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Veterans with disabilities are often hesitant to request an accommodation in the workplace, despite the fact that many intranational legal frameworks require employers to provide reasonable accommodation. This study draws from social identity and disability help-seeking theoretical perspectives to examine various factors – veteran identity, disability attributes, and workplace inclusive climate perceptions – which shape feelings of psychological safety and the decision to request a disability accommodation among military veterans with disabilities. Findings suggest veteran identity strain (an incongruence between one's civilian work and military identity) is related to withholding of an accommodation request through decreased psychological safety. We also find veteran identity strain is less likely to be associated with decreased psychological safety when an organization is perceived to have a strong climate of inclusion, especially for military veterans with higher degrees of disability invisibility. The current study sheds light on why veterans with disabilities might not engage in help-seeking behaviors, and contributes to research streams on workplace disability and veteran workplace integration. Practically, we encourage employers to be especially aware of the needs of vulnerable employees and to develop inclusive climates in order to better support all military personnel transitioning to a civilian workforce. [ABSTRACT FROM AUTHOR]

This study examined the multidimensional nature of experiences of being an intimate partner of an Australian veteran or emergency service first responder (ESFR) with posttraumatic stress disorder (PTSD). Using a qualitative phenomenological approach, inductive thematic analysis was undertaken on data collected in 2017–2018 through individual interviews with a purposive sample of 22 partners of veterans, paramedics, fire and police officers living in Australia. Analysis revealed that the key concern of the participants was to protect their family unit and the intimate relationship, highlighting the ways in which they adapted, managed and coped with the changes that PTSD brought to the relationship. However, lack of understanding by healthcare providers, government, military and emergency service organizations of their daily lives, and of the strength of commitment to their relationship, resulted in a sense of invisibility and was revealed as the key barrier to the support they crave. The findings underscore the importance of recognizing the significance of the intimate relationship in trauma recovery and of responding to the support needs of the intimate partner. [ABSTRACT FROM AUTHOR]

Formerly incarcerated military veterans—comprising approximately 8% of the prison population—experience significant barriers to reentry including homelessness, mental illness, and mortality. One of the most consequential barriers is relapsing into substance use. Most justice-involved veterans (JIV) possess histories of substance abuse before imprisonment, and this rate continues upon release. Mental illness—depression in particular—is often comorbid with substance abuse. With high rates of depression and substance use in a JIV population, it is important to determine to what extent release from prison contributes to predicting substance use and negative clinical outcomes. This study compares rates of substance use and negative outcomes between two matched samples of JIV and general veterans, both with depression and a substance use disorder. It is hypothesized that JIV will have a higher rate of substance use and that use will be associated with higher negative outcomes in the JIV condition. Rates of use of veterans released from prison and general veterans were collected during six-year follow-up periods. Use was defined as the use of an illicit substance or alcohol, if an alcohol use disorder was present, and determined by urine drug tests or self-report recorded in medical notes. Results indicate that JIV used substances at a higher rate compared to those not recently incarcerated, and that such use is predictive of several other negative outcomes including homelessness, use of inpatient substance treatment, and reincarceration. Structured drug treatment programs and other interventions should cater to veterans recently released from prison to offer help in these areas. [ABSTRACT FROM AUTHOR]

Objective: To explore the potential efficacy of multi‐modular motion‐assisted memory desensitization and reprocessing (3MDR) in British military veterans with treatment‐resistant service‐related PTSD. Methods: Exploratory single‐blind, randomized, parallel arm, cross‐over controlled trial with nested process evaluation to assess fidelity, adherence and factors that influence outcome. Results: A total of 42 participants (all male) were randomized with 83% retention at 12 weeks and 86% at 26 weeks. The difference in mean Clinician‐Administered PTSD Scale for DSM‐5 scores between the immediate and delayed 3MDR arms was −9.38 (95% CI −17.33 to −1.44, P = 0.021) at 12 weeks and −3.59 (−14.39 to 7.20, P = 0.513) at 26 weeks when both groups had received 3MDR. The likely effect size of 3MDR was found to be 0.65. Improvements were maintained at 26‐week follow‐up. 3MDR was found to be acceptable to most, but not all, participants. Several factors that may impact efficacy and acceptability of 3MDR were identified. Conclusion: 3MDR is a promising new intervention for treatment‐resistant PTSD with emerging evidence of effect. [ABSTRACT FROM AUTHOR]

Purpose/Objective: The purpose of this study was 2-fold: (a) to evaluate whether perception of work ability is associated with employment status in a sample of combat-exposed veterans, and (b) to determine whether the same sets of variables that are associated with employment status are also associated with perception of work ability. Research Method/Design: In this cross-sectional study, veterans (N = 83) underwent a neuropsychological assessment and completed questionnaires assessing demographic characteristics, combat-related experiences, and psychiatric and neurobehavioral/health-related symptoms. Primary outcomes of interest were employment status (unemployed vs. employed) and veterans' perception of whether their ability to work has declined due to an ongoing condition (yes vs. no). Results: A chi-square analysis revealed a significant relationship between perception of work ability and employment status. Additionally, psychiatric and neurobehavioral/health-related symptoms were associated with employment status and perception of work ability, whereas demographic characteristics (i.e., service-connected disability rating) and combat-related experiences (i.e., mTBI history) were only associated with perception of work ability. Objective cognitive functioning was not associated with employment status or perception of work ability. Conclusions/Implications: Although preliminary, results suggest that perception of work ability is an important factor to consider when evaluating employment-related outcomes in veterans. Moreover, results indicate that while there is some overlap among the variables associated with employment status and perception of work ability, additional variables are linked with perception of work ability. Taken together, these findings suggest that perception of one's ability to work and factors that influence it may be particularly important treatment targets in the veteran population. Impact and Implications: This is one of the first studies to examine the relationship between perceptions of work ability and actual employment status in a sample of combat-exposed veterans. Study findings indicate that work perception is related to actual employment status. Furthermore, psychiatric and neurobehavioral/health-related symptoms are associated with both employment status and perception of ability to work, but additional variables are related to perception, including demographic characteristics and combat-related experiences. Our findings suggest that symptom reduction and psychoeducation may lead to improved perception of work ability and, in turn, actual employment. The information from this study may ultimately be used clinically to address objective barriers to working, as well as negative beliefs about one's ability to work. [ABSTRACT FROM AUTHOR]

