Matthew Jakupcak

Posttraumatic Stress Disorder as a Risk Factor for Suicidal Ideation in Iraq and Afghanistan War Veterans

Posttraumatic stress disorder (PTSD) was examined as a risk factor for suicidal ideation in Iraq and Afghanistan War veterans (N = 407) referred to Veterans Affairs mental health care. The authors also examined if risk for suicidal ideation was increased by the presence of comorbid mental disorders in veterans with PTSD. Veterans who screened positive for PTSD were more than 4 times as likely to endorse suicidal ideation relative to non-PTSD veterans. Among veterans who screened positive for PTSD (n = 202), the risk for suicidal ideation was 5.7 times greater in veterans who screened positive for two or more comorbid disorders relative to veterans with PTSD only. Findings are relevant to identifying risk for suicide behaviors in Iraq and Afghanistan War veterans.

Meta-Analysis of Dropout in Treatments for Posttraumatic Stress Disorder.

OBJECTIVE Many patients drop out of treatments for posttraumatic stress disorder (PTSD); some clinicians believe that trauma-focused treatments increase dropout. METHOD We conducted a meta-analysis of dropout among active treatments in clinical trials for PTSD (42 studies; 17 direct comparisons). RESULTS The average dropout rate was 18%, but it varied significantly across studies. Group modality and greater number of sessions, but not trauma focus, predicted increased dropout. When the meta-analysis was restricted to direct comparisons of active treatments, there were no differences in dropout. Differences in trauma focus between treatments in the same study did not predict dropout. However, trauma-focused treatments resulted in higher dropout compared with present-centered therapy (PCT), a treatment originally designed as a control but now listed as a research-supported intervention for PTSD. CONCLUSION Dropout varies between active interventions for PTSD across studies, but variability is primarily driven by differences between studies. There do not appear to be systematic differences across active interventions when they are directly compared in the same study. The degree of clinical attention placed on the traumatic event does not appear to be a primary cause of dropout from active treatments. However, comparisons of PCT may be an exception to this general pattern, perhaps because of a restriction of variability in trauma focus among comparisons of active treatments. More research is needed comparing trauma-focused interventions to trauma-avoidant treatments such as PCT.

PTSD symptom clusters in relationship to alcohol misuse among Iraq and Afghanistan war veterans seeking post-deployment VA health care

Demographic factors, characteristics of military service, PTSD, and depression were examined as predictors of alcohol misuse in Iraq and Afghanistan War Veterans (N=287) presenting for post-deployment Veteran Affairs (VA) health care. Results indicated that alcohol misuse was more common among younger male Veterans who served in the Army or Marine Corps. Accounting for demographic factors and characteristics of service, Veterans who screened positive for PTSD or depression were two times more likely to report alcohol misuse relative to Veterans who did not screen positive for these disorders. The examination of specific PTSD symptom clusters suggested that emotional numbing symptoms were most strongly associated with alcohol misuse. The implications for interventions for alcohol misuse in returning Veterans are discussed.

Health Indicators for Military, Veteran, and Civilian Women

BACKGROUND Women who have served in the military are a rapidly growing population. No previous studies have compared directly their health status to that of civilians. PURPOSE To provide estimates of several leading U.S. health indicators by military service status among women. METHODS Data were obtained from the 2010 Behavioral Risk Factor Surveillance Survey, a U.S. population-based study. Health outcomes were compared by military status using multivariable logistic regression among the female participants (274,399 civilians, 4221 veterans, 661 active duty, and 995 National Guard or Reserves [NG/R]). Data were analyzed in August 2011. RESULTS Veterans reported poorer general health and greater incidence of health risk behaviors, mental health conditions, and chronic health conditions than civilian women. Active duty women reported better access to health care, better physical health, less engagement in health risk behaviors, and greater likelihood of having had a recent Pap than civilian women. Women from the NG/R were comparable to civilians across most health domains, although they had a greater likelihood of being overweight or obese and reporting a depressive and anxiety disorder. CONCLUSIONS Compared with civilian women, NG/R women rated their health and access to health care similarly and active duty women rated theirs better on several domains, but veterans consistently reported poorer health.

Exploring the relationship between childhood maltreatment and intimate partner abuse: gender differences in the mediating role of emotion dysregulation

Despite evidence that childhood maltreatment is associated with increased risk for intimate partner abuse perpetration, the mechanisms underlying this relationship remain unclear. Given literature suggesting that violent behaviors may serve an emotion regulating function, this study examined the mediating role of emotion dysregulation in the relationship between childhood maltreatment and intimate partner abuse perpetration among 341 male and female undergraduates. However, given evidence of gender differences in the underlying mechanisms of intimate partner abuse, emotion dysregulation was expected to be more relevant to the perpetration of partner abuse among men. Consistent with hypotheses, emotion dysregulation mediated the relationship between childhood maltreatment and intimate partner abuse among men; conversely, emotion dysregulation was not associated with partner abuse among women.

posttraumatic stress and its relationship to physical health functioning in a sample of Iraq and Afghanistan War veterans seeking postdeployment VA health care.

