James O. E. Pittman

Post-traumatic stress disorder, depression, and health-related quality of life in OEF/OIF veterans

PurposeComorbid post-traumatic stress disorder (PTSD) and depression are often associated with negative physical and mental health outcomes in Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF) combat veterans. The current study examines the individual contributions of these two disorders on health-related quality of life (HRQoL) in an OEF/OIF cohort. The study hypothesizes that PTSD and depression will each significantly predict lower physical and mental HRQoL even when controlling for overlapping symptoms: anhedonia, concentration, and insomnia.MethodParticipants were 220 OEF/OIF combat veterans who completed an interview and self-report questionnaires examining study variables. All study hypotheses were tested with multiple regression analyses.ResultsPTSD and depression significantly contributed to mental and physical HRQoL, even after controlling for overlapping symptoms. However, while independent main effects of PTSD and depression, with and without overlapping symptoms, emerged for predicting mental HRQoL, no significant independent main effects emerged for predicting physical HRQoL.ConclusionFindings suggest PTSD and depression contribute uniquely to the negative relationship with HRQoL, adding to the growing literature on distinctive and common effects of these disorders in OEF/OIF veterans. Results highlight the need to better understand the implications for assessment and treatment.

Female veterans of the OEF/OIF conflict: Concordance of PTSD symptoms and substance misuse

This study examined the post-deployment rates of comorbid PTSD and substance abuse in a cohort of female veterans who served in Operation Enduring Freedom and Operation Iraqi Freedom (OEF/OIF). Female OEF/OIF veterans and reservists (N=36) completed a battery of assessments as part of a larger study. Of the 36 participants, 11 (31%) screened positive for posttraumatic stress disorder (PTSD), 17 (47%) screened positive for high-risk drinking and 2 (6%) screened positive for drug abuse. Higher scores on measures of alcohol and drug use predicted positive PTSD status (p < or = 0.01) and alcohol misuse was significant in explaining unique variance of PTSD status (p < or = 0.05). Our findings suggest a trend toward increased problematic drinking among female OEF/OIF veterans and reservists and a relationship between substance misuse and PTSD. Future research should investigate needs for gender-specific PTSD and substance-abuse treatment needs.

Veterans health administration vocational services for operation iraqi freedom/operation enduring freedom veterans with mental health conditions

High rates of mental health conditions and unemployment are significant problems facing Veterans of Operation Iraqi Freedom/Operation Enduring Freedom (OIF/OEF). We examined two national Veterans Health Administration (VHA) databases from fiscal years 2008-2009: a larger database (n = 75,607) of OIF/OEF Veterans with posttraumatic stress disorder, depression, substance use disorder, or traumatic brain injury (TBI) and a smaller subset (n = 1,010) of those Veterans whose employment was tracked during their participation in VHA vocational services. Only 8.4% of Veterans in the larger database accessed any vocational services and retention was low, with most Veterans attending one or two appointments. Veterans with TBI and with more mental health conditions overall were more likely to access vocational services. Only 2.2% of Veterans received evidence-based supported employment. However, supported employment was effective, with 51% of those Veterans receiving it obtaining competitive work. Effect sizes quantifying the effect of supported employment provision on competitive work attainment, number of jobs, job tenure, and retention in vocational services were large. Given the high success rate of supported employment for these Veterans, additional supported employment specialists for this population would be expected to improve work outcomes for post-9/11 Veterans who want assistance returning to work.

Post-Traumatic Stress Disorder, Depression, and Aggression in OEF/OIF Veterans

Aggression is a problem among some combat veterans. Post-traumatic stress disorder (PTSD) is associated with physical aggression in veterans, and co-occurring depression increases the risk of committing aggressive acts. Few studies have examined the impact of PTSD on various forms of aggression. While using a standardized multidimensional measure of aggression, this study examines the impact of depressive symptoms on the relationship between PTSD and various forms of aggression in Operation Enduring Freedom or Operation Iraqi Freedom (OEF/OIF) veterans. Depressive symptoms are hypothesized to mediate the relationship between PTSD and four types of aggression: (1) physical aggression toward others, (2) physical aggression toward objects, (3) physical aggression toward self, and (4) verbal aggression. Seventy-two OEF/OIF veterans completed assessment batteries and clinical interviews upon enrollment into a postdeployment mental health clinic. Study results partially supported the study hypotheses; depressive symptoms indirectly mediated the relationship between PTSD and two forms of aggression: verbal aggression and physical aggression toward self. In contrast to some prior studies of intimate partner violence in veterans with PTSD, no mediation relationship between depression and physical aggression toward others was found. Study results have implications for the development of interventions to treat aggressive behaviors in OEF/OIF veterans with PTSD and depression.

Differential impact of combat on postdeployment symptoms in female and male veterans of Iraq and Afghanistan

OBJECTIVES We aimed to describe differences in combat experience for male and female veterans and characterize differential effects on postdeployment physical and mental health symptoms, including aggression. METHODS Retrospective cross-sectional health screening data from 554 Operation Enduring Freedom and Operation Iraqi Freedom veterans who enrolled for Veterans Affairs health care in San Diego were examined including measures of combat experience, pain intensity, traumatic brain injury symptoms, military sexual trauma, post-traumatic stress disorder, depression, alcohol use, and aggression. RESULTS Although male veterans (n = 458) experienced significantly higher rates of combat than female veterans (n = 96), both experienced similar levels of postdeployment post-traumatic stress disorder and depression symptoms as well self-reported aggressive behavior compared to male veterans. Female veterans had higher rates of military sexual trauma and lower alcohol consumption than male veterans. CONCLUSIONS All Operation Enduring Freedom and Operation Iraqi Freedom veterans returning from deployment may benefit from broad-based screening of physical and mental health symptoms, beyond those currently mandated by Veterans Affairs, including anger and aggression.