Use of a codebook to categorize meaning units is a well-known research strategy in qualitative inquiry. However, methodology for the creation of a codebook in practice is not standardized, and specific guidance for codebook ideation is sometimes unclear, especially to novice qualitative researchers. This article describes the procedure that was utilized to create a codebook, which adapted an affinity diagram methodology (Scupin, 1997), an approach used in user-centered design. For this research, affinity diagramming was applied to a method outlined by Kurasaki (2000) for codebook ideation. Annotations of a subset of military veterans’ transcripts were utilized in congruence with affinity diagramming to create a codebook to categorize the phenomenon of reintegration into the civilian community after service (Haskins Lisle, 2017). This method could be useful in exploratory research that utilizes a codebook generated in vivo from annotations, especially for novice researchers who are overwhelmed by the codebook creation phase. [ABSTRACT FROM AUTHOR]

Research suggests that psychiatric service dogs may be an effective complementary treatment option for military veterans with posttraumatic stress disorder (PTSD). Although this practice continues to increase in popularity and research has reached the rigor of clinical trials, the components of the PTSD service dog intervention remain largely undefined. This research aimed to (1) quantify the importance, usage, and PTSD symptom specificity of service dog trained and untrained behaviors, (2) explore how PTSD severity, time since receiving the service dog, and the veteran-dog relationship relate to outcomes, and (3) compare expectations of veterans on the waitlist to experiences of veterans with service dogs. In a cross-sectional design, 217 post-9/11 military veterans with PTSD were recruited from a national service dog provider, including n = 134 with a service dog and n = 83 on the waitlist. Results showed that the service dog's trained tasks of calming and interrupting anxiety were perceived as the most important for veterans' PTSD, the most frequently used in a typical day, and as helping the most PTSD symptoms. Trained tasks were most helpful to the PTSD symptoms of hypervigilance and intrusion, and least helpful toward the symptoms of amnesia and risk-taking. Although all trained tasks were helpful toward PTSD symptoms, veterans rated the service dog's untrained behaviors on average as more important for their PTSD. After controlling for covariates, there was no relationship between a veteran's PTSD severity and perceived importance or frequency of task use. However, veterans who reported feeling closer to their service dogs reported using trained tasks more often, and veterans who had their service dogs for longer reported using trained tasks less often. Finally, veterans on the waitlist reported higher expectations regarding task use and importance than described by veterans with a service dog. In conclusion, findings describe the core components of the PTSD service dog intervention by quantifying the use and value of trained and untrained dog behaviors. Overall, this study helps explain the PTSD service dog's clinically relevant value while contributing to the scientific understanding of this emerging practice. [ABSTRACT FROM AUTHOR]

We aimed to evaluate whether military service and access to veteran heath care coverage attenuates racial/ethnic disparities in time to mental health treatment initiation for posttraumatic stress disorder (PTSD), major depressive disorder, and/or alcohol-use disorder. Results are based on 13,528 civilians and 1392 veterans from NESARC-III. Among civilians, racial/ethnic minorities reported longer time to PTSD and depression treatment initiation than non-Hispanic whites. Among veterans, racial/ethnic minorities did not differ from whites in time to PTSD and depression treatment initiation, and showed shorter time to treatment initiation for alcohol-use disorder treatment. Racial/ethnic minorities with past year veteran health care coverage showed the strongest evidence for attenuated disparities. [ABSTRACT FROM AUTHOR]

Background: Social connectedness exerts strong influences on health, including major depression and suicide. A major component of social connectedness is having individual relationships with close supports, romantic partners, and other trusted members of one's social network. Objective: The objective of this study was to understand how individuals' relationships with close supports might be leveraged to improve outcomes for primary care patients with depression and at risk for suicide. Design: In this qualitative study, we used a semi-structured interview guide to probe patient experiences, views, and preferences related to social support. Participants: We conducted interviews with 30 primary care patients at a Veterans Health Administration (VA) medical center who had symptoms of major depression and a close support. Approach: Thematic analysis of qualitative interview data examined close supports' impact on patients. We iteratively developed a codebook, used output from codes to sort data into themes, and selected quotations that exemplified themes for inclusion in this manuscript. Key Results: "Being there" as an important quality of close supports emerged as a key concept. "Being there" was defined in three ways: physical proximity, frequent or responsive contact, or perceived availability. Close supports who were effective at "being there" possessed skills in intuitively sensing the patient's emotional state and communicating indirectly about depression. Three major barriers to involving close supports in depression care were concerns of overburdening the close support, a perception that awareness of the patient's depression would make the close support unnecessarily worried, and a desire and preference among patients to handle depression on their own. Conclusions: "Being there" represents a novel, patient-generated way to conceptualize and talk about social support. Suicide prevention initiatives such as population-level communication campaigns might be improved by incorporating language used by patients and addressing attitudinal barriers to allowing help and involvement of close supports. [ABSTRACT FROM AUTHOR]

Can the military bridge social schisms? Conventional wisdom supports this assumption. However, it seems that, at best, the effect of military service on bridging social schisms and promoting social cohesion is limited. This article examines the extended effect of contact hypothesis in the military, both in practice and as an element capable of bringing about a change in veterans' thinking. It asks: are veterans who had diverse friendships during their service more likely to have diverse friendships in the future? If so, do they attribute their ability and willingness to include others within their ingroup to their military service? Based on findings from a study of Israeli college and university students, the article demonstrates that while indeed service friendships may be short lived, service alongside members of outgroups has certain longer-term effects and influences the social perception of veterans. Social messages can be both positive and negative and teach veterans the limits of redrawing social boundaries. [ABSTRACT FROM AUTHOR]

