Kent D. Drescher

An Exploration of the Viability and Usefulness of the Construct of Moral Injury in War Veterans

It is widely recognized that, along with physical and psychological injuries, war profoundly affects veterans spiritually and morally. However, research about the link between combat and changes in...

Relationships among PTSD symptoms, social support, and support source in veterans with chronic PTSD

The present study examined the temporal relationship between posttraumatic stress disorder (PTSD) and social support among 128 male veterans treated for chronic PTSD. Level of perceived interpersonal support and stressors were assessed at two time points (6 months apart) for four different potential sources of support: spouse, relatives, nonveteran friends, and veteran peers. Veteran peers provided relatively high perceived support and little interpersonal stress. Spouses were seen as both interpersonal resources and sources of interpersonal stress. More severe PTSD symptoms at Time 1 predicted greater erosion in perceived support from nonveteran friends, but not from relatives. Contrary to expectations, initial levels of perceived support and stressors did not predict the course of chronic PTSD symptoms.

Sixand Ten-Item Indexes of Psychological Distress Based on the Symptom Checist-90:

Clinicians, provider organizations, and researchers need simple and valid measures to monitor mental health treatment outcomes. This article describes development of 6and 10-item indexes of psychological distress based on the Symptom Checklist-90 (SCL-90). A review of eight factor-analytic studies identified SCL-90 items most indicative of overall distress. Convergent validity of two new indexes and the previously developed SCL-10 were compared in an archival sample of posttraumatic stress disorder patients (n = 323). One index, the SCL-6, was further validated with archival data on substance abuse patients (n = 3,014 and n = 316) and hospital staff (n = 542). The three brief indexes had similar convergent validity, correlating .87 to .97 with the SCL-90 and Brief Symptom Inventory, .49 to .76 with other symptom scales, and .46 to .73 with changes in other symptom measures over time. These results indicate the concise, easily administered indexes are valid indicators of psychological distress.

Causes of death among male veterans who received residential treatment for PTSD.

Previous studies have shown elevated mortality among psychiatric and substance abusing patients, including veterans with PTSD. Although early studies showed elevated deaths from external causes among Vietnam veterans in the early postwar years, more recent studies have also shown increased health problems among veterans with PTSD. This study compared mortality due to behavioral causes versus other diseases among 1,866 male veterans treated for PTSD. Death certificates obtained for 110 veterans indicated behavioral causes accounted for 62.4% of deaths, standardized mortality ratio = 3.4–5.5, including accidents (29.4%), chronic substance abuse (14.7%), and intentional death by suicide, homicide, or police (13.8%). Results suggest possible opportunities to improve outcomes of this at-risk patient population through harm reduction interventions and improved continuity of care.

Predicting high-risk behaviors in veterans with posttraumatic stress disorder.

The present study sought to identify posttraumatic stress disorder (PTSD) patients at high risk for negative behavioral outcomes (violence, suicide attempts, and substance use). The Mississippi Scale for Combat-Related PTSD, the Beck Depression Inventory, and demographic and behavioral data from 409 male combat veterans who completed a VA residential rehabilitation program for PTSD were analyzed using signal detection methods (receiver operating characteristics). A validation sample (N = 221) was then used to test interactions identified in the signal detection analyses. The best predictors of behaviors at follow-up were those same behaviors shortly before intake, followed by depressive and PTSD symptoms. However, for each of the models other than that for hard drug use, cutoffs determined at the symptom level did not lend themselves to replication. Recent high-risk behaviors, rather than patients’ history, appear to be more predictive of high-risk behaviors postdischarge.

Moral Injury Themes in Combat Veterans’ Narrative Responses From the National Vietnam Veterans’ Readjustment Study:

Spiritual changes, or “soul wounds,” have long been described as expectable consequences of combat, useful in understanding the profound changes in many surviving warriors. However, moral injury as a research construct has only recently been introduced into the combat trauma literature (Drescher et al., 2011), and it is in the early stages of construct validation. To extend validation efforts, the current study examined National Vietnam Veterans’ Readjustment Study (NVVRS) veterans’ narrative responses to questions about the lingering effects of their combat participation for themes consistent with moral injury as reported by combat trauma experts in the Drescher et al., (2011) study. Findings confirmed key experiences involving civilian deaths and betrayal as themes among NVVRS participants’ responses about their troublesome combat experiences.

