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The MOD Rehabilitation Department (RD) offers three types of rehabilitation tracks (RTs): (a) education, (b) work placement, (c) economic independence. This study aimed to examine which of the offered RTs predicted a better integration into the workforce. This is an observational, prospective, case‐controlled study. Data were collected from administrative files. The data pertained to soldiers injured in military service, under RD care and recognised as posttraumatic stress disorder (PTSD) patients between 2001 and 2006. As rehabilitation takes 5–6 years, we examined two points in time: 2015 and 5 years later, in 2020. The studied population comprised 462 male military veterans injured during military service and diagnosed with PTSD (mean age at the time of injury was 24.60 [SD 5.70]; median = 22). Of the participants, 87.9% (n = 406) also sustained physical injury, and 12.1% were not injured physically (n = 56; 12.1%). A regression analysis indicated that the educational RT (OR = 19.509; p =.001) predicted integration into the workforce. The whole model explained 49.0% of the variance. Of the three RT types examined, education is the most important. The more years of study, the better the ability to integrate into the workforce. [ABSTRACT FROM AUTHOR]

Introduction Methods Results Conclusions This study sought to better understand discussions of emergency dispatches (i.e., activation of local crisis services to conduct a welfare check) and the circumstances under which Veterans Crisis Line (VCL) callers and responders feel they are able contribute to (collaboration) and agree upon (consent) the decision to initiate an emergency dispatch.Semi‐structured interviews gathered data on veterans' (n = 40) experiences receiving an emergency dispatch and VCL responders' (n = 35) perspectives on initiating dispatches. Data were analyzed using a thematic analysis approach.Veterans calling the VCL were often seeking emotional support and were surprised to receive a suicide risk assessment and emergency dispatch. Responders reported they strive for collaboration and consent prior to sending a dispatch, but the crisis setting challenged this ideal. Overall, veterans and responders described similar features of the ideal, collaborative conversation about dispatches yet noted threats to achieving collaboration: complex standard operating procedures, responder training quality, and responder lack of comfort with de‐escalation.Increasing veteran awareness of VCL services, altering the timing and type of suicide risk assessment, enhancing de‐escalation skill, increasing consistency of VCL responder proficiencies, and revising guidelines for dispatch disclosure were identified as ways to improve collaboration and consent around emergency dispatches. [ABSTRACT FROM AUTHOR]

Objective: In 2020, Army National Guard members demonstrated greater risk of suicide than their military and civilian counterparts. Though literature on deployment-related experiences and suicidal ideation (SI) is mixed, investigations of specific deployment-related experiences (e.g., injuries) may further elucidate the relationship between deployment and suicide risk. Deployment-related injuries, including pain severity and functional impairment, have been linked to increased risk of SI, and correlates like perceived burdensomeness (PB) and hopelessness. The current study sought to examine the cross-sectional relationship between deployment-related injuries, including pain severity and functional impairment, and severity of SI through PB and hopelessness. Method: Immediately post-deployment, Army National Guard members (N = 2,261) completed validated self-report measures on past-week SI, PB, hopelessness, and single items regarding injury sustained during deployment and associated functional impairment and pain severity. Results: Indirect effect analyses revealed that experience of deployment-related injury was related to SI through PB and hopelessness (R2 =.1993), functional impairment was related to SI through PB, and pain severity was related to SI through PB. Contrary to hypotheses, hopelessness was not associated with SI when PB was simultaneously considered. Conclusions: Army National Guard members who develop a sense of PB related to their injury and functional impairment of that injury may be at increased risk for suicidal ideation. Military suicide-prevention efforts may be potentiated through targeting distorted cognitions such as PB and hopelessness, especially in service members who have been injured. [ABSTRACT FROM AUTHOR]

This study focuses on the subjective well-being (SWB) of a sample of military veterans before and after their engagement with a nonclinical, alternative mental health therapies residential retreat in the United Kingdom. The study findings have relevance for trauma-exposed individuals globally. Military veterans will actively avoid seeking traditional mental health treatments due to factors such as stigma and life-long labels, as well as a reluctance to engage in talk therapies. This is despite the widespread occurrence of diagnosed and undiagnosed chronic mental health conditions such as posttraumatic stress disorder following periods of service. Moving beyond trauma-informed practice and embracing a healing-centered approach involving holistic therapies delivered during a retreat-type format has a positive impact on the SWB of service users. Positive changes in SWB were recorded using the Warwick–Edinburgh Mental Well-Being Scale and the lived experiences of the participants. A shared military identity contributes immeasurably to a veteran-centered approach to holistic therapy, healing, and recovery. [ABSTRACT FROM AUTHOR]