The present study evaluates the effectiveness of a supervisor support training programme on both supervisor attitudes and employee sleep and stress outcomes by drawing on a multi‐level rigorous randomized controlled trial in 35 organizations. Utilizing theory from the social support and training literatures, the purpose of the current study was to understand ways to improve the transition, and ultimately the health and well‐being, of military veteran employees in the workplace via a supervisor support training intervention. Drawing on a sample of 982 supervisors and a subsample of 189 matched supervisor–employee dyads, the current study demonstrated that supervisor support training led to improved supervisor attitudes towards veteran employees. Additionally, supervisors' attitudes towards veteran employees at baseline significantly moderated the effects of the training on employee sleep and stress outcomes, suggesting that the training was more effective when supervisors started out with more positive attitudes towards veterans. These results demonstrate the importance of training supervisors to support employed veterans and employees more generally, and have implications for research, practice, and theory development. Practitioner points: The Veteran Supportive Supervisor Training (VSST) promotes more positive supervisor attitudes towards veteran employees.When supervisor attitudes towards veteran employees are more positive, the supportive supervisor training improves sleep and stress outcomes for veteran employees.The VSST effects suggest that the training has promise to be extended to other leadership support domains, such as supervisor support for health; to other types of vulnerable and underserved workers, such as those with disabilities; and to other employee well‐being outcomes, such as engagement and satisfaction at work and at home. [ABSTRACT FROM AUTHOR]

In this paper, we propose a treatment-derived qualitative strategy for examining written narratives created through therapeutic encounters in trauma-informed care. This investigation involves the analysis of ten trauma monologues written by military veterans participating in a treatment program that uses dramatic verse as its therapeutic foundation. Our analysis revealed that the veterans' monologues presented primary traumas that were related to their decisions to join the military but that were themselves mostly non-military in nature. We argue that the analysis of dramatic verse used in a therapeutic context can contribute to our understanding of the role of trauma in psychological distress, as well as the role of earlier life trauma in precipitating subsequent traumatic events. We also argue that creative arts therapies can be extremely beneficial in treating the effects of trauma in military populations. [ABSTRACT FROM AUTHOR]

Because many military veterans face mental health issues, it is important to research and practice alternative treatments including therapeutic recreation. The purpose of this study was to examine the effects of a single 45-minute adaptive scuba diving session on veterans' psychological well-being, specifically state-level mindfulness (Brown & Ryan, 2003) and contentment (Taylor, 2015). A one-group pretest-posttest evaluation was conducted with 28 veteran divers. Of them, 16 had mental health issues (e.g., posttraumatic stress disorder), while 11 had physical impairments (e.g., spinal cord injuries). Statistical results indicated that the post-dive mindfulness and contentment levels were significantly higher than their pre-dive counterparts (p = .007 and < .001, respectively). Moreover, the changes in mindfulness through scuba diving were positively correlated with the changes in contentment. The significant increases in mindfulness were present only among veterans with mental or physical health issues. These findings are discussed in relation to the literature on scuba diving, therapeutic recreation, mindfulness, and contentment. [ABSTRACT FROM AUTHOR]

Posttraumatic stress disorder (PTSD) may not fully explain why some who experience war feel as though their assumptive world and sense of meaning has been shattered. Two concepts mentioned in the literature that address this feature of trauma are moral injury and spiritual injury. This work reports on qualitative findings from postgroup interviews with 18 participants who completed a spiritually integrated eight-session group intervention known as Search for Meaning. The group is designed to deal directly with issues of moral and spiritual wounds. This article discusses three main themes related to (a) the group process, (b) spiritual struggles and repair, and (c) the role of the group leaders. The findings support the call for specialized interventions to supplement mainstream PTSD treatments. [ABSTRACT FROM AUTHOR]

Objective: We describe the development and implementation of a telephonic intervention (SAVE-CLC) piloted at three VA sites for Veterans returning to the community from VA nursing facilities (Community Living Centers or "CLCs"). Care transitions present a known period of medical risk for older adults and may pose increased risk for suicide. Veterans discharging from CLCs are at elevated risk compared to age and gender matched controls. Methods: Using a quality improvement approach, input was gathered from key stakeholders to aid in the development of the intervention. Veterans were screened for depressive symptoms and need for additional support by phone. Results: Of the Veterans who received the SAVE-CLC intervention, 87.9% had at least one prior mental health diagnosis, though only 19.7% had an outpatient mental health appointment arranged at CLC discharge. Results suggest that the intervention is feasible across multiple outpatient settings and is generally well-received by Veterans and caregivers, with 97% of those contacted reporting that the telephone calls were helpful. Conclusion: This flexible, telephone-based intervention addresses the unmet need of integrating mental health care into discharge planning during care transitions. Clinical Implications: SAVE-CLC offers a feasible and acceptable solution to suicide risk in older Veterans exiting a CLC. [ABSTRACT FROM AUTHOR]

United States (U.S.) military veterans experience significant physical health problems. Lifestyle modifications, such as increasing daily physical activity, are often considered the first course of action in treatment for the general public. However, veterans report low levels of physical activity, often due to perceived barriers to engaging in exercise. Trauma exposure type and cumulative trauma burden may be differentially associated with exercise attitudes and behaviors.We surveyed U.S. military veterans on perceived self-efficacy to overcome barriers to engaging in exercise and physical activity levels. Additionally, we explored the relationship between the type of traumatic event exposure and cumulative trauma on these constructs.Veterans exposed to sexually aggressive traumatic events (vs. did not) reported significantly lower physical activity levels; no difference in perceived self-efficacy to overcome barriers to exercise existed between groups. Greater cumulative trauma was associated with lower physical activity and self-efficacy to engage in exercise.These novel results indicate that both trauma type and cumulative trauma burden should be considered when designing exercise interventions for military veterans. [ABSTRACT FROM AUTHOR]

Some research shows that physical activity levels are low among veterans, but research gaps exist specifically in regards to promoting physical activity in veterans with multiple morbidities. For the present study, we retrieved data from the 2015 Behavioral Risk Factor Surveillance System. The study sample included 57,842 military service members and veterans. We carried out a mediation analysis to determine the effect of social support on the relationship between multiple morbidities and aerobic physical activity. Social support partially mediated the relationship between the presence of multiple morbidities and aerobic physical activity, a*b= -0.003, [95% CI = -0.007, -0.001]. Programs aimed at facilitating adequate social support among service members and veterans with multiple morbidities may increase their uptake of aerobic physical activity, and thus, decrease concomitant risk for health-related disorders.