The relationship between posttraumatic stress and physical health functioning was examined in a sample of Iraq and Afghanistan War veterans seeking postdeployment VA care. Iraq and Afghanistan War veterans (N = 108) who presented for treatment to a specialty postdeployment care clinic completed self-report questionnaires that assessed symptoms of posttraumatic stress disorder (PTSD), chemical exposure, combat exposure, and physical health functioning. As predicted, PTSD symptom severity was significantly associated with poorer health functioning, even after accounting for demographic factors, combat and chemical exposure, and health risk behaviors. These results highlight the unique influence of PTSD on the physical health in treatment seeking Iraq and Afghanistan War veterans.

The role of emotional inexpressivity and experiential avoidance in the relationship between posttraumatic stress disorder symptom severity and aggressive behavior among men exposed to interpersonal violence

Abstract Posttraumatic stress disorder (PTSD) has been found to be associated with aggressive behavior. Recent evidence suggests that the ways in which individuals respond to their emotions may account for this relationship. In particular, to the extent that aggressive behaviors serve an emotion regulatory function, responding to emotions with avoidance (i.e., experiential avoidance) or the active suppression of emotional expression may heighten emotion dysregulation, increasing the risk for aggressive behavior as individuals attempt to regulate that dysregulated state. This study examined whether these two ways of responding to emotions account for the relationship between PTSD symptom severity and self-reported engagement in aggressive behavior among a diverse sample of 113 men with past exposure to interpersonal violence. Experiential avoidance and emotional inexpressivity each accounted for a significant amount of unique variance in aggressive behavior, above and beyond PTSD symptom severity and trait anger. Clinical and research implications of findings are discussed.

Hopelessness and suicidal ideation in Iraq and Afghanistan war veterans reporting subthreshold and threshold posttraumatic stress disorder

We examined hopelessness and suicidal ideation in association with subthreshold and threshold posttraumatic stress disorder (PTSD) in a sample of Iraq and Afghanistan War Veterans (U.S., N = 275) assessed within a specialty VA postdeployment health clinic. Veterans completed paper-and-pencil questionnaires at intake. The military version of the PTSD Checklist was used to determine PTSD levels (No PTSD; subthreshold PTSD; PTSD), and endorsement of hopelessness or suicidal ideation were used as markers of elevated suicide risk. Veterans were also asked if they received mental health treatment in the prior 6 months. Veterans reporting subthreshold PTSD were 3 times more likely to endorse these markers of elevated suicide risk relative to the Veterans without PTSD. We found no significant differences in likelihood of endorsing hopelessness or suicidal ideation comparing subthreshold and threshold PTSD groups, although the subthreshold PTSD group was less likely to report prior mental health treatment. Clinicians should be attentive to suicide risk in returned Veterans reporting both subthreshold and threshold PTSD.

Behavioral Activation as a Primary Care-Based Treatment for PTSD and Depression Among Returning Veterans

This preliminary study examined treatment-satisfaction and potential therapeutic benefits of Behavioral Activation as a primary care-based treatment for posttraumatic stress disorder (PTSD) and depression among Iraq and Afghanistan War veterans. Eight veterans were enrolled, 6 completed at least 4 sessions, and 5 veterans completed posttreatment and 3-month follow-up assessments after receiving 5-8 weekly sessions of Behavioral Activation delivered in a specialty postdeployment primary care clinic. Significant and meaningful reductions in PTSD symptoms were found on structured clinical assessments and self-report measures. Posttraumatic stress disorder treatment gains (measured by structured clinical assessments) were maintained at 3-month follow-up. The majority of veterans demonstrated meaningful improvements on depression and quality of life and veterans reported a high satisfaction with treatment.

Modeling PTSD Symptom Clusters, Alcohol Misuse, Anger, and Depression as They Relate to Aggression and Suicidality in Returning U.S. Veterans

Suicidal ideation and aggression are common correlates of posttraumatic stress disorder (PTSD) among U.S. Iraq and Afghanistan war veterans. The existing literature has established a strong link between these factors, but a more nuanced understanding of how PTSD influences them is needed. The current study examined the direct and indirect relationships between PTSD symptom clusters and suicidal ideation in general aggression (without a specified target) regarding depression, alcohol misuse, and trait anger. Participants were 359 (92% male) U.S. Iraq/Afghanistan war veterans. Path analysis results suggested that the PTSD numbing cluster was directly (β = .28, p < .01) and indirectly (β = .17, p = .001) related through depression. The PTSD hyperarousal cluster was indirectly related to suicidal ideation through depression (β = .13, p < .001). The PTSD reexperiencing cluster was directly related to aggression (β = .17, p < .05), whereas the PTSD numbing and hyperarousal clusters were indirectly related to aggression through trait anger (β = .05, p < .05; β = .20, p < .001). These findings indicate that adjunct treatments aimed at stabilizing anger, depression, and alcohol misuse may help clinicians ameliorate the maladaptive patterns often observed in veterans. These results also point to specific manifestations of PTSD and co-occurring conditions that may inform clinicians in their attempts to identify at risk veterans and facilitate preventative interventions.