Keith D. Renshaw

The relation between child maltreatment and adolescent suicidal behavior: a systematic review and critical examination of the literature

A large body of research suggests that child maltreatment (CM) is associated with adolescent suicidal ideation and attempts. These studies, however, have not been critically examined and summarized in a manner that allows us to draw firm conclusions and make recommendations for future research and clinical work in this area. In this review, we evaluated all of the research literature to date examining the relationship between CM and adolescent suicidal ideation and attempts. Results generally suggest that childhood sexual abuse, physical abuse, emotional abuse, and neglect are associated with adolescent suicidal ideation and attempts across community, clinical, and high-risk samples, using cross-sectional and longitudinal research designs. In most studies, these associations remain significant when controlling for covariates such as youth demographics, mental health, family, and peer-related variables. When different forms of CM are examined in the same multivariate analysis, most research suggests that each form of CM maintains an independent association with adolescent suicidal ideation and suicide attempts. However, a subset of studies yielded evidence to suggest that sexual abuse and emotional abuse may be relatively more important in explaining suicidal behavior than physical abuse or neglect. Research also suggests an additive effect—each form of CM contributes unique variance to adolescent suicide attempts. We discuss the current limitations of this literature and offer recommendations for future research. We conclude with an overview of the clinical implications of this research, including careful, detailed screening of CM history, past suicidal behavior, and current suicidal ideation, as well as the need for integrated treatment approaches that effectively address both CM and adolescent suicidal ideation and suicide attempts.

Combat exposure, psychological symptoms, and marital satisfaction in National Guard soldiers who served in Operation Iraqi Freedom from 2005 to 2006

Abstract In current military operations in Iraq and Afghanistan, US National Guard (NG) troops are serving longer deployments than ever before. Little is known, however, about how such deployments affect this population of individuals, relative to active component (AC) troops. This study investigated the extent of combat exposure, severity of post-deployment psychological symptoms, and general interpersonal functioning, as well as the interrelationships of these variables, in 50 NG soldiers who served a 12-month deployment in Iraq from 2005 to 2006. The results indicate that combat exposure and post-deployment post-traumatic stress symptoms in this sample are greater than those in NG veterans of past military operations, and similar to those of full-time soldiers in current operations. Furthermore, the patterns of interrelationships between combat exposure, psychological symptoms, and interpersonal variables were similar to those detected in prior research on AC troops. These results suggest that NG veterans of current military operations may require similar services as active duty veterans. Given that NG troops are less integrated into the military structure, specific outreach efforts may be needed to help NG veterans to receive such services.

Stigma and demographic correlates of help-seeking intentions in returning service members.

Many U.S. Iraq/Afghanistan-era veterans return from deployment with posttraumatic stress (PTS) symptoms, but few veterans seek psychological help. Research on barriers to care is growing, but the link between stigma and help-seeking is understudied. The present study examined anticipated enacted stigma from military and nonmilitary sources, self-stigma, PTS, perceived likelihood of deploying again, marital status, and history of mental health care engagement as correlates of help-seeking intentions from a mental health professional or medical doctor/advance practice registered nurse (MD/APRN) in a sample of 165 combat veterans. Using structural equation modeling, results demonstrated that self-stigma was negatively associated with help-seeking intentions from a mental health professional and MD/APRN with small-to-medium effect sizes. Being married was positively associated with help-seeking intentions from a mental health professional and MD/APRN with small effect sizes. History of previous mental health care engagement was positively associated with help-seeking intentions from a mental health professional with a medium effect size, but unrelated to help-seeking intentions from a MD/APRN. Anticipated enacted stigma from any source, PTS, and greater perceived likelihood of deploying again were unrelated to help-seeking intentions from a mental health professional and MD/APRN. Implications for interventions aimed at decreasing self-stigma and increasing intention to seek help are discussed.

An integrated model of risk and protective factors for post-deployment PTSD symptoms in OEF/OIF era combat veterans

BACKGROUND Few attempts have been made to integrate the known risk factors for combat-related posttraumatic stress disorder (PTSD) into a comprehensive model. This study investigated relative contributions of combat experiences, post-battle experiences, and perceptions of threat to post-deployment PTSD symptoms, and also examined whether pre-deployment preparedness moderated associations among these variables. METHODS Two hundred seven troops deployed to the Middle East between 2001 and 2008 completed self-report measures. Data were analyzed using path analysis and regressions. A comprehensive model including additive effects, mediation, and moderation was examined. RESULTS Perceptions of threat mediated the association of combat experiences with PTSD, but not that of post-battle experiences with PTSD. Sense of preparedness for deployment moderated the association of combat experiences with perceived threat, such that troops with low preparedness perceived high levels of threat regardless of combat exposure, whereas troops with high preparedness perceived levels of threat that were correlated with levels of combat. LIMITATIONS Data were cross-sectional, all assessment was retrospective self-report, and the sample was primarily White, male, and married. CONCLUSIONS Combat and post-battle experiences appear linked to PTSD via separate pathways. Thus, PTSD prevention efforts may need to vary based on types of events experienced. Pre-deployment preparation mitigated perceived threat in the context of low combat exposure, but it did not moderate direct associations of risk factors with PTSD symptoms. Thus, pre-deployment training and preparation do not appear sufficient to protect against PTSD.