Anger problems are most evident in veterans who are diagnosed with Posttraumatic Stress Disorder (PTSD) and have been exposed to combat. Because of the institutionalized role anger plays in military training, identity, and culture, anger problems are also an issue for former soldiers who have neither PTSD nor combat experience. Consequently, anger problems are an issue for many veterans whose inability to manage and express their anger constructively inhibits psychosocial functioning in multiple areas, including personal relationships, employment, self-esteem, and behavioral self-control. Empirically supported group interventions addressing this issue adhere to the principles of evidence-based practice and are particularly important given the current geopolitical climate. This paper reviews some of the current literature on clinical interventions for veterans experiencing anger problems and acknowledges the increasingly important role social workers are playing as mental health service providers to veterans with anger problems at institutions such as the Department of Veterans Affairs.

Background: The WHO International Classification of Diseases, 11th version (ICD-11), includes a trauma-related diagnosis of complex posttraumatic stress disorder (CPTSD) distinct from posttraumatic stress disorder (PTSD). Results from previous studies support the validity of this distinction. However, no studies to date have evaluated the ICD-11 model of PTSD and CPTSD in treatment-seeking military veterans. Objective: To determine if the distribution of symptoms in treatment-seeking Danish veterans was consistent with the ICD-11 PTSD and CPTSD symptom profiles. Based on previous studies, we hypothesized that separate classes representing PTSD and CPTSD would be found that membership of a potential CPTSD-class would be predicted by a larger number of childhood traumas, and that a potential distinction between PTSD and CPTSD would be supported by differences in sociodemographic and functional outcomes. Method: Participants (N = 1,541) were formerly deployed Danish soldiers who completed proxy measures of ICD-11 PTSD and disturbances in self-organization (DSO) symptoms, along with self-report measures of traumatic life events, prior to starting treatment at the Military Psychology Department of the Danish Defence. Results: All hypotheses were supported. Latent profile analysis (LPA) revealed separate classes representing PTSD and CPTSD. In comparison to the PTSD-class, membership of the CPTSD-class was predicted by more childhood traumatic experiences, and members of this class were more likely being single/divorced/widowed and more likely to use psychotropic medication. Besides a PTSD-class and a CPTSD-class, LPA revealed a Low Symptoms-class, a Moderate DSO-class, a Hyperarousal-class, and a High DSO-class, with clear differences in functional outcomes between classes. Conclusion: Findings replicate previous studies supporting the distinction between ICD-11 PTSD and CPTSD. In addition, there seem to be groups of treatment-seeking military veterans that do not fulfil full criteria for a trauma-related disorder. Further research should explore subsyndromal PTSD and CPTSD profiles in veterans and other populations.

For most individuals with traumatic brain injury (TBI), the ability to work is crucial to financial and psychological well-being. TBI produces a wide range of cognitive, physical, emotional, and interpersonal impairments that may undermine the ability to work. Employment is therefore a primary goal of TBI rehabilitation and has been the focus of extensive research. Although this literature has identified predictors of employment outcomes, few studies have examined the mechanisms that underlie these associations. Mediation analysis can identify these mechanisms, provide a more nuanced view of how predictors jointly affect rehabilitation outcomes, and identify predictors that, if treatable conditions, could be useful targets for tertiary prevention. Such efforts are aimed at reducing long-term impairments, disability, or suffering resulting from the injury. The study sample comprised 83 U.S. military veterans with TBI who had participated in a larger rehabilitation study and were interviewed in their homes. Bivariate tests revealed significant associations of employment with pain, cognitive functioning, self-rated health, depressive symptoms and physical functioning; the latter variable was operationalized in two ways—using the Patient Competency Rating Scale and the SF–36V physical functioning subscales. Because these physical functioning measures were highly intercorrelated (r = 0.69, p < 0.0001), separate regression models were conducted. In the hierarchical binary logistic regression models, predictors were entered in order of modifiability, with comorbidities (pain) entered in block 1, physical health/functioning sequelae in block 2, and depressive symptoms in block 3. In the regression using the SF-36V measure of physical functioning, pain's effect was mediated by the physical functioning/health predictors, with only physical functioning emerging as significant, but this effect was itself mediated by depressive symptoms. In the regression using the PCRS physical-function measure, only depressive symptoms emerged as a mediator of other effects. Findings underscore the central role of depression in the employment status of veterans with TBI, suggesting that negative effects of other problems/limitations could be mitigated by more effective treatment of depression. Thus, for many with chronic TBI who live with vocational limitations, outcomes may improve with lower depression. Findings argue for the wider use of mediation approaches in TBI research as a means of identifying targets for tertiary prevention of poor outcomes.

