear whether the impact of military status differs for women and men. We addressed these research issues in a sample of 311 female and male Gulf War I veterans. Several differences were observed in deployment stressor exposures and results based on differential associations generally suggested more negative impacts of deployment experiences for active duty women and NG/R men. The potential role of unit cohesion in explaining these findings is discussed.

Targeting self-stigma in returning military personnel and veterans: A review of intervention strategies.

Research suggests that mental health-related stigma significantly decreases the use of mental health services by military personnel and veterans. The goal of this article is to review what is known about mental health stigma as it relates to military personnel and veterans, as well as to offer an interpretive review of self-stigma intervention strategies that have been applied within the field. Target areas for future work and the concerns and challenges faced by interventionists are discussed.

PTSD and substance-related problems : The mediating roles of disconstraint and negative emotionality

The authors examined competing hypotheses regarding the role of 2 personality dimensions, disconstraint and negative emotionality, in mediating the relationship between posttraumatic stress disorder (PTSD) severity and substance-related problems. Data were drawn from a large sample of male Vietnam veterans. The best-fitting structural model included significant indirect paths from PTSD to both alcohol- and drug-related outcomes through disconstraint, and a significant indirect path from PTSD to alcohol-related problems through negative emotionality. There were no direct effects of PTSD on either substance-related outcome. These findings indicate distinct pathways to different forms of substance-related problems in PTSD and underscore the role of personality in mediating these relationships.

Barriers to Veterans Health Administration Care in a Nationally Representative Sample of Women Veterans

AbstractBACKGROUND: Women veterans are generally less healthy than their nonveteran female counterparts or male veterans. Accumulating evidence suggests there may be barriers to women veterans’ access to and use of Veterans Health Administration (VHA) care. OBJECTIVE: To document perceived and/or actual barriers to care in a nationally representative sample of women veterans and examine associations with VHA use. DESIGN: Cross-sectional telephone survey. PARTICIPANTS: Women who are current and former users of VHA from VA’s National Registry of Women Veterans. MEASUREMENTS: Assessments of perceptions of VHA care, background characteristics, and health service use. RESULTS: Perceptions of VHA care were most positive regarding facility/physical environment characteristics and physician skill and sensitivity and least positive regarding the availability of needed services and logistics of receiving VHA care (M=0.05 and M=−0.10; M=−0.23 and M=−0.25, respectively). The most salient barrier to the use of VHA care was problems related to ease of use. Moreover, each of the barriers constructs contributed unique variance in VHA health care use above and beyond background characteristics known to differentiate current users from former VHA users (Odds ratio [OR]=4.03 for availability of services; OR=2.63 for physician sensitivity and skill: OR=2.70 for logistics of care; OR=2.30 for facility/physical environment). Few differences in barriers to care and their association with VHA health care use emerged for women with and without service-connected disabilities. CONCLUSIONS: Findings highlight several domains in which VHA decisionmakers can intervene to enhance the care available to women veterans and point to a number of areas for further investigation.

Effects of military trauma exposure on women veterans' use and perceptions of Veterans Health Administration care.

BackgroundFew studies have addressed how military trauma exposure, particularly sexual assault and combat exposure, affects women veterans’ use and perceptions of Veterans Health Administration (VHA) care.ObjectiveThe aim of the present study was to evaluate the effects of military sexual assault and combat exposure on women veterans’ use and perceptions of different aspects of VHA care.DesignCross-sectional telephone survey of a national sample of women veterans.ParticipantsWomen from the VA’s National Registry of Women Veterans.MeasurementsSociodemographic characteristics, VHA care utilization, perceptions of care.ResultsWomen veterans with histories of military sexual assault reported more use of VHA services, but less satisfaction, poorer perceptions of VHA facilities and staff, and more problems with VHA services compared to women veterans without histories of sexual assault. Combat exposure was related to more problems with VHA staff, although few other differences were observed for women with and without histories of combat exposure.ConclusionsFindings provide information on areas that can be targeted with respect to caring for women veterans exposed to military sexual trauma and combat exposure, including improving interactions with VHA staff and the ease of using VHA services.