Experiencing sexual harassment and bullying during military service can lead to negative consequences for a soldier's mental health and life satisfaction, including increased risk of depression, anxiety, and posttraumatic stress. No studies have to date investigated the prevalence and correlates of sexual harassment and bullying among Norwegian Afghanistan veterans, despite the increased global focus on these topics. In 2020, 6,205 Norwegian Afghanistan veterans (8.3% women) completed an online post-deployment survey, including questions about experiences of sexual harassment, bullying, mental health, and life satisfaction. Compared to their male counterparts, female veterans experienced significantly more sexual harassment and bullying during Afghanistan deployment (3.2% vs. 0.04% for experiencing sexual harassment, and 4.0% vs. 1.0% for bullying) and during other military services (14.3% vs. 0.4% for sexual harassment, and 15.9% vs. 3.7% for bullying). Sexual harassment was associated with younger age and experiencing childhood sexual harassment for both women and men, with men also having longer deployments. Bullying was associated with longer deployments and childhood sexual harassment for women, while men who reported bullying more often had longer deployments, held an officer rank, were less inclined to have a spouse/intimate partner, and reported childhood sexual harassment and bullying. Both sexual harassment and bullying were associated with increased risk of mental health problems and reduced life satisfaction for women, but this was only true for bullying among men. Despite lower reported rates of workplace harassment compared to studies from other cultures, this study demonstrates that sexual harassment and bullying in the military can negatively impact soldiers' mental health and life satisfaction. Notably, female veterans' mental health and life satisfaction appear to be particularly affected by sexual harassment during military service, an association not seen in males. This underscores the need for gender-specific, cultural, and context-sensitive prevention and support for workplace harassment experiences. [ABSTRACT FROM AUTHOR]

Abstract Background Equine-assisted services (EAS) involves the use of horses within therapy, learning or horsemanship sessions and has been used with military veterans suffering from post-traumatic stress disorder (PTSD). This study systematically reviewed existing research on the use of EAS in the treatment of PTSD in military veterans and evaluated its effectiveness. Methods A systematic review was performed, in May 2023, with searches and data extraction carried out from three separate databases (PubMed, JSTOR and Science Direct) related to testing the effect of EAS on PTSD outcomes in veterans. A risk of bias assessment of included studies was conducted and meta-analysis of outcomes performed when two or more studies reported the same outcomes. Other effects of EAS on veterans’ health were also discussed. Results A total of 13 studies were identified based on our inclusion and exclusion criteria with 11 originating from the US and the remaining two from Australia and Israel. There were 344 participants amongst all of the studies with a mean age of 47 years and a male:female ratio of 19:6. Eight out of the 13 studies reported PTSD scores, as measured by either PTSD Checklist for DSM-5 (PCL-5) or PCL-Veteran/-Military versions (PCL-V/-M), and results suggested a reduction in PTSD score after EAS treatment of 22.6%. A meta-analysis confirmed that EAS favored a significantly lower PTSD score after treatment, with a mean difference of 12.46, 95% CI [9.03,15.88], p

Self-reported histories of mild traumatic brain injury (mTBI) and posttraumatic stress disorder (PTSD) symptoms are prevalent among post-9/11 veterans. Both are associated with subjective and often overlapping symptom complaints, but variably with objective neuropsychological test performances. These outcomes are seldom explored in relation to lifetime mTBI burden. This cross-sectional study examined associations of PTSD and lifetime mTBI with subjective (persistent symptoms after concussion and cognitive complaints) and objective (performances across five cognitive domains) measures among 46 veterans. Within this sample, 20 veterans had Clinician-Administered PTSD Scale for DSM-5 (CAPS-5) confirmed PTSD (PTSD+), whereas 26 demographically-similar participants did not meet criteria (PTSD−). The Boston Assessment of Traumatic Brain Injury-Lifetime (BAT-L) yielded total mTBI scores ranging from 0 to 8. Regressions showed PTSD was associated with increased subjective symptoms/cognitive complaints, along with reduced verbal fluency, visuospatial memory, and processing speed performances. Lifetime mTBI burden was associated with subjective symptoms, but not with objective cognitive test performance, after controlling for PTSD. No significant interactions were observed. Exploratory correlations suggested that all PTSD symptom clusters were generally associated with the subjective and objective measures. However, fewer significant associations emerged within the PTSD+/− groups separately, with each group yielding somewhat different patterns of relationships. PTSD and increasing mTBI burden are consistently associated with negative subjective symptoms, including cognitive complaints. Each condition likely explains some degree of unique variance in symptom reporting. PTSD is associated with poorer objective cognition on some tasks, including processing speed, executive functioning, and learning/memory. Implications are explored. [ABSTRACT FROM AUTHOR]