Cannabis Use Among Military Veterans After Residential Treatment for Posttraumatic Stress Disorder

The present investigation prospectively evaluated whether treatment changes in PTSD symptom severity, among military Veterans in residential PTSD treatment, were related to cannabis use 4 months after discharge from residential rehabilitation. The sample was comprised of 432 male military Veteran patients (Mage = 51.06 years, SD = 4.17), who had a primary diagnosis of PTSD and were admitted to a VA residential rehabilitation program for PTSD. Results demonstrated that lower levels of change in PCL-M scores between treatment intake and discharge were significantly predictive of greater frequency of cannabis use at 4-month follow-up (p < .05), even after accounting for the effects of length of treatment stay and frequency of cannabis use during the 2 months before treatment intake. Furthermore, post hoc analyses revealed that less change in PTSD avoidance/numbing and hyperarousal symptom severity during treatment was significantly predictive of a greater frequency of cannabis use at 4-month follow-up, after controlling for relevant covariates. Notably, these effects were specific to cannabis and were not found for the other substances examined among this sample, including alcohol and opiates. Implications of the findings are discussed with regard to the extant literature and future directions.

Chaplaincy and Mental Health in the Department of Veterans Affairs and Department of Defense

Chaplains play important roles in caring for Veterans and Service members with mental health problems. As part of the Department of Veterans Affairs (VA) and Department of Defense (DoD) Integrated Mental Health Strategy, we used a sequential approach to examining intersections between chaplaincy and mental health by gathering and building upon: 1) input from key subject matter experts; 2) quantitative data from the VA / DoD Chaplain Survey (N = 2,163; response rate of 75% in VA and 60% in DoD); and 3) qualitative data from site visits to 33 VA and DoD facilities. Findings indicate that chaplains are extensively involved in caring for individuals with mental health problems, yet integration between mental health and chaplaincy is frequently limited due to difficulties between the disciplines in establishing familiarity and trust. We present recommendations for improving integration of services, and we suggest key domains for future research.

Aggressive and unsafe driving in male veterans receiving residential treatment for PTSD

Aggressive and unsafe driving was examined in 474 male veterans receiving Veterans Affairs residential treatment for posttraumatic stress disorder (PTSD). Specifically, the authors evaluated if PTSD was associated with aggressive and unsafe driving and if Iraq and Afghanistan War veterans were at higher risk than other war veterans. Approximately two thirds of the sample reported lifetime aggressive driving and one third reported current aggressive driving. Posttraumatic stress disorder severity was associated with aggressive driving, but not other forms of unsafe driving. Iraq and Afghanistan veterans endorsed higher rates of and more frequent aggressive driving than did other veterans. After accounting for PTSD severity, age, income, and marital status being an Iraq and Afghanistan War veteran predicted aggressive driving frequency and infrequent seatbelt use.

MMPI-2 Assessment of Differential Post-Traumatic Stress Disorder Patterns in Combat Veterans and Sexual Assault Victims

This study compared MMPI-2 profiles and trauma-specific subscales of the MMPI-2 in groups of combat veterans and sexual assault victims. Analyses indicated a trend toward externalizing symptoms for combat veterans and internalizing symptoms for sexual assault survivors. For diagnostic classification purposes, the PS scale was found to best differentiate post-traumatic stress disorder (PTSD) cases from non-PTSD cases for the combat group, whereas the F-2-8 standard decision rule best differentiated the sexual trauma group from comparisons. These results suggest that type of trauma experienced is a key variable in understanding the patient and dictates the need for different therapeutic focuses. In addition, the results suggest that the MMPI-2 PTSD scales provide a reasonable classification of PTSD status.