Miranda E Worthen

The Challenges of Afghanistan and Iraq Veterans' Transition from Military to Civilian Life and Approaches to Reconnection

Afghanistan and Iraq veterans experienced traumas during deployment, and disrupted connections with friends and family. In this context, it is critical to understand the nature of veterans’ transition to civilian life, the challenges navigated, and approaches to reconnection. We investigated these issues in a qualitative study, framed by homecoming theory, that comprised in-depth interviews with 24 veterans. Using an inductive thematic analysis approach, we developed three overarching themes. Military as family explored how many veterans experienced the military environment as a “family” that took care of them and provided structure. Normal is alien encompassed many veterans experiences of disconnection from people at home, lack of support from institutions, lack of structure, and loss of purpose upon return to civilian life. Searching for a new normal included strategies and supports veterans found to reconnect in the face of these challenges. A veteran who had successfully transitioned and provided support and advice as a peer navigator was frequently discussed as a key resource. A minority of respondents—those who were mistreated by the military system, women veterans, and veterans recovering from substance abuse problems—were less able to access peer support. Other reconnection strategies included becoming an ambassador to the military experience, and knowing transition challenges would ease with time. Results were consistent with and are discussed in the context of homecoming theory and social climate theory. Social support is known to be protective for veterans, but our findings add the nuance of substantial obstacles veterans face in locating and accessing support, due to disconnection and unsupportive institutions. Larger scale work is needed to better understand how to foster peer connection, build reconnection with family, and engage the broader community to understand and support veterans; interventions to support reconnection for veterans should be developed.

Building meaningful participation in reintegration among war-affected young mothers in Liberia, Sierra Leone and northern Uganda

When young mothers, formerly associated with armed groups, return to communities, they are typically social isolated, stigmatised, and marginalised. This creates reintegration challenges for themselves, and their communities. Their children face child protection problems such as neglect, rejection and abuse. In this paper, the authors describe an innovative field practice – community based, participatory action research (PAR) – that meaningfully involved formerly associated young mothers, and other vulnerable young mothers, in their communities. The project took place in 20 field sites in three countries: Liberia, northern Uganda and Sierra Leone. It was implemented through an academic, nongovernmental organisation (NGO) partnership. The participants were 658 young mothers, both formerly associated with armed groups and other mothers seen to be vulnerable. Within the context of caring psychosocial support, these young mothers organised themselves into groups, defined their problems, and developed social actions to address and change their situations. Some project outcomes included: young mothers and their children experiencing improved social reintegration evidenced by greater family and community acceptance; more positive coping skills; and decreased participation in sex work for economic survival.

Participation as Principle and Tool in Social Reintegration: Young Mothers Formerly Associated with Armed Groups in Sierra Leone, Liberia, and Northern Uganda

Experience of traumatic stressors within armed groups can negatively impact social cognitions of mastery, self-efficacy, and control. This could be compounded by postreturn conditions of stigma, little access to education, and limited means of livelihood. We explore an intervention that placed girls’ participation as a central organizing principle. Based on study reports and ethnographic field work, we examine how young mothers transformed their identity and membership within communities of return through drama, songs and poetry, and engagement in social actions. Meaningful participation offers a culturally grounded intervention in which the impacts of traumatic stressors on individual functioning and the social relational world are directly targeted, resulting in a positive modification of developmental trajectories for young women and, ultimately, their children.

The Relations Between Traumatic Exposures, Posttraumatic Stress Disorder, and Anger in Male and Female Veterans

Military personnel who have served in Operation Iraqi Freedom and Operation Enduring Freedom have experienced high rates of combat exposure, which is associated with posttraumatic stress disorder. Less is known about the relations between military sexual trauma (sexual harassment, assault, and rape while serving in the military) and posttraumatic stress disorder. Little is known about anger problems in this Operation Enduring Freedom/Operation Iraqi Freedom veteran population, which research from prior conflicts suggests may be a consequence of both traumas and posttraumatic stress disorder. Anger is an emotional state closely related to aggression, hostility, and violence. Veterans who have difficulty controlling anger are at greater risk of interpersonal and employment problems. Uncontrolled anger can lead to aggressive or violent behavior, posing health risks to those around the veteran and increasingly the likelihood that the veteran will come into conflict with the law. This article contributes a review of the literature on what little is known about military sexual trauma and posttraumatic stress disorder as well as reviews literature on anger, which may be associated with high combat exposure or military sexual trauma. Notably, there is almost no research on any of these problems among women veterans. Given that women make up more than 15% of deployed service members in Iraq and Afghanistan, research on these relations in women is imperative.

