Kathrine Sullivan

Substance Abuse and Other Adverse Outcomes for Military-Connected Youth in California: Results From a Large-Scale Normative Population Survey

IMPORTANCE Military families and military-connected youth exhibit significant strengths; however, a sizeable proportion of these families appear to be struggling in the face of war-related stressors. Understanding the consequences of war is critical as a public health concern and because additional resources may be needed to support military families. OBJECTIVE To determine whether rates of adverse outcomes are higher for military-connected adolescents during war compared with nonmilitary peers. DESIGN, SETTING, AND PARTICIPANTS This study is a secondary data analysis of a large, normative, and geographically comprehensive administrative data set (2013 California Healthy Kids Survey) to determine whether military-connected youth are at risk for adverse outcomes, including substance use, experiencing violence and harassment, and weapon carrying, during wartime. These outcomes are of particular concern because they affect socioemotional adjustment and academic success. Data were collected in March and April 2013 and participants included 54,679 military-connected and 634,034 nonmilitary-connected secondary school students from public civilian schools in every county and almost all school districts in California. MAIN OUTCOMES AND MEASURES Outcomes included lifetime and recent use of alcohol, tobacco, marijuana, prescription medications, and other drugs, as well as experiences of physical and nonphysical violence and harassment and weapon carrying during the last year. RESULTS Multivariable logistic regression models indicated that military-connected youth had greater odds of substance use, experience of physical violence and nonphysical harassment, and weapon carrying. For example, military-connected youth had 73% greater odds of recent other drug use (eg, cocaine and lysergic acid diethylamide; odds ratio [OR], 1.73; 95% CI, 1.66-1.80) and twice the odds of bringing a gun to school (OR, 2.20; 95% CI, 2.10-2.30) compared with nonmilitary-connected peers. Their odds of being threatened with a weapon or being in a fight were also significantly higher than their civilian counterparts (OR, 1.87; 95% CI, 1.80-1.95 and OR, 1.67; 95% CI, 1.62-1.71, respectively). CONCLUSIONS AND RELEVANCE Most military-connected youth demonstrate resilience. However, results suggest that during wartime, military-connected youth are at increased risk for adverse outcomes. Further, when compared with data from 2011, the rates of these negative outcomes appear to be increasing. These findings suggest a need to identify and intervene with military-connected adolescents and reflect a larger concern regarding the well-being of military families during wartime.

PTSD symptoms, suicidality and non-suicidal risk to life behavior in a mixed sample of pre- and post-9/11 veterans

ABSTRACT This study investigated relationships between symptom clusters of posttraumatic stress disorder (PTSD), suicidal ideation, suicide plan, and non-suicidal risk to life behavior (NSRB) behavior in a sample of 1,356 pre- and post-9/11-era military veterans. After controlling for a positive PTSD screen, results indicated that suicidal ideation was significantly associated with re-experiencing symptoms (OR = 1.12), White race (OR = 1.82) and use of pain medication (COR = 1.62). Suicide plan was associated with avoidance symptoms (OR = 1.08), and NSRB with hyperarousal symptoms (OR = 1.11) and severe alcohol use (OR = 2.10). Standardized coefficients indicated that re-experiencing symptoms (b = .38) were a stronger predictor of suicidal ideation than White race (b = .16) or pain medication (b = .12) and that hyperarousal symptoms (b = .36) were a stronger predictor of NSRB than severe alcohol use (b = .15). The interpersonal–psychological theory of suicide was used to frame a discussion of military specific suicide risk as well as the risk of premature death among veterans who endorse NSRB but not suicidality. We suggest that this subset of veterans may be overlooked by traditional screening methods while nonetheless presenting with great risk for premature death.

