Monty T. Baker

Overcoming the fear of lethal injury: Evaluating suicidal behavior in the military through the lens of the Interpersonal-Psychological Theory of Suicide

Suicide rates have been increasing in military personnel since the start of Operation Enduring Freedom and Operation Iraqi Freedom, and it is vital that efforts be made to advance suicide risk assessment techniques and treatment for members of the military who may be experiencing suicidal symptoms. One potential way to advance the understanding of suicide in the military is through the use of the Interpersonal-Psychological Theory of Suicide. This theory proposes that three necessary factors are needed to complete suicide: feelings that one does not belong with other people, feelings that one is a burden on others or society, and an acquired capability to overcome the fear and pain associated with suicide. This review analyzes the various ways that military service may influence suicidal behavior and integrates these findings into an overall framework with relevant practical implications. Findings suggest that although there are many important factors in military suicide, the acquired capability may be the most impacted by military experience because combat exposure and training may cause habituation to fear of painful experiences, including suicide. Future research directions, ways to enhance risk assessment, and treatment implications are also discussed.

An investigation of the interactive effects of the capability for suicide and acute agitation on suicidality in a military sample

According to the interpersonal theory of suicide (1, 2), the difficulties inherently associated with death by suicide deter many individuals from engaging in suicidal behavior. Consistent with the notion that suicide is fearsome, acute states of heightened arousal are commonly observed in individuals immediately prior to lethal and near‐lethal suicidal behavior. We suggest that among individuals who possess elevated levels of the capability for suicide, the heightened state of arousal experienced during periods of acute agitation may facilitate suicidal behavior in part because it would provide the necessary energy to approach a potentially lethal stimulus. Among individuals who are low on capability, the arousal experienced during agitation may result in further avoidance.

Patterns and Perceptions of Intimate Partner Violence Committed by Returning Veterans with Post-Traumatic Stress Disorder

Data from a recent mixed-methods study conducted among Veterans of Iraq and Afghanistan diagnosed with Post-Traumatic Stress Disorder (PTSD) raise important questions regarding the occurrence of Intimate Partner Violence (IPV) in this population. Three case studies illustrate two main findings. First, Veterans and family members participating in the study described three patterns of partner violence—violence committed in anger; dissociative violence; and parasomniac/hypnopompic violence—suggesting that distinct patterns of IPV may emerge in relation to PTSD symptoms. Second, participants’ descriptions suggest that common ideas about PTSD and war-related suffering can play an important role in influencing how Veterans and their partners respond to episodes of partner violence. It is important for those providing care to PTSD-diagnosed Veterans and their partners to understand when and how partner violence may occur, and how both parties may perceive and respond to it, in order to aid in developing appropriate plans for coping and safety-seeking.

Combat Disclosure in Intimate Relationships: Mediating the Impact of Partner Support on Posttraumatic Stress

Although previous research has shown a negative relation between partner support and posttraumatic stress disorder (PTSD) symptom severity among military service members following deployment, the mediating mechanisms of this effect remain poorly understood. This study examined willingness to disclose deployment- and combat-related experiences as a mediating mechanism underlying the linkage between intimate partner support and PTSD symptom severity in a sample of 76 U.S. Air Force service members deployed to Iraq in a year-long, high-risk mission. Airmens reports of overall social support, and partner support specifically, significantly predicted concurrent postdeployment PTSD symptom severity. Subsequent mediation analyses demonstrated that level of disclosure of deployment- and combat-related experiences by service members to their intimate partners accounted for a significant portion of the relation between partner support and postdeployment PTSD symptom severity. The level of Airmens disclosure was also inversely related to levels of relationship distress. Implications of these findings for prevention and intervention strategies and for further research are discussed.

Impact of Combat Deployment on Psychological and Relationship Health: A Longitudinal Study

Although previous research has indicated an elevated prevalence of posttraumatic stress disorder (PTSD) and other mental health problems among veterans of Operations Iraqi Freedom and Enduring Freedom following deployment, most of this research has been cross-sectional and has focused on a limited range of military groups and outcome criteria. This investigation was a longitudinal study of U.S. Air Force security forces assigned to a year-long high-threat ground mission in Iraq to determine the degree to which airmens emotional and behavioral health and committed relationships were adversely impacted by an extended deployment to a warzone. Participants were a cohort of 164 security forces airmen tasked to a 365-day deployment to train Iraqi police. Airmen completed study measures both prior to and 6-9 months following deployment. Rates of deterioration in individual and interpersonal adjustment were both significant and medium to large in magnitude of effect, d = 0.43 to 0.90. Results suggest that the negative effects of deployment are related to levels of traumatic experiences and do not spontaneously remit within the first 6-9 months following return from deployment-particularly among those service members having relatively lower levels of social support.