Anger and Posttraumatic Stress Disorder Symptom Severity in a Trauma-Exposed Military Population: Differences by Trauma Context and Gender

Studies have found a stronger association between anger and posttraumatic stress disorder (PTSD) severity in military populations than in nonmilitary populations. Two hypotheses have been proposed to explain this difference: Military populations are more prone to anger than nonmilitary populations, and traumas experienced on deployment create more anger than nondeployment traumas. To examine these hypotheses, we evaluated the association between anger and PTSD severity among never-deployed military service members with nondeployment traumas (n = 226) and deployed service members with deployment traumas (n = 594) using linear regression. We further examined these associations stratified by gender. Bivariate associations between anger and PTSD severity were similar for nondeployment and deployment events; however, gender modified this association. For men, the association for deployment events was stronger than for nondeployment events (β = .18, r = .53 vs. β = .16, r = .37, respectively), whereas the reverse was true for women (deployment: β = .20, r = .42 vs. nondeployment: β = .25, r = .65). Among men, findings supported the hypothesis that deployment traumas produce stronger associations between PTSD and anger and are inconsistent with hypothesized population differences. In women, however, there was not a clear fit with either hypothesis.

A San Francisco Bay Area CBPR Training Institute Experiences, Curriculum, and Lessons Learned

The rapid increase of community-based participatory research (CBPR) as an approach to research underscores the importance of expanding access to training in CBPR principles and strategies. CBPR is increasingly recognized as a collaborative approach that can reduce health disparities through building on the strengths of each partner and using scientific knowledge for health action. However, there is a need to increase access to CBPR training for academics, public health professionals, and especially underserved communities that may benefit significantly from new collaborative research projects. This article reports on the efforts of a regional CBPR training consortium in the United States to develop, implement, and evaluate a 5-day CBPR training curriculum tailored to a diverse audience of public health practitioners, academics, students, and community members. The conference goals were to create partnerships and networks for designing, implementing, and evaluating CBPR projects and to identify ways to integrate knowledge from academic, agency, and community partners. The curriculum addressed the following core daily themes: Creating, Building, and Maintaining Partnerships; Collaborative Study and Intervention Design; Collaborative Data Collection, Analysis, and Dissemination; The Intersection of CBPR, Policy, and Social Change; and Fundraising and Sustainability for CBPR. The CBPR curriculum achieved its goal of expanding access to CBPR training for diverse stakeholders in the area, including those from underserved communities and developing a training curriculum with the potential for replication in other locations nationally and internationally. Lessons learned from the implementation and evaluation of the training are shared.

Transformative spaces in the social reintegration of former child soldier young mothers in Sierra Leone, Liberia, and Northern Uganda

A significant but insufficiently considered category of female former child soldiers is those that become mothers as a result of rape or through relationships with “bush husbands”. This article reflects on learning from a participatory action research (PAR) study which aimed to facilitate the social reintegration of formerly associated young mothers and other war-affected vulnerable young mothers in Sierra Leone, Liberia, and northern Uganda. We argue that it is useful to delineate 3 nodes of individual-community relations which we identify as possible transformative spaces in psychosocial programming for social reintegration: the intersection between individual emotional experience and the emotional climate, between individual agency and public engagement, and between individual and community resilience. The PAR study involved 658 young war-affected mothers across 20 communities in the 3 countries. The results demonstrate how the PAR mobilized positive emotions and aligned the activities of the young mothers’ groups with individuals with power to facilitate change (community leaders) and contributed to limited transformative change. Further research is needed on engaging men and on tackling structural factors in interventions with war-affected young mothers.

Risk and Protective Factors for Difficulty Controlling Violent Behavior in National Guard and Reserve Service Members.

Violent behavior is an important problem for military service members and veterans. A representative cohort of U.S. Reserve and National Guard personnel ( N = 1,293) were interviewed to assess self-reported problems controlling violent behavior, deployment traumas, posttraumatic stress disorder (PTSD), alcohol abuse, and social support. Poisson regression models were used to estimate the associations of violent behavior with risk and protective factors. Problems controlling violent behavior were uncommon among male (3.3%) and female (1.7%) service members. Adjusted prevalence ratios (aPR) showed associations between violent behavior and deployment traumas (aPR = 1.67, 95% confidence interval [CI] = [1.34, 2.08]), PTSD (aPR = 9.95, 95% CI = [5.09, 19.48]), and PTSD symptom severity (aPR for each additional PTSD symptom = 1.07, 95% CI = [1.06, 1.09]). Social support was associated with lower prevalence of violent behavior (aPR = 0.62, 95% CI = [0.52, 0.76]). The association between violent behavior and alcohol abuse was not statistically significant (aPR = 1.94, 95% CI = [0.92, 4.09]). Results were consistent when the population was restricted to personnel who had deployed to a war zone. Problems controlling violent behavior were less common in this cohort than has been documented in other studies. Associations of violent behavior with risk and protective factors are consistent with prior research.

After the Medical Error

I grew up knowing that my father had saved my mother’s life. This wasn’t some romantic drama. During her first cone-down radiation treatment for invasive breast cancer, she convinced the radiologist to let my father, an internist practicing in the same hospital, watch. As the machine was lowered, he realized that the cone was aimed at a 10-year-old fibroadenoma scar instead of her cancerous tumor. My dad stopped the treatment and my mom had new tattoos drawn, only to realize that these were also incorrectly placed. They drove to the surgeon’s office, where the surgeon consulted his handwritten note and drew the location of the recent tumor with permanent marker.