Evaluating the effectiveness of a consumer delivered anti-stigma program: replication with graduate-level helping professionals.

OBJECTIVE This study evaluated a consumer delivered anti-stigma presentation, In Our Own Voice (IOOV), with Masters of Social Work (MSW) students, replicating a previous study with undergraduates. METHODS Thirty MSW students completed pre and post surveys to measure changes in attitude, knowledge and social distance after the presentation. RESULTS Paired samples t-tests showed increases in attitude (p < .001), knowledge (p < .05), and social distance (p < .001). Compared with previous research on undergraduate students, MSW students scored higher on all three pre-test measures (all p < .001). CONCLUSIONS The results further support the effectiveness of IOOV and indicate that graduate level helping professionals can benefit from anti-stigma programs. Future research should go beyond self-report knowledge and attitude evaluation, test the efficacy of the components of the IOOV program (video, contact with presenters), and test the lasting effects of the program.

Associations of military sexual trauma, combat exposure, and number of deployments with physical and mental health indicators in Iraq and Afghanistan veterans.

Trauma exposure (TE) and numerous deployments have been associated with negative health outcomes in veterans, many of whom have military sexual trauma (MST) and combat exposure (CE). The aims of this study were to examine the relationships between physical and mental health symptoms with MST and CE and number of deployments. Iraq and Afghanistan veterans at the Veterans Affairs San Diego Healthcare System completed self-report measures for MST, CE, number of deployments, posttraumatic stress disorder (PTSD) symptoms, depression symptoms, alcohol use, somatic symptoms, health functioning, and body mass index (BMI). Regression analyses examined main and interaction effects of CE and MST and the linear and quadratic trends of number of deployments. The sample (N = 1,294) had a mean age of 31 and was 85% male. The MST by CE interaction on BMI was significant (p = .005), such that MST was associated with lower BMI in veterans with CE and with higher BMI in veterans without CE. MST and CE were associated with higher somatic, PTSD, and depression symptoms and with lower mental health functioning (ps < .001 to .002). CE was associated with lower physical health functioning and higher alcohol use (ps < .001 to .025). Number of deployments was linearly related to higher BMI (p = .004) and had a quadratic association with alcohol use (p = .008). Findings highlight the relationship between TE and poor health outcomes and the need to further study the mechanisms of TE on physical and mental health.

Alcohol-Related Consequences Mediating PTSD Symptoms and Mental Health–Related Quality of Life in OEF/OIF Combat Veterans

Veterans returning from Operation Enduring Freedom and Operation Iraqi Freedom (OEF/OIF) have been found to be at increased risk for post-traumatic stress disorder (PTSD) and alcohol use disorders, leading to negative mental health-related quality of life (MHRQoL). The current study examined the unique impact of alcohol consumption levels versus alcohol-related consequences on the relationship between PTSD symptoms and MHRQoL in a sample of OEF/OIF combat veterans (N = 205, median age 29, 95% men). Mediation analyses indicated that the effect of PTSD symptoms on MHRQoL was explained only by alcohol-related consequences and not by alcohol consumption. Findings highlight the importance of including alcohol-related consequences in clinical assessment and intervention programs for OEF/OIF veterans. Additionally, this study enhances knowledge regarding the underlying mechanisms of functional impairment related to PTSD and alcohol use disorders.

Latino Veterans with PTSD: A Systematic Review.

Latinos have a long history of military service with recent service including combat conditions and multiple deployments, which are highly associated with posttraumatic stress disorder (PTSD). Clinical acumen underscores the importance of culture in assessment and treatment, but there has been little scientific literature that investigates the unique needs of veteran Latinos with PTSD. The primary goal of this systematic review was to analyze the existing literature on Latino veterans with PTSD and to critically evaluate attention to cultural issues. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses were used to guide this review. Peer-reviewed, research reports written in English on Latino Veterans with PTSD since 1980 were included; 20 were assessment related, and nine were treatment related. All studies were quantitative. Only 13 studies mentioned culture as part of the context for Latino veterans, and only seven included cultural factors as part of the study design. Present findings highlight a lack of research focused on understanding cultural factors related to the assessment and treatment of Latino veterans with PTSD. Culturally-informed research on Latino veterans from current wars, Latina veterans and Latino veteran treatment outcomes are necessary to provide culturally-appropriate care to this growing veteran subgroup.

Combat exposure and pain in male and female Afghanistan and Iraq veterans: The role of mediators and moderators

Veterans experience physical health problems associated with disability and poor quality of life following combat exposure (CE). Understanding the CE-physical health relationship, specifically pain intensity and somatic pain, may inform etiological models and interventions. This study examined the CE-pain relationship, associated mediators, and gender as a moderator. 2381 veterans at the VA San Diego Healthcare System completed paper or electronic self-report measures of pain intensity and somatic pain. Analyses examined associations of pain with CE and posttraumatic stress disorder (PTSD), depression, and resilience as mediators of the CE-pain association. Moderated mediation models explored gender as a moderator of significant mediated pathways. Controlling for age, veterans with CE had significantly higher pain intensity and somatic pain, and PTSD and depression scores significantly mediated the CE-pain relationships. Gender significantly moderated the CE-pain intensity association through depression scores such that the indirect effect was stronger for female veterans relative to male veterans. CE is associated with pain intensity and somatic pain, with greater levels of PTSD and depression mediating the CE-pain link and gender moderating the depression mediated CE-pain association. Future studies should examine gender differences and mediators in the CE-pain relationships using longitudinal designs to inform etiological models and targeted pain interventions.