This study evaluated measurement invariance across males and females on the Neurobehavioral Symptom Inventory (NSI) in U.S. military veterans enrolled in the VA Million Veteran Program. Participants (N = 17,059; males: n = 15,450; females: n = 1,609) included Veterans who took part in the VA Traumatic Brain Injury (TBI) Screening and Evaluation Program and completed the NSI. Multiple-group confirmatory factor analyses investigated measurement invariance of the NSI 4-factor model. The configural (comparative fit index [CFI] = 0.948, root mean square error of approximation [RMSEA] = 0.060) and metric (CFI = 0.948, RMSEA = 0.058) invariance models showed acceptable fit. There was a minor violation of scalar invariance (Δχ2 = 232.50, p <.001); however, the degree of noninvariance was mild (ΔCFI = −0.002, Δ RMSEA = 0. 000). Our results demonstrate measurement invariance across sex, suggesting that the NSI 4-factor model can be used to accurately assess symptoms in males and females following TBI. Findings highlight the importance of considering validity of measurement across study groups to increase confidence that a measure is interpreted similarly by respondents from different subgroups. [ABSTRACT FROM AUTHOR]

Imagery rescripting (ImRs) interventions have been found effective in improving sleep outcomes, although research has mostly focused on civilian, rather than military, samples. The aim of this review was to estimate the overall effectiveness of ImRs interventions for military veterans on primary outcomes of nightmare frequency and sleep quality. A systematic search was conducted in CINAHL, MEDLINE, PsycArticles, PsycINFO, Psychology and Behavioural Sciences Collection and the PTSDpubs database and was completed on 1 November 2021. Randomised controlled trials, nonrandomised trials and pre–post studies of ImRs interventions in veterans with sleep disturbances or nightmares were included. The methodological quality of the studies was assessed using the Effective Public Health Practice Project (EPHPP) tool, and meta‐analysis was performed using Stata. Nineteen articles from 15 empirical studies were included in the review, and data from the 15 studies (involving 658 participants) were included in the meta‐analysis. Meta‐analysis findings indicated that ImRs interventions are associated with significant positive changes from pretreatment to posttreatment for nightmare and sleep quality. Significantly greater improvements were found in ImRs interventions compared to control groups for sleep quality (Hedges' g = −0.65, 95% CI [−1.20, −0.10]) but not for nightmare frequency (Hedges' g = −0.10, 95% CI [−0.34, 0.14]). Overall, the meta‐analysis included a relatively small number of studies with poor methodological quality and considerable heterogeneity; therefore, findings should be cautiously interpreted. Further research should focus on veteran participants with larger samples and from a broader range of sources to determine effectiveness more confidently. [ABSTRACT FROM AUTHOR]

Examine group differences among women and men United States Veterans with chronic fatigue syndrome (CFS) and chronic pain (CP). Administrative data from the VA Corporate Data Warehouse were derived from a cohort that met criteria for CP in 2018. Differences across sociodemographic characteristics, psychiatric comorbidities, and pain-related healthcare utilization were examined. Analyses included group comparisons (chi-square tests for independence or independent samples t-tests) and effect size differences (Cohen's d or Cramer's V). The period prevalence for comorbid CFS and CP was greater among women Veterans (1.20% vs. 0.61%). Women Veterans with CFS and CP were younger (d = 0.80), more likely to be Black, and less likely to be White (V = 0.13). Women Veterans with CFS and CP were more likely to have fibromyalgia (V = 0.23), headache (V = 0.24), or urogenital, pelvic, and menstrual pain (V = 0.14), and less likely to have neuropathy relative to men; they were also more likely to have depression (V = 0.15) or anxiety (V = 0.13). Comorbid CFS and CP are more prevalent among women Veterans relative to men. Group differences in pain clusters and psychiatric comorbidities may have implications for clinical offerings to women Veterans with these conditions. [ABSTRACT FROM AUTHOR]