Introduction: Psychiatric service dogs are increasingly being sought out by military veterans as a complementary intervention for posttraumatic stress disorder (PTSD). After receiving a service dog, many veterans continue training their service dog at home. Our objective was to explore the associations between training methods, PTSD severity, service dog behavior, and the veteran-service dog bond in a population of military veterans with PTSD.Methods: Post-9/11 military veterans with PTSD who had received a psychiatric service dog were recruited from a national service dog provider. A total of 111 veterans (M = 40.1 ± 8.3 years, 80% male) participated in an online survey regarding frequency of training methods, PTSD symptom severity, service dog behavior, and the human-animal bond. Service dogs were predominately Labrador Retriever purebreds or mixes of various breeds (66% male) and mostly obtained from shelters or rescues (58%). Training methods were divided into five categories: positive reinforcement (e.g., physical praise), negative punishment (e.g., ignoring the dog), positive punishment (e.g., verbal correction), dominance (e.g., alpha roll), and bond-based (e.g., co-sleeping). Data were analyzed using general linear models.Results: Veterans self-reported using all five categories of training methods at least once a month. More frequent use of positive punishment was associated with less closeness with their service dog (p = 0.02), more fear (p = 0.003), less eye contact (p < 0.0001), and less trainability (p = 0.04). More frequent use of positive reinforcement was associated with higher closeness to their service dog (p = 0.002) and perceived increased attachment behavior (p = 0.002) and playfulness (p = 0.002). More frequent use of bond-based methods was associated with higher closeness to their service dog (p = 0.02). PTSD severity was not significantly associated with reported dog behavior, temperament, or veteran-service dog closeness.Conclusion: Military veterans with PTSD service dogs reported using many training methods that were associated with different outcomes. In general, the reported use of positive reinforcement or bond-based training methods were associated with reporting more positive outcomes while the reported use of positive punishment was associated with reporting more negative outcomes. Educating service dog organizations and recipients about the impacts of training methods could be beneficial for service dog efficacy and welfare.

The U.S. Air Force asked RAND Project AIR FORCE (PAF) to help assess the well-being of its wounded members and the quality of services provided to facilitate their recovery and reintegration. RAND PAF fielded a survey in the fall of 2016 to assess wounded airmen's functioning in the domains of physical health, mental health, interpersonal relationships, unemployment, and financial status, as well as their utilization and perceptions of Air Force nonmedical programs for wounded airmen. The authors of this study invited all 713 wounded airmen enrolled in the Air Force Wounded Warrior program to complete the survey, and 270 airmen (38 percent) completed it. One-third of airmen reported difficulty obtaining care for physical or mental health conditions, and one-quarter expressed dissatisfaction with coordination of care. Similar proportions of airmen reported barriers to care for physical and mental health conditions. Difficulty scheduling appointments was the most commonly endorsed barrier for both types of conditions. Small but notable proportions of airmen reported potential social support deficits, unemployment, and financial problems. For many of the Air Force's programs for wounded airmen, over 80 percent of program users reported overall program satisfaction. The authors recommend that the Air Force consider focusing on improving care coordination, increasing health care system capacity, continuing employment assistance, and improving marketing of programs with low uptake., (Copyright © 2024 RAND Corporation.)

Many military veterans who experienced blast-related traumatic brain injuries in the conflicts in Iraq and Afghanistan currently suffer from chronic cognitive and mental health problems that include depression and post-traumatic stress disorder (PTSD). Male rats exposed to repetitive low-level blast develop cognitive and PTSD-related behavioral traits that are present for more than 1 year after exposure. We previously reported that a group II metabotropic receptor (mGluR2/3) antagonist reversed blast-induced behavioral traits. In this report, we explored mGluR2/3 expression following blast exposure in male rats. Western blotting revealed that mGluR2 protein (but not mGluR3) was increased in all brain regions studied (anterior cortex, hippocampus, and amygdala) at 43 or 52 weeks after blast exposure but not at 2 weeks or 6 weeks. mGluR2 RNA was elevated at 52 weeks while mGluR3 was not. Immunohistochemical staining revealed no changes in the principally presynaptic localization of mGluR2 by blast exposure. Administering the mGluR2/3 antagonist LY341495 after behavioral traits had emerged rapidly reversed blast-induced effects on novel object recognition and cued fear responses 10 months following blast exposure. These studies support alterations in mGluR2 receptors as a key pathophysiological event following blast exposure and provide further support for group II metabotropic receptors as therapeutic targets in the neurobehavioral effects that follow blast injury.

Background: People who support Veterans as they transition from their military service into civilian life may be at an increased risk of psychological distress. Existing studies focus primarily on paid family caregivers, but few studies include spouses and informal non-family "care partners." We sought to identify key challenges faced by care partners of Veterans with invisible injuries., Methods: Semi-structured interviews were conducted with 36 individuals involved in supporting a recently separated US military Veteran enrolled in a 2-year longitudinal study. CPs completed validated measures on perceived stress, caregiving burden, quality of their relationship, life satisfaction, and flourishing. Independent t -tests were used to compare cases in these groups on caregiving burden, quality of their relationship, life satisfaction, and flourishing. Care partners were categorized as reporting high and low levels of stress. Exemplar cases were used to demonstrate divergences in the experiences of CPs with different levels of stress over time., Results: Care partners reported shifts in self-perception that occurred from supporting a Veteran, emphasizing how they helped Veterans navigate health systems and the processes of disclosing health and personal information in civilian contexts. Exemplar cases with high and low burdens demonstrated divergent experiences in self-perception, managing multi-faceted strain, and coping with stress over time. Case studies of specific care partners illustrate how multi-faceted strain shifted over time and is affected by additional burdens from childcare, financial responsibilities, or lack of education on mental health issues., Conclusions: Findings suggest the unique needs of individuals who support military Veterans with invisible injuries, highlighting variations and diachronic elements of caregiving. This sample is younger than the typical caregiver sample with implications for how best to support unpaid care partners caring for Veterans in the early to mid-period of their use of VA and civilian health services., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Rattray, Flanagan, Mann, Danson, Do, Natividad, Spontak and True.)