PTSD and Physical Health Symptoms Among Veterans: Association with Child and Relationship Functioning

ABSTRACT This study examines the association between veterans’ physical and mental health symptoms and perceptions of adverse child and relationship functioning. Veteran responses to the PHQ-15, assessing physical health; the PCL-C, assessing PTSD symptoms; and reports of family challenges were drawn from a countywide veterans survey. Findings indicate physical health (OR = 1.048; 95% CI, 1.002, 1.098) and post-traumatic stress disorder (PTSD) symptomatology (OR = 1.019; 95% CI, 1.004, 1.034) independently predicted increased child difficulties. Similarly, physical health (OR = 1.081; 95% CI, 1.012, 1.154) and PTSD symptoms (OR = 1.043; 95% CI, 1.022, 1.065) independently impacted relationship difficulties. Using standardized coefficients to compare, PTSD symptoms were a stronger predictor across both models. Results highlight the dual importance of assessing both veterans’ physical and mental health symptoms to understand family functioning. Additionally, these findings underscore the importance of longitudinal research, which can follow families beyond separation from the military.

Attitudes, Norms, and the Effect of Social Connectedness on Adolescent Sexual Risk Intention

BACKGROUND Risky sexual behaviors put adolescents at increased risk of adverse outcomes. Parents, school-based adults, and peers play important roles in influencing these sex intentions. METHODS This work explored the influence of parent-child sex communication on adolescent attitudes, perceived norms, and intentions to have sex, including the moderating role of social support from school-based adults, in a sample of 21,731 adolescents in California. RESULTS Although increased parent-child sex communication was associated with intentions to have sex, it also exhibited protective effects, increasing abstinence attitudes among youth that led to decreased intention directly and via support from school-based adults. CONCLUSIONS Although many factors influencing sexual behaviors are largely intrapersonal, these findings indicate the importance of an ecological approach to reducing adolescent sexual risk behaviors through engagement of parents and increased school connectedness.

Adult Relationships in Multiple Contexts and Associations with Adolescent Mental Health

Purpose: Adult relationships provide critical support for adolescents because of their potential to foster positive development and provide protective influences. Few studies examine multiple ecological layers of adult relationships in connection with well-being and depression. This study examines the influence of relationships from multiple contexts for adolescents and their mental health. Method: Data from the 2011 California Healthy Kids Survey was used for this analysis; a sample of 7th-, 9th-, and 11th-grade students (N = 14,931) was drawn from 6 school districts in Southern California. Results: Regression analyses revealed that parent, teacher, and community adult support were all significantly positively associated with well-being and significantly negatively associated with depression. Discussion: Social support explained more variance in well-being than in depression, indicating that adult support may be more important for supporting well-being. This study supports the belief that individual categories and combinations of adult support are important.

STD and Abortion Prevalence in Adolescent Mothers With Histories of Childhood Protection Involvement

CONTEXT Early sexual debut and unprotected sexual activity place adolescents at risk of adverse sexual health outcomes. Adolescents involved with child protective services (CPS) may be a particularly vulnerable population. METHODS California birth records for 86,946 adolescents who became first-time mothers in 2008-2010 were probabilistically linked to statewide CPS records from 1998 and later. The prevalence of STDs at birth and of abortion history were explored by preconception CPS involvement. Generalized linear models, adjusted for health, socioeconomic and demographic characteristics, were used to assess correlates of current STDs and history of abortion. RESULTS At the time they gave birth, 1% of adolescents had a documented STD, and 5% reported a previous abortion. After adjustment for other characteristics, CPS involvement was associated with a significantly elevated prevalence both of STDs (relative risk, 1.2) and of previous abortion (1.4). Other characteristics also were associated with both outcomes, but not always in the same direction. For example, delaying prenatal care until after the first trimester or getting none at all was associated with an increased prevalence of STDs (1.3), but a reduced prevalence of abortion (0.8-0.9); having public insurance coverage for the birth was associated with a reduced STD prevalence (0.9) and an elevated abortion history prevalence (1.2). CONCLUSIONS To assess whether adolescents with a history of CPS involvement need targeted sexual health interventions, further research is needed on the mechanisms that underlie associations between CPS involvement and adverse sexual health outcomes.

