James E. McCarroll

Suicide among soldiers: a review of psychosocial risk and protective factors.

Suicide is difficult to predict and prevent and remains a leading cause of death worldwide. Although soldiers historically have had a suicide rate well below that of the general population, the suicide rate among members of the U.S. Army has increased markedly over the past several years and now exceeds that of the general population. This paper reviews psychosocial factors known to be associated with the increased risk of suicidal behavior in general and describes how some of these factors may be especially important in understanding suicide among soldiers. Moving forward, the prevention of suicide requires additional research aimed at: (a) better describing when, where, and among whom suicidal behavior occurs, (b) using exploratory studies to discover new risk and protective factors, (c) developing new methods of predicting suicidal behavior that synthesize information about modifiable risk and protective factors from multiple domains, and (d) understanding the mechanisms and pathways through which suicidal behavior develops. Although the scope and severity of this problem is daunting, the increasing attention and dedication to this issue by the Armed Forces, scientists, and society provide hope for our ability to better predict and prevent these tragic outcomes in the future.

The nature of a traumatic stressor: handling dead bodies.

The Nature of a Traumatic Stressor: Handling Dead Bodies Robert Ursano;James McCarroll; The Journal of Nervous and Mental Disease

Positive and Negative Consequences of a Military Deployment

This study determined the perception by 951 U.S. Army soldiers of positive and negative consequences of a peacekeeping deployment to Bosnia. Seventy-seven percent reported some positive consequences, 63% reported a negative consequence, and 47% reported both. Written comments were also provided. Of the 951 soldiers, 478 wrote at least one positive comment and 403 at least one negative comment. Single soldiers were more likely than married soldiers to report positive consequences (82% vs. 72%). Married soldiers were more likely than single soldiers to report negative consequences (70% vs. 55%). Positive consequences included making additional money, self-improvement, and time to think. Negative consequences included the military chain of command, being away from home, and deterioration of marital/significant other relationships.

Postdeployment Domestic Violence by U.S. Army Soldiers

The objective of this study was to determine whether a military deployment of 6 months predicted domestic violence against the wives of deployed and nondeployed soldiers during the postdeployment period. The method involved the completion of an anonymous questionnaire by a sample of the spouses of soldiers deployed from a large U.S. Army post. The Conflict Tactics Scale identified incidents of domestic violence by the soldier husbands, and a logistic regression model predicted domestic violence during the postdeployment period. The results indicate that deployment was not a significant predictor of domestic violence during the first 10 months of the postdeployment period. Younger wives and those who were victims of predeployment domestic violence were more likely to report postdeployment domestic violence. The conclusion was that interventions for domestic violence in the U.S. Army should address risks among younger couples and those with a previous incident of domestic violence.

Drinking and Spouse Abuse Among U.S. Army Soldiers

BACKGROUND This study examines the relationship between typical weekly drinking and perpetration of spouse abuse as well as the relationship between the perpetrators typical weekly drinking and alcohol use during the abuse event among U.S. Army male soldiers. METHODS Cases include all active duty, male, enlisted Army spouse abusers identified in the Armys Central Registry who had also completed an Army Health Risk Appraisal Survey (HRA) between 1991 and 1998 (N = 9534). Cases were matched on sex, rank, and marital status with 21,786 control subjects who had also completed an HRA. RESULTS In multivariate logistic regression models, heavy drinkers (22 or more drinks per week) were 66% more likely to be spouse abusers than were abstainers (odds ratio 1.66; 95% confidence interval 1.40-1.96). In addition, self-reported moderate and heavy drinkers were three times as likely and light drinkers (1-7 drinks per week) were twice as likely as nondrinkers to be drinking during the time of the abuse event. CONCLUSION Self-reported heavy drinking is an independent risk factor for perpetration of spouse abuse among male, enlisted Army soldiers. Even 5 years or more after ascertainment of typical drinking habits, there is a significant association between self-reported heavy drinking and alcohol involvement at the time of the spouse abuse event. Personnel who work with perpetrators and victims of spouse abuse should be trained carefully to query about current and typical drinking patterns.

Child emotional maltreatment: a 2-year study of US Army cases.