The Aid and Attendance (A&A) benefit is a cash entitlement for Veterans who served in the U.S. military to obtain personal care services. Our objective was to identify factors contributing to variation in A&A enrollment across VA Medical Centers (VAMCs). We used VA data to calculate the enrollment rate among older Veterans receiving a VA pension or compensation in 2015, then purposefully sampled social work leaders at 15 VAMCs with the highest ( n  = 7) and lowest ( n  = 8) enrollment rates for interviews. All respondents viewed A&A as an important benefit. Participants at high-enrollment sites indicated strong working relationships with Veterans Benefits Administration (VBA) and Veterans Service Organizations (VSOs) with onsite presence and education about A&A facilitate access. Participants at low-enrollment sites indicated they desired education around A&A eligibility criteria and collaboration with VBA/VSOs. VA and non-VA social workers would benefit from education about VBA's benefits, and this requires collaboration with VBA representatives.

Objective: Because service professionals often lack cultural competence in working with veterans, veterans often perceive such professionals as "not understanding." The authors developed, evaluated, and implemented Veteran Cultural Competence Training (VCCT), combining educational and experiential components in an in-person training focused on building awareness, knowledge, and skills to better work with veterans., Methods: Study 1 was a type 1 effectiveness-implementation hybrid trial examining VCCT effectiveness in a sample of social service professionals (N=41) compared with a matched comparison group (N=41) via the Multicultural Counseling Self-Efficacy Scale-Veteran Form (MCSE-V) instrument. In study 2, the authors used the reach, effectiveness, adoption, implementation, and maintenance (RE-AIM) framework to conduct a type 2 effectiveness-implementation hybrid trial and implemented VCCT with an expanded population (N=312) during eight training sessions in three U.S. states., Results: Results from study 1 indicated that VCCT significantly increased self-efficacy of trainees in veteran cultural competence compared with the matched group (p<0.001). In study 2, the RE-AIM framework highlighted the importance of building coalitions and utilizing implementation facilitation to maintain fidelity. The within-group effectiveness of VCCT was statistically significant and maintained across settings and professions (p<0.001), and trainees were satisfied with VCCT. Maintenance analysis revealed expansion of VCCT after implementation in terms of the number of training sessions (N=9), regions hosting the training (N=5), staff hired (N=13), and trainee applications (N=1,018)., Conclusions: VCCT effectively increases self-efficacy in veteran cultural competence. Gains appeared across different professions, demographic characteristics, and locations. Participation in VCCT may increase professionals' competence in understanding veteran culture, thereby potentially improving veteran services., Competing Interests: Dr. Goodman is a consultant for Boehringer Ingelheim. The other authors report no financial relationships with commercial interests.

Background The 'healthy worker effect' predicts that longer employment is positively associated with reduced mortality, but few studies have examined mortality in military veterans irrespective of exposure to conflict. Aims To examine mortality in a large national cohort of Scottish veterans by length of service. Methods Retrospective cohort study comparing survival in up to 30-year follow-up among 57 000 veterans and 173 000 people with no record of service, matched for age, sex and area of residence, who were born between 1945 and 1985. We compared antecedent diagnoses in the two groups to provide information on probable risk factors. Results By the end of follow-up, 3520 (6%) veterans had died, compared with 10 947 (6%) non-veterans. Cox proportional hazard analysis confirmed no significant difference overall unadjusted or after adjusting for deprivation. On subgroup analysis, those who left prematurely (early service leavers) were at significantly increased risk of death (hazard ratio (HR) 1.16, 95% confidence interval (CI) 1.09–1.24, P < 0.001), although the increase became non-significant after adjusting for socioeconomic status (HR 1.05, 95% CI 0.99–1.12). Longer-serving veterans were at significantly lower risk of death than non-veterans; the risk decreased both with length of service and in more recent birth cohorts. Smoking-related disease was the greatest contributor to increased mortality in early leavers. Conclusions Among longer-serving veterans, there was evidence of a HWE partly attributable to selective attrition of early service leavers, but birth cohort analysis suggests improvements over time which may also reflect a causal effect of improved in-service health promotion. [ABSTRACT FROM AUTHOR]

Since at least T. H.Marshall, scholars have recognized military service as a form of sacrifice that warrants compensation from the state. War-widow pensions, expansion of the franchise, and subsidized higher education are all examples of rights and benefits “bestowed” in return for wartime mobilization. Similarly, in the United States, governments have hired veterans preferentially for civilian public jobs as recompense for active military service. Although oft overlooked, those policies seem influential: the percentage of job holders identifying as veterans in the civilian US executive branch exceeds the proportion in the wider population by several multiples. This century-old pattern suggests another way that wartime mobilization has influenced the state. Yet, efforts to understand it have struggled to rule out the possibility that those who serve in the armed forces are predisposed to work for the state in both military and civilian capacities. Here, we rule out this possibility by examining whether birthdates randomly called for induction in the Vietnam-Era Selective Service Lotteries (VSSL) appear disproportionately in the population of nonsensitive personnel records of the civilian US executive branch. We find that birthdates called for induction appear with unusually high frequency among employees who were draft eligible and at risk for induction but not among other employees. This finding suggests a treatment effect frommilitary service, thus dovetailingwith the hypothesis that wartime mobilization has substantially and continually influenced who works in the contemporary administrative state. [ABSTRACT FROM AUTHOR]

Military veterans can experience spiritual/religious struggles such as weakening of beliefs, loss of meaning, increased guilt, difficulty forgiving, and moral challenges as a result of military trauma. While mainstream treatments (e.g., exposure therapy) have been shown to be effective for many, they often fail to address these issues adequately. This paper describes an 8-session spiritually-based group intervention designed to treat trauma-related spiritual wounds among military veterans. A program evaluation conducted with 24 veterans revealed significant reductions in PTSD symptoms, spiritual injury, and negative religious coping from pretest to posttest. The findings support the need for additional PTSD treatment approaches. [ABSTRACT FROM AUTHOR]

