Wendy J. Travis

Child Maltreatment Among U.S. Air Force Parents Deployed in Support of Operation Iraqi Freedom/Operation Enduring Freedom

This study examined child maltreatment perpetration among 99,697 active-duty U.S. Air Force parents who completed a combat deployment. Using the deploying parent as the unit of analysis, we analyzed whether child maltreatment rates increased postdeployement relative to predeployment. These analyses extend previous research that used aggregate data and extend our previous work that used data from the same period but used the victim as the unit of analysis and included only deploying parents who engaged in child maltreatment. In this study, 2% (n = 1,746) of deploying parents perpetrated child maltreatment during the study period. Although no overall differences were found in child maltreatment rates postdeployment compared to predeployment, several maltreatment-related characteristics qualified this finding. Rates for emotional abuse and mild maltreatment were lower following deployment, whereas child maltreatment rates for severe maltreatment were higher following deployment. The finding that rates of severe child maltreatment, including incidents involving alcohol use, were higher postdeployment suggests a need for additional support services for parents following their return from combat deployment, with a focus on returning parents who have an alcohol use problem.

The Role of Natural Support Systems in the Post-deployment Adjustment of Active Duty Military Personnel

Abstract This study examined the relations among three different types of naturally occurring social support (from romantic partners, friends and neighbors, and unit leaders) and three indices of service member well-being (self reports of depressive symptoms, satisfaction with military life, and perceptions of unit readiness) for service members who did and did not report negative experiences associated with military deployment. Data were drawn from the 2011 Community Assessment completed anonymously by more than 63,000 USAF personnel. Regression analyses revealed that higher levels of social support was associated with better outcomes regardless of negative deployment experiences. Evidence of moderation was also noted, with all forms of social support moderating the impact of negative deployment experiences on depressive symptoms and support from unit leaders moderating the impact of negative deployment experience on satisfaction with military life. No moderation was found for perceptions of unit readiness. Subgroup analyses revealed slightly different patterns for male and female service members, with support providing fewer moderation effects for women. These findings may have value for military leaders and mental health professionals working to harness the power of naturally occurring relationships to maximize the positive adjustment of service members and their families. Implications for practices related to re-integration of post-deployment military personnel are discussed.

Characteristics Associated With Incidents of Family Maltreatment Among United States Air Force Families

From 2002 until 2007, the United States Air Force (USAF) revised the process of determining whether incidents of suspected family maltreatment met the criteria for maltreatment. In this study, all reported child maltreatment and partner abuse incidents in the USAF from January 2008 to July 2011 were examined to determine the extent to which characteristics of victims, offenders, and incidents affected whether incidents were determined to have met criteria for maltreatment. For both child maltreatment and partner abuse, alleged incidents in which offenders used substances and more severe incidents were more likely to have met maltreatment criteria than alleged incidents that did not involve offender substance use and less severe incidents. However, characteristics of the persons involved (e.g., age, gender, military status) were generally unassociated with an incident meeting criteria. Consistent with the goals of the criteria revisions, these results suggest that the current USAF criteria are associated with incident characteristics and not with demographic characteristics of the persons involved in the incident.

Spouse abuse among United States Air Force personnel who deployed in support of Operation Iraqi Freedom/Operation Enduring Freedom.

The authors examined spouse abuse perpetration among all married U.S. Air Force personnel who deployed in support of Operation Iraqi Freedom/Operation Enduring Freedom. Using Poisson and conditional Poisson regression, they compared rates of spouse abuse perpetration predeployment and postdeployment in the population of married U.S. Air Force personnel who had a combat-related deployment between October 1, 2001 and October 31, 2008 (N = 156,296). Just over 2% (n = 3,524) of deployers perpetrated at least one substantiated incident of spouse physical or emotional abuse within the 308,197,653 days at risk for abuse during the study period. Male deployers perpetrated spouse abuse at approximately twice the rate of female deployers. Regarding changes in rates of spouse abuse perpetration postdeployment versus predeployment among all deployers, the authors found no differences overall; however, several deployer and incident-related characteristics moderated this effect. Rates of emotional abuse, mild abuse, and abuse not involving alcohol were significantly lower postdeployment, whereas rates of moderate/severe abuse and abuse involving alcohol were significantly higher postdeployment. Although the majority of U.S. Air Force deployers did not perpetrate any substantiated incidents of spouse abuse, there was variability in the impact of deployment on spouse abuse rates before versus after deployment. The finding that rates of moderate/severe spouse abuse incidents involving alcohol were higher postdeployment suggests a need for focused prevention/intervention efforts.

What difference does a day make? Examining temporal variations in partner maltreatment.

Routine activities (RA) theory posits that changes in peoples typical daily activities covary with increases or decreases in criminal behaviors, including, but not limited to, partner maltreatment. Using a large clinical database, we examined temporal variations among 24,460 incidents of confirmed partner maltreatment across an 11-year period within the U.S. Air Force (USAF). Specifically, we created regression models that predicted the number of partner maltreatment incidents per day. In addition to several control variables, we coded temporal variables for days of the week, month, year, and several significant days (e.g., holidays, Super Bowl Sunday), which allowed us to examine the independent influence of these variables on partner maltreatment prevalence. While accounting for the influence of all other study variables, we observed significant increases in partner maltreatment for weekend days, New Years Day, Independence Day, and Super Bowl Sunday. Similar results were found for partner maltreatment incidents involving offender alcohol/drug use. Furthermore, the proportion of incidents involving offender alcohol/drug use increased on New Years Day and Independence Day. Consistent with RA theory and data from civilian samples, the current results indicate that certain days are associated with increased incidents of partner maltreatment within the USAF. These findings should be used to inform future preventive efforts.