Objectives: US veterans report more adverse childhood experiences (ACEs) than nonveterans, and a greater number of ACEs has been linked to substance use disorders (SUDs). To date, however, no study has examined whether specific ACEs may be linked to SUDs in this population in a sex-related fashion. Methods: We analyzed data from the National Health and Resilience in Veterans Study, a nationally representative survey of 4069 US veterans. ACEs, current alcohol use disorder (AUD), and current drug use disorder (DUD) were assessed using validated self-report measures. Results: Being raised in a household with people with SUDs was independently associated with current AUD. Childhood sexual abuse and having an incarcerated family member were independently associated with current DUD. Sex moderated associations with specific ACEs. Specifically, female veterans who had experienced physical neglect in childhood or were raised with a mentally ill family member in the home were more likely to endorse current AUD and DUD, whereas male veterans who experienced sexual abuse in childhood or who were raised in a home with someone who used substances were more likely to endorse current AUD and DUD. Conclusions: Results underscore the importance of targeted and sexsensitive interventions in addressing potentially unresolved childhood traumas as part of treatment efforts for SUDs in veterans. [ABSTRACT FROM AUTHOR]

Objectives: Growing evidence supports the role of mindfulness in regulating emotions in the general population. However, the interactive network of mindfulness facets and difficulties in regulating emotions is not well understood, which is specifically important for individuals involved in high-risk professions, such as first responders. The aim of this study was to investigate the interactive relations between mindfulness facets (acting with awareness, non-judging, describing, observing, and non-reacting), ability to regulate emotions and alcohol use in a sample of firefighters, including military veterans. Method: A sample of 685 career firefighters, of whom 154 (22.5%) are military veterans, completed measures of mindfulness and difficulties in regulating emotions. The dataset was subjected to network analysis. Results: The mindfulness facet non-judging was negatively related to emotion-regulation challenges, such as nonaccepting attitudes and lack of clarity, and positively related to deficits in goal-directed behaviour. Acting with awareness was negatively related to goal-directed behaviour deficits and impulsivity. Alcohol use was positively linked to impulsivity and negatively linked to describing. Overall, emotion-regulation difficulties were positively linked together, and positive links were found between most mindfulness facets. Directed network analysis found non-judging and emotion-regulation strategy as primary predictors. Non-judging acted as a protective factor, supporting other mindfulness facets, while emotion-regulation strategy exacerbated emotion-regulation challenges acted as a risk factor. Conclusions: This network analysis demonstrated that acting with awareness and a non-judgmental attitude, facets of mindfulness, are linked to better emotion-regulation and may play protective role against impulsivity and alcohol use. [ABSTRACT FROM AUTHOR]

Background: ICD-11 complex post-traumatic stress disorder is a more severe condition than post-traumatic stress disorder, and recent studies indicate it is more prevalent among military samples. In this study, we tested the psychometric properties of the International Trauma Questionnaire, assessed the relative prevalence rates of post-traumatic stress disorder and complex post-traumatic stress disorder in the sample population and explored relationships between complex post-traumatic stress disorder and post-traumatic stress disorder and a range of risk factors. Methods: Survey participants (N = 189) were mental health support-seeking former-serving veterans of the Australian Defence Force (ADF) recruited from primary care. Confirmatory factor analysis was used to test the factorial validity of the International Trauma Questionnaire. Results: The latent structure of the International Trauma Questionnaire was best represented by a two-factor second-order model consistent with the ICD-11 model of complex post-traumatic stress disorder. The International Trauma Questionnaire scale scores demonstrated excellent internal reliability. Overall, 9.1% (95% confidence interval = [4.8%, 13.5%]) met diagnostic requirements for post-traumatic stress disorder and an additional 51.4% (95% confidence interval = [44.0%, 58.9%]) met requirements for complex post-traumatic stress disorder. Those meeting diagnostic requirements for complex post-traumatic stress disorder were more likely to have served in the military for 15 years or longer, had a history of more traumatic life events and had the highest levels of depression, anxiety and stress symptoms. Conclusion: The International Trauma Questionnaire can effectively distinguish between post-traumatic stress disorder and complex post-traumatic stress disorder within primary care samples of Australian Defence Force veterans. A significantly greater proportion of Australian Defence Force veterans met criteria for complex post-traumatic stress disorder than post-traumatic stress disorder. Australian military mental health services should adopt the International Trauma Questionnaire to routinely screen for complex post-traumatic stress disorder and develop complex post-traumatic stress disorder specific interventions to promote recovery in Australian Defence Force veterans with complex post-traumatic stress disorder. [ABSTRACT FROM AUTHOR]