Military Families Research: Department of Defense Funding and the Elements of a Fundable Proposal

This chapter focuses on describing the basics of DOD’s research funding process, including a review of the Psychological Health Research Continuum (Castro, Eur J Psychotraumatol, 5:1–12, 2014), as it pertains to military families research. We discuss important elements of a fundable research proposal from the perspective of the DOD, including a review of relevant family theories with the goal of providing a useful framework for future proposals aimed at addressing gaps in the military families knowledge base. Lastly, we discuss challenges in military families research including ethical issues and the time and costs associated with conducting research with military families.

The association of parentification indicators with substance use patterns among military-connected adolescents.

Military-connected youths are a vulnerable population exposed to a unique set of stressors, which may put them at increased risk for adverse mental and behavioral health outcomes, compared to their civilian counterparts. Among military-connected adolescents, emotional and instrumental parentification are mechanisms hypothesized to account for negative outcomes, including substance use. However, parentification may be protective in some cultures and has not been examined in the military population. Data were drawn from 1,441 7th-, 9th-, and 11th-graders who had a parent in the military and completed the 2013 California Healthy Kids Survey. Latent class analysis was used to examine patterns of instrumental parentification indicators among military-connected youths and associated patterns of substance use. Military-connected students in the high parentification class were significantly less likely to be in the frequent polysubstance using class (odds ratio = 0.376, 95% confidence interval [0.180, 0.782]). Findings suggest that experiences of instrumental parentification, including having more responsibilities at home, being more independent, and being able to solve problems better than peers, may be protective. For military-connected youths, these skills, developed in the context of their families, may translate to better coping with other stressful situations. Professionals may be able to build on these strengths and develop adaptive coping strategies to support military-connected youths in managing the stressors of wartime military life. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

The Influence of Social Support on Dyadic Functioning and Mental Health Among Military Personnel During Postdeployment Reintegration

Objectives: Although many service members successfully cope with exposure to stress and traumatic experiences, others have symptoms of depression, posttraumatic stress disorder (PTSD), and anxiety; contextual factors may account for the variability in outcomes from these experiences. This work sought to understand mechanisms through which social support influences the mental health of service members and whether dyadic functioning mediates this relationship. Methods: We collected cross-sectional data as part of a larger study conducted in 2013; 321 military personnel who had at least 1 deployment were included in these analyses. Surveys were completed online; we collected data on demographic characteristics, social support, mental health measures (depression, PTSD, and anxiety), and dyadic functioning. We performed process modeling through mediation analysis. Results: The direct effects of social support on the mental health of military personnel were limited; however, across all types of support networks, greater social support was significantly associated with better dyadic functioning. Dyadic functioning mediated the relationships between social support and depression/PTSD only when social support came from nonmilitary friends or family; dyadic functioning mediated social support and anxiety only when support came from family. We found no indirect effects of support from military peers or military leaders. Conclusion: Findings here highlight the need to continue to explore ways in which social support, particularly from family and nonmilitary-connected peers, can bolster healthy intimate partner relationships and, in turn, improve the well-being of military service members who are deployed.

The Role of Service Member Mental Health and Marital Satisfaction in Postdeployment Family Reintegration

ABSTRACT The postdeployment period is critical for National Guard members readjusting to the family unit. This study sought to determine whether marital satisfaction protects against reintegration difficulties. Army National Guard members (N = 114) who recently returned from a 12-month deployment to Iraq completed mental health, marital satisfaction, and family reintegration assessments. Linear and ordinary least squares regression models were used. Although few service members reported symptoms of depression, anxiety, and posttraumatic stress disorder exceeding clinical cutoff points, marital satisfaction significantly moderated the relationship between service member mental health and family reintegration. These findings highlight the potentially protective role of satisfying and supportive marital relationships. Results have implications for the health of service members and well-being of military families after a combat deployment.