OBJECTIVE Reports of childhood emotional maltreatment have increased greatly over the past decade. The objective of this research was to determine the types of emotional maltreatment substantiated in a community of US Army families residing temporarily in Germany. Such a description may help to improve the understanding of how a jurisdictional body defines emotional maltreatment in day-to-day practice. METHOD Data were obtained from a review of the minutes of case review committees (CRCs) for 181 cases of child emotional abuse in 1997-1998. We determined the type, number, and severity of incidents, the substantiation rate, and the situations to which children were exposed. RESULTS The most frequently substantiated type of incident was witnessing domestic violence, 60% of all cases. Primary emotional abuse was found in 26% of cases, while emotional abuse in conjunction with child physical abuse or child neglect was found in 14% of cases. The more severe the case, the more likely it was to be substantiated. CONCLUSIONS Emotional maltreatment was substantiated more as a single type than in combination with other forms of maltreatment. Seeing emotional abuse as a single entity may allow clinicians to focus on a relationship or situation (such as spouse abuse) that is potentially harmful to a child. However, recognizing the emotionally abusive aspects of child physical abuse and neglect could allow an expanded treatment plan that could include treatment of the emotionally abusive behavior to strengthen the relationship of the caregiver to the child, in addition to the focus on the physical abuse and neglect.

Somatic symptoms in Gulf War mortuary workers.

Objective The objective of this article is to examine the relationship between exposures to the dead and the development of somatic symptoms. Methods We studied the pre-post responses of 352 military men and women who worked in the mortuary that received the dead from the Persian Gulf War (Operation Desert Storm) in 1990 to 1991. Symptoms of somatization were measured before and after exposure to the dead. The respondents were volunteers and nonvolunteers for assignment to the mortuary; some had prior experience in handling the dead and some did not. Four groups of participants were examined based on the degree of exposure to remains. Age, sex, volunteer status, prior experience handling remains, and preexposure measures of depression and mutilation fear were statistically controlled. Results Postexposure somatic symptoms increased significantly over preexposure levels for the two groups with the most exposure to the dead. Conclusions These results provide additional evidence that exposure to the dead is related to somatic distress.

Spouse abuse recidivism in the U.S. Army by gender and military status

Recidivism by spouse abusers was investigated using records of offenders in the U.S. Army Central Registry. Recidivism by gender and military status (active-duty or civilian spouse) was compared over a 70-month period. Between fiscal years 1989-1997, 48,330 offenders were identified in initial and recidivist incidents. Recidivism was analyzed by means of a Cox proportional hazard rate model, controlling for age, race, number of dependents, education, and substance abuse. Two different sets of survival curves were obtained: (a) Men were much more likely than women to have a recurrence and (b) within gender, civilians were more likely to have a recurrence than were active-duty military personnel. At 70 months, 30% of the male civilian offenders and 27% of the male active-duty offenders had committed a subsequent spouse abuse incident compared with 20% of the female civilian offenders and 18% of the female active-duty offenders, controlling for other variables.

Patterns of mutual and nonmutual spouse abuse in the U.S. Army (1998-2002).

The pattern and severity of substantiated mutual and nonmutual spouse abuse between U.S. Army enlisted personnel and their spouses was determined for 1998 to 2002. The number of nonmutual and mutual abuse victims was equal in 1998, but by 2002 there were about twice as many non mutual as mutual victims. The rate per thousand of mutual abuse decreased by 58% while that of nonmutual abuse decreased by 13%. The rate per thousand of female victims was always greater than male victims for non-mutual abuse and the severity of abuse of female victims was always more severe than male victims. The active duty female had the highest risk of becoming a victim. These patterns of mutual and nonmutual domestic abuse in the U.S. Army suggest that prevention and educational approaches could be developed that would be useful to prevention specialists and to clinicians as the Army pursues avenues to reduce domestic violence.

Comparison of U.S. Army and civilian substantiated reports of child maltreatment

Little is known about the similarities and differences between civilian and military child maltreatment cases and no recent study has compared them directly. Understanding the nature of the problems in each could lead to identifying strengths and weaknesses for the development of more helpful prevention and treatment programs. The overall rates of child maltreatment in the U.S. civilian population (14.7 to 11.8 per 1,000) were about double the Army rates (7.6 to 6.0 per 1,000) from 1995 to 1999. These differences were largely because of the higher rate of neglect in the U.S. data—about three times that of the Army—and may be because of factors that are largely controlled in the Army such as poverty, severe substance abuse, homelessness, and other social variables. For 1999 only, we examined the type of maltreatment by age and sex, the victim rates by race/ethnicity, and the relationship of perpetrator to victim.