Objective: Treatment for posttraumatic stress disorder (PTSD) is a commonly sought mental health service among military service members and veterans (SM/Vs). Such treatment is typically individually‐based, despite many SM/Vs reporting a desire for greater partner involvement in treatment. This review examined couple‐based treatments for PTSD among SM/Vs and their romantic partners. Method: A database search conducted in July, 2018 yielded 167 studies, of which 16 (10%) met inclusion criteria. Brief intervention summaries, effect sizes, and distress change scores (where applicable) are reported. Results: The 16 studies tested 7 interventions, which showed a reduction in self‐rated and clinician‐rated PTSD symptoms with large effect sizes observed in most studies. Relationship outcomes also improved for SM/Vs and their partners, with effect sizes ranging from small‐to‐medium for SM/Vs and small‐to‐large for partners. Conclusions: Couple‐based interventions show success in reducing PTSD symptoms and improving relationship outcomes, offering several alternatives to individual‐based interventions among partnered SM/Vs. [ABSTRACT FROM AUTHOR]

Lesbian, gay, and bisexual persons have served in the military throughout history despite military policies that necessitated concealment of their sexual orientation. This secondary data analysis of research from a community-based study of sexual and gender minority (SGM) older adults sought to explore the unique needs of this growing "out" population and identify the future program, policy, and research goals. The sampling population for this study was drawn from a community-based study conducted initially by researchers from the ACRIA center. The SGM veterans in this pilot study were recruited from the Center on Halstead, the largest SGM community-based center in the Midwest. Twenty-six veterans' self-identified as gay men. Considering the minority stress model, data from this study identified a group of men with less social support – either formal or informal, less housing and economic security, and low service utilization. Interestingly, this group also self-reported as having a more positive mental and physical health outlook than previous research with this population. This study also identified a clear need for education, more extensive population-based mixed methods studies to help understand fully the needs of this previously "invisible" population of older military veterans. [ABSTRACT FROM AUTHOR]

The impact of losing a limb in military service extends well beyond initial recovery and rehabilitation, with long-term consequences and challenges requiring health-care commitments across the lifecourse. This paper presents a systematic review of the current state of knowledge regarding the long-term impact of ageing and limb-loss in military veterans. Key databases were systematically searched including: ASSIA, CINAHL, Cochrane Library, Medline, Web of Science, PsycArticles/PsychInfo, ProQuest Psychology and ProQuest Sociology Journals, and SPORTSDiscus. Empirical studies which focused on the long-term impact of limb-loss and/or health-care requirements in veterans were included. The search process revealed 30 papers relevant for inclusion. These papers focused broadly on four themes: (a) long-term health outcomes, prosthetics use and quality of life; (b) long-term psycho-social adaptation and coping with limb-loss; (c) disability and identity; and (d) estimating the long-term costs of care and prosthetic provision. Findings present a compelling case for ensuring the long-term care needs and costs of rehabilitation for older limbless veterans are met. A dearth of information on the lived experience of limb-loss and the needs of veterans' families calls for further research to address these important issues. [ABSTRACT FROM AUTHOR]

Objective We evaluated the influence of the APOE-ε4 allele on post-concussive symptoms in military Veterans with a remote history of mild traumatic brain injury (mTBI). Method Participants (N = 77) were administered neuropsychiatric measures, on average, approximately 5 years following their most recent mTBI and provided a DNA sample for APOE genotyping. Veterans were divided into two groups based on their ε4 status (n = 14 ε4+, n = 63 ε4–). The Neurobehavioral Symptom Inventory (NSI) was the primary outcome measure, from which a total score was derived, as well as three symptom clusters (somatic, cognitive, and affective). Results ANCOVAs showed a significant main effect of ε4 genotype on the NSI total score and somatic symptom cluster after adjusting for posttraumatic stress symptoms and mTBI history (p =.019–.028, ηp2 =.064–.073), such that ε4+ Veterans endorsed significantly greater symptoms than ε4– Veterans. Conclusions Our findings suggest that genetic risk may help to explain the poorer long-term outcomes often observed in this population. [ABSTRACT FROM AUTHOR]

Background: We developed and validated the Well‐Being Inventory (WBI) to address the need for a tool that can provide a comprehensive assessment of key aspects of military veterans' lives. This multidimensional instrument assesses status, functioning, and satisfaction with regard to vocation, finances, health, and social relationships. Methods: Two large multi‐phase studies (Study 1 Ns = 301, 286; Study 2 Ns = 9,566, 7,342) were conducted to develop and validate this tool among military veterans. Results: Confirmatory factor analyses supported the proposed factor structure, with separate factors observed for all scales except the health functioning scale, which was best represented as three factors rather than a single factor. Cronbach's alphas were satisfactory, with an average alpha of 0.86. Most WBI measures discriminated among individuals with and without mental health conditions and demonstrated expected declines among those with a new mental health condition. Conclusions: This study provides initial evidence for the reliability, validity, and sensitivity to change of the WBI. This tool can be used to provide insight into areas in which military veterans would benefit from additional support and inform efforts to promote the well‐being of this population. Given its broad focus, it may also prove useful with other civilian populations. [ABSTRACT FROM AUTHOR]

This study examined the transition of veterans from the military to the classroom. Guided by communication accommodation theory (CAT), results of semi-structured interviews (N = 20) of military veterans were analyzed to see how and why participants described communication approaches in the university setting. Approaches appeared guided by inculcated values developed during earlier cultural experiences, in the military. Participants described interpersonal and group communication exchanges in three broad themes: cultural clash, perspective taking, and self-silencing. This research supports prior psychological research that explored difficulties combat veterans face after exit and extends this research to non-combat veterans from a communicative perspective. [ABSTRACT FROM AUTHOR]