Shame in the obsessive compulsive related disorders: A conceptual review

BACKGROUND Theoretical and anecdotal support for the role of shame in obsessive compulsive related disorders (OCRDs) is prominent. Developing our understanding of shame׳s role in OCRDs is important to building knowledge about this new diagnostic category. This review aims to consolidate our understanding of shame in each OCRD, through summarizing existing clinical, conceptual, and empirical work. METHODS We provide an overview of shame, its measurement considerations, and a full review of 110 articles addressing shame in OCRDs. RESULTS General shame and shame about having a mental illness are the broadest types of shame relevant to OCRDs; symptom-based shame and body shame may be more specific to OCRDs. In OCD, violent, sexual, or blasphemous obsessions may trigger symptom-based shame. In trichotillomania (TTM) and skin picking (SP), symptom-based shame may be related to pulling, picking, and post-pulling/picking behaviors. In hoarding disorder, symptom-based shame may accompany beliefs about being defective due to living with clutter. Body shame appears inherent to body dysmorphic disorder, while in TTM and SP it may arise as a secondary response to damage resulting from body focused repetitive behaviors. LIMITATIONS Much of the current knowledge on shame in OCRDs comes from anecdotal, case, and conceptual work. Empirical studies do not always assess specific types of shame, instead assessing shame as a general construct. CONCLUSIONS Shame is closely related to OCRDs. Clinical and research recommendations drawing from the literature are provided.

Internalizing and externalizing personality styles and psychopathology in OEF-OIF veterans.

Previous research with other trauma populations demonstrated that internalizing and externalizing personality styles are associated with different PTSD comorbidities. The present study tested this association in two distinct Operation Enduring Freedom-Operation Iraqi Freedom (OEF/OIF) combat samples. Cluster analysis was used to categorize subtypes, which were compared on measures of PTSD, depression, anxiety, and substance use. Internalizers showed the highest rates of PTSD and depression. Externalizers had higher rates of alcohol problems in one sample only, whereas the other sample showed more substance misuse. In general, these findings suggest that this method of classifying trauma survivors is useful in OEF/OIF populations. Results suggest some differences across this population in terms of how substance use issues are expressed in externalizers.

The utility of the relationship assessment scale in multiple types of relationships

Several self-report scales of marital satisfaction exist, but many are too lengthy for research protocols, and none allow for parallel assessment of satisfaction in non-romantic relationships. This paper presents results from the assessment of satisfaction in multiple types of close relationships with slight adaptations to the wording of the seven-item Relationship Assessment Scale. This scale was tested in a series of four research protocols with over 1000 undergraduate students. The scale demonstrated good internal consistency, item reliabilities, test—retest reliability, and factorial validity across diverse types of close relationships, with preliminary evidence supporting its convergent and predictive validity as well. These results suggest that the Relationship Assessment Scale can briefly and adequately assess satisfaction in multiple types of relationships.

Associations of coping processes with posttraumatic stress disorder symptoms in national guard/reserve service members deployed during the OEF-OIF era

Studies have identified coping processes as one potential factor influencing PTSD in veterans. This study examined the associations between coping, combat exposure, and PTSD among 218 National Guard veterans deployed overseas since 2001. Problem-focused coping was unrelated to combat exposure and PTSD symptoms. In contrast, increased levels of emotion focused coping (EFC) were found in veterans who reported higher levels of combat exposure. Moreover, the severity of combat was a curvilinear moderator of the relation between coping process and PTSD, such that EFC was unrelated to PTSD symptom severity at low levels of combat, associated with higher symptom severity at moderate levels of combat, and associated with lower symptom severity at high levels of combat. These findings indicate that the type and severity of trauma may moderate the association of coping and psychological outcomes, and that these associations might not be linear.

Posttraumatic Stress and Stigma in Active‐Duty Service Members Relate to Lower Likelihood of Seeking Support

Posttraumatic stress disorder (PTSD) is a common mental health concern for returning service members. Social support is a robust predictor of resiliency and recovery from PTSD; however, barriers to seeking support are understudied. PTSD and anticipated enacted stigma from family and friends were explored as correlates of the likelihood of seeking support among 153 Iraq/Afghanistan U.S. service members. Results showed that PTSD (r = -.31, p < .001) and anticipated enacted stigma (r = -.22, p ≤ .01) were negatively associated with likelihood of seeking support. Post hoc analyses showed that only dysphoria (r = -.32, p < .001) was significantly related to the likelihood of seeking support after accounting for anticipated enacted stigma and other PTSD clusters. Implications of these findings and ways to increase likelihood of seeking support are discussed.

Personality traits as moderators of the associations between deployment experiences and PTSD symptoms in OEF/OIF service members

Abstract This investigation examined traits from the five-factor model of personality as moderators of the associations of combat and aftermath of battle experiences with symptoms of posttraumatic stress disorder (PTSD) in 214 National Guard/Reserve service members deployed to operations enduring and Iraqi freedom. Extraversion significantly moderated the associations of both combat experiences and aftermath of battle experiences with PTSD severity, with associations weakening as levels of extraversion increased. The relation between aftermath of battle experiences and PTSD was also moderated by the other four personality factors, with the relation being weaker at higher levels of agreeableness, conscientiousness, and openness, and lower levels of neuroticism. These results suggest that personality traits may impact individual responses to war trauma, particularly war-related experiences that are not directly threatening to ones safety (i.e., aftermath of battle events vs. actual combat events). Although this investigation was cross-sectional, these findings indicate that personality traits are an important risk/resiliency factor to consider in peoples responses to traumatic events.