Suitability Screening During Basic Military Training

Results are presented for suitability screening conducted by the United States Air Force during basic military training. The Lackland Behavioral Questionnaire has been used operationally since 2007, and its use has led to an increase in predictive validity. For the prediction of outcomes during the first 4 years of service, one can identify trainees with a 49% likelihood of being separated for unsuitability and a 56% likelihood of being diagnosed with a mental disorder. A formal suitability screening program allows referrals and recommendations to be made using a combination of empirical evidence and clinical judgment.

Identifying high-needs families in the U.S. Air Force New Parent Support Program

The U.S. Air Force (USAF) New Parent Support Program (NPSP) is a voluntary family maltreatment prevention program for expectant parents and parents of young children. NPSP mothers are classified as “low needs” (LN) or “high needs” (HN) based on their Family Needs Screener (FNS) responses and NPSP service providers’ clinical judgment. Using data from 112,478 mothers, we analyzed classifications based on FNS scores, classifications based on NPSP service providers’ clinical judgments, and whether these classifications predicted mothers’ subsequent maltreatment of a child. Overall, 75% of mothers were classified as LN based on their FNS responses. Clinical judgments resulted in overrides for the classifications of 6% of cases and, when overrides occurred, mothers’ classifications were more likely changed from LN to HN than vice versa. Further, both FNS-based HN classifications and clinical overrides from LN to HN predicted subsequent child maltreatment. These data suggest FNS and clinical overrides are useful for predicting child maltreatment within USAF families.

Postdeployment Psychological Health and Interpersonal Problems Among Air Force Mental Health Personnel

This study is one of the first to use validated screening measures to examine the rates of self-reported mental health and interpersonal problems following deployment of military mental health personnel (MMHP). Research has examined the impact of deployment on military personnel finding 10.2% to 29.0% screen positive for at least one mental health problem. However, little is known about impacts of deployment among MMHP. Utilizing health data collected three to twelve months post-deployment from a sample of 759 Air Force MMHP, this study examined rates of positive screens for psychological health or interpersonal problems, subsequent confirmation of positive screens by a medical provider upon examination, and the demographic characteristics associated with psychological health or interpersonal problems. The study found 13.9% screened positive for “possible or probable PTSD,” 4.6% for depressive symptoms, 3.9% for alcohol problems, and 12.6% for interpersonal problems. In total, nearly 26% screened positive for one or more psychological or interpersonal problem. Of those who screened positive, 48.5% of depressive problems, 36.0% of PTSD, 20.0% of alcohol problems and 29.7% of interpersonal problems were confirmed upon subsequent examination by a medical provider. Those who screened positive were more likely to be (a) female, (b) separated, widowed, or divorced, (c) a mental health nurse or psychiatric nurse practitioner, and (d) deployed to Iraq or Afghanistan. The significance, limitations, and implications of the results, along with recommendations for future research are discussed.

Treating PTSD in active duty service members using cognitive processing therapy or prolonged exposure therapy: Examining everyday practice at a military outpatient clinic

ABSTRACT The Institute of Medicine has stressed the need for evaluations of evidence-based treatments (EBTs) for posttraumatic stress disorder (PTSD) among active duty service members (AD) using a variety of evaluation approaches (Institute of Medicine, 2012). The current study examined the clinical files of 134 service members who completed treatment for PTSD using either prolonged exposure (PE) or cognitive processing therapy at an outpatient clinic. At the completion of each session, therapists made a clinical rating as to whether or not the session was protocol adherent. The total number of treatment sessions and the proportion of sessions rated as being protocol adherent were calculated. Multi-level models estimated the change in patient PTSD and other psychological symptoms over time as a function of clinician-rated protocol adherence and total number of sessions. Approximately 65% of clinic encounters were rated by therapists as being protocol adherent. Significant reductions in PTSD and psychological symptoms were associated with protocol adherence, and this was particularly true for patients who began treatment above clinical thresholds for both PTSD and other psychological symptoms. However, as the number of sessions increased, the impact of protocol adherence was attenuated. Patient characteristics, including gender, ethnicity, and co-morbidity for other psychiatric disorders were not related to symptom change trajectories over time. These findings suggest that protocol adherence and efficiency in delivery of EBTs for the treatment of PTSD with AD is critical.

Air Force Chaplains’ Perceived Effectiveness on Service Member's Resilience and Satisfaction

This study examined how 3,777 active duty male United States Air Force service members’ (SMs) rank and residence location moderated the associations between perceived chaplain effectiveness, SMs’ resilience, family coping, marital satisfaction, and satisfaction with the Air Force (AF). A multiple-sample structural equation model was conducted with four subgroups of SMs who had received chaplain support: enlisted members living on base, enlisted members living off base, officers living on base, and officers living off base. Chaplain effectiveness was significantly related, both directly and indirectly, to SM’s spirituality, resilience, family coping, marital satisfaction, and AF satisfaction. Resilience was significantly associated with increased AF satisfaction for all SMs, except for those living on base. However, living on base was found to strengthen the protective factor between family coping and relationship satisfaction. Rank was found to moderate the link between resilience and family coping. Family coping was significantly related to increased relationship satisfaction.