A significant portion of firefighters are military veterans, and both populations experience high rates of trauma and posttraumatic stress disorder (PTSD) symptomatology. We investigated main and interactive effects of military veteran status (MVS) and emotion regulation difficulties (ERD) with regard to PTSD symptom severity in firefighters. Covariates included trauma load, number of years in the fire department, and depressive symptom severity. The sample was composed of 839 (93.9% men; mean age = 38.4, SD = 8.5) trauma-exposed firefighters who completed a web-based questionnaire battery. Structural equation modeling was used. ERD were significantly, positively associated with PTSD symptom severity (β = 0.30, confidence interval [CI] = 0.20-0.41, p < 0.001). A significant interactive effect was noted (β = 0.07, CI = 0.01-0.14, p = 0.020); firefighters who endorsed MVS and greater ERD had the highest levels of PTSD symptom severity. It is vital that future work examine associations between MVS and relevant cognitive mechanisms for the purposes of informing effective screening, intervention, and prevention programs. [ABSTRACT FROM AUTHOR]

For most individuals with traumatic brain injury (TBI), the ability to work is crucial to financial and psychological well-being. TBI produces a wide range of cognitive, physical, emotional, and interpersonal impairments that may undermine the ability to work. Employment is therefore a primary goal of TBI rehabilitation and has been the focus of extensive research. Although this literature has identified predictors of employment outcomes, few studies have examined the mechanisms that underlie these associations. Mediation analysis can identify these mechanisms, provide a more nuanced view of how predictors jointly affect rehabilitation outcomes, and identify predictors that, if treatable conditions, could be useful targets for tertiary prevention. Such efforts are aimed at reducing long-term impairments, disability, or suffering resulting from the injury. The study sample comprised 83 U.S. military veterans with TBI who had participated in a larger rehabilitation study and were interviewed in their homes. Bivariate tests revealed significant associations of employment with pain, cognitive functioning, self-rated health, depressive symptoms and physical functioning; the latter variable was operationalized in two ways—using the Patient Competency Rating Scale and the SF–36V physical functioning subscales. Because these physical functioning measures were highly intercorrelated (r = 0.69, p < 0.0001), separate regression models were conducted. In the hierarchical binary logistic regression models, predictors were entered in order of modifiability, with comorbidities (pain) entered in block 1, physical health/functioning sequelae in block 2, and depressive symptoms in block 3. In the regression using the SF-36V measure of physical functioning, pain's effect was mediated by the physical functioning/health predictors, with only physical functioning emerging as significant, but this effect was itself mediated by depressive symptoms. In the regression using the PCRS physical-function measure, only depressive symptoms emerged as a mediator of other effects. Findings underscore the central role of depression in the employment status of veterans with TBI, suggesting that negative effects of other problems/limitations could be mitigated by more effective treatment of depression. Thus, for many with chronic TBI who live with vocational limitations, outcomes may improve with lower depression. Findings argue for the wider use of mediation approaches in TBI research as a means of identifying targets for tertiary prevention of poor outcomes. [ABSTRACT FROM AUTHOR]

Based on in-depth qualitative interviews with student veterans in the United States pursuing Bachelor's degrees in engineering across four institutions, we present findings relating military leadership and its application to engineering education. Our findings address three themes: (1) how leadership skills are learned, (2) motivation to be a leader, and (3) translation into, and enactment of military leadership skills in, engineering education. The interviews show that leadership skills and experiences acquired in the military play an important role in the academic experiences and success of student veterans in engineering (SVEs). Findings can help inform strategies and programs to encourage more SVEs to translate their leadership skills to an academic setting in an asset-based framework. Providing leadership opportunities for SVEs in the classroom has the potential to increase their engagement in engineering, strengthen their pathways to professional engineering practice, and provide important role models of servant leadership for the other engineering undergraduates who work with them. [ABSTRACT FROM AUTHOR]

Background While traumatic limb loss in military personnel is widely known, the threat posed by peripheral arterial disease (PAD) in those who have served is less well recognized. The aim of our study was to examine the risk of PAD in a Scotland-wide cohort of veterans who served between 1960 and 2012. Methods Retrospective 30-year cohort study of 56 205 veterans born 1945–85, and 172 741 non-veterans, matched for age, sex and area of residence, using Cox proportional hazard models to examine the association between veteran status, birth cohort, length of service and risk of PAD leading to hospitalization or death. Results Overall, veterans were at increased risk of PAD compared with non-veterans, unadjusted hazard ratio (HR) = 1.46, 95% confidence intervals (CI): 1.33–1.60, P < 0.001. The highest risk was in veterans born between 1950 and 1954, HR = 1.76, 95% CI: 1.50–2.07, P < 0.001, and in those with the shortest service (early service leavers), HR = 1.84, 95% CI: 1.49–2.27, P < 0.001. Conclusions The findings provide evidence for a hidden burden of life- and limb-threatening PAD in older veterans and are consistent with the higher rates of military smoking which have been reported previously. The study emphasizes the need for vascular preventive measures in this group. [ABSTRACT FROM AUTHOR]

• The concept of mimesis can be a way of thinking about how we use our imagination when we witness theatre and read fiction. • There can be therapeutic effects of theatre because it allows us to imagine possibilities for our future selves. • The DE-CRUIT program uses theatre and the imagination to treat the trauma in military veterans. • The imagination opens up emotional and psychological space for the explorating trauma and constructs a path to recovery for veterans. The concept of mimesis has existed since the time of the ancient Greeks and continues to be debated by artists and scholars alike concerning its meaning and implications for our understanding of the effects of theatre and fiction. In this article, we consider the possible therapeutic potential of mimesis, which can be seen as a way of thinking about theatre as a form of simulated story in which we can imagine ourselves. We focus on the healing effects of the imagination by analyzing its application through DE-CRUIT, a theatre-based treatment program for traumatic stress in military veterans. Through examples of specific veterans who have taken part in DE-CRUIT, we show how the imagination opens up emotional and psychological space for the exploration of trauma, thereby constructing a path to recovery that draws upon the human capacity for story-telling and meaning-making. [ABSTRACT FROM AUTHOR]