Tobacco use during military deployment

INTRODUCTION Tobacco use among military personnel is associated with significant health care expenditures, lost productivity, and compromised combat readiness. The prevalence remains high among military personnel and may increase in high-risk situations such as deployment. We assessed the prevalence of tobacco use across the deployment cycle, changes in tobacco use (nonuse, continued use, initiation/harm escalation, cessation/harm reduction) during deployment, and the impact of deployment history on tobacco use. METHOD Cigarette smoking, smokeless tobacco (ST) use, and dual tobacco use were evaluated among 278U.S. Air Force Security Forces personnel undertaking a 1-year deployment to a high-threat combat environment. Multinomial regression was used to examine prediction of tobacco use patterns both cross-sectionally and longitudinally. RESULTS More than half (53%-63%) of all Security Forces used tobacco at all stages of the deployment cycle. Individual tobacco use trajectories showed significant differences in prevalence rates of initiation/harm escalation and cessation/harm reduction when comparing the transition from predeployment to the deployed environment versus returning to postdeployment status. Airmen who had deployed more than once previously had a higher likelihood of using ST use at predeployment and engaging in dual tobacco use during deployment. CONCLUSIONS Findings suggest the potential benefit of targeted or universal interventions at each stage of the deployment cycle to reduce the onset, maintenance, or escalation of tobacco use behaviors in the U.S. military.

Combat Stress Casualties in Iraq. Part 1: Behavioral Health Consultation at an Expeditionary Medical Group

PURPOSE We review the role of military mental health professionals in consulting with inpatient medical patients and staff at a combat hospital and aeromedical evacuation staging facility in Iraq. CONCLUSIONS Behavioral health consultation with medical and surgical patients during hospitalization and prior to aeromedical evacuation can help identify patients with combat stress exposure that may require future mental health follow-up. PRACTICE IMPLICATIONS Extensive use of civilian mental health practitioners including nurse psychotherapists and psychiatric nurse practitioners will be needed to provide psychiatric care for the large number of U.S. veterans who return from deployment with combat stress related disorders.

Does the Repressor Coping Style Predict Lower Posttraumatic Stress Symptoms

We tested whether a continuous measure of repressor coping style predicted lower posttraumatic stress disorder (PTSD) symptoms in 122 health care professionals serving in Operation Iraqi Freedom. Zero-order correlational analyses indicated that predeployment repressor coping scores negatively predicted postdeployment PTSD symptoms, r(s) = -0.29, p = 0.001, whereas predeployment Connor-Davidson Resilience Scale (CD-RISC) scores did not predict postdeployment PTSD symptoms, r(s) = -0.13, p = 0.14. However, predeployment trait anxiety was chiefly responsible for the association between repressor coping and PTSD symptom severity, r(s) = 0.38, p = 0.001. Four percent of the subjects qualified for a probable PTSD diagnosis. Although service members with relatively higher PTSD scores had lower repressor coping scores than did the other subjects, their level of predeployment anxiety was chiefly responsible for this relationship. Knowing someones predeployment level of trait anxiety permits better prediction of PTSD symptoms among trauma-exposed service members than does knowing his or her level of repressive coping.

Resilience in the United States Air Force: Psychometric Properties of the Connor-Davidson Resilience Scale (CD-RISC).

Results are presented for the largest study (N = 53,692) ever conducted on the 25-item Connor-Davidson Resilience Scale (CD-RISC), a popular measure of resilience. We examined the internal consistency of the CD-RISC items and associated mean resilience levels within a sample of enlisted basic trainees in the United States Air Force. In addition, the predictive validity of the CD-RISC Total Score was examined for real-life military outcomes, including attrition from service and mental health diagnosis. The CD-RISC items demonstrated strong internal consistency. Item-level examinations of scores revealed that most trainees reported relatively high resilience. Results indicated that resilience measured at the beginning of military service is a significant predictor of (a) attrition from service and (b) obtaining a mental health diagnosis within 6 months of entry. Implications and future directions are discussed.

Assessing Posttraumatic Stress in Military Service Members: Improving Efficiency and Accuracy

Posttraumatic stress disorder (PTSD) is assessed across many different populations and assessment contexts. However, measures of PTSD symptomatology often are not tailored to meet the needs and demands of these different populations and settings. In order to develop population- and context-specific measures of PTSD it is useful first to examine the item-level functioning of existing assessment methods. One such assessment measure is the 17-item PTSD Checklist-Military version (PCL-M; Weathers, Litz, Herman, Huska, & Keane, 1993). Although the PCL-M is widely used in both military and veteran health-care settings, it is limited by interpretations based on aggregate scores that ignore variability in item endorsement rates and relatedness to PTSD. Based on item response theory, this study conducted 2-parameter logistic analyses of the PCL-M in a sample of 196 service members returning from a yearlong, high-risk deployment to Iraq. Results confirmed substantial variability across items both in terms of their relatedness to PTSD and their likelihood of endorsement at any given level of PTSD. The test information curve for the full 17-item PCL-M peaked sharply at a value of θ = 0.71, reflecting greatest information at approximately the 76th percentile level of underlying PTSD symptom levels in this sample. Implications of findings are discussed as they relate to identifying more efficient, accurate subsets of items tailored to military service members as well as other specific populations and evaluation contexts.