Identifying factors that moderate cognitive outcomes following mild traumatic brain injury (mTBI) is crucial. Prospective memory (PM) is a cognitive domain of interest in mTBI recovery as it may be especially sensitive to TBI-related changes. Since studies show that genetic status – particularly possession of the apolipoprotein E (APOE) ε4 allele – can modify PM performance, we investigated associations between mTBI status and APOE-ε4 genotype on PM performance in a well-characterized sample of Veterans with neurotrauma histories. 59 Veterans (mTBI = 33, Military Controls [MCs] = 26; age range: 24–50; average years post-injury = 10.41) underwent a structured clinical interview, neuropsychological assessment, and genotyping. The Memory for Intentions Test (MIST) measured PM across multiple subscales. ANCOVAs, adjusting for age and posttraumatic stress symptoms, tested the effects of mTBI status (mTBI vs. MC) and ε4 status (ε4+ vs. ε4−) on MIST scores. Veterans with mTBI history performed more poorly compared to MCs on the MIST 15-min delay (p=.002, ηp2 =.160), Time Cue (p =.003, ηp2 =.157), and PM Total (p =.016, ηp2 =.102). Those with at least one copy of the ε4 allele performed more poorly compared to ε4- Veterans on the MIST 15-min delay (p =.011, ηp2 =.113) and PM Total (p =.048, ηp2 =.071). No significant interactions were observed between mTBI and APOE-ε4 status on MIST outcomes (ps>.25). Within the mTBI group, APOE-ε4+ Veterans performed worse than APOE-ε4− Veterans on the MIST 15-min delay subscale (p =.031, ηp2 =.150). mTBI history and APOE-ε4 genotype status were independently associated with worse PM performance compared to those without head injury histories or possession of the APOE-e4 genotype. Performance on the MIST 15-min delay was worse in Veterans with both risk factors (mTBI history and APOE-ε4 positivity). Findings suggest that genetic status may modify outcomes even in relatively young Veterans with mTBI histories. Future research examining longitudinal associations and links to neuroimaging and biomarker data are needed. [ABSTRACT FROM AUTHOR]

This paper reports on the development and validation of a communication measure designed to assess how military veterans feel toward civilian communication. Specifically, we theorize that some veterans experience a mild negative moral emotion (i.e., contempt) toward civilians' communication habits. The emotion is likely a consequence of intense professional socialization and membership in a totalistic organization. Veterans who served in the military since September 11, 2001 (N = 215) responded to items, which were factor analyzed. Then, in a second study, the scale was validated using another sample of post-9/11 veterans (N = 466). Together, these studies contribute an original communication measure that could help identify whether a veteran will have difficulty reintegrating into civilian work life. The scale could be useful in developing interventions to aid veterans in successful reintegration. Ultimately, the measure holds the potential to promote workplace diversity through the successful inclusion of more veterans in the workforce. [ABSTRACT FROM AUTHOR]

Most U.S. military service members are discharged routinely, but about 15% receive non-routine discharges. Little is known about how patterns of arrests prior-to and in-service relate to neuropsychological symptoms acquired through military service, or how these symptoms and patterns are associated with discharge type. We investigated latent group differences in post-9/11 era veterans' patterns of arrests; examined mental health-related predictors of subgroup membership; and modeled associations between latent class structure and non-routine discharge. Veterans with traumatic brain injury, alcohol misuse, and post-traumatic stress disorder, had greater odds of belonging to a high-risk vs. low-risk class with the highest probabilities of arrests in-service. The high-risk class had a 45% chance of non-routine discharge compared with 35% for a stable-risk class and 6% for a low-risk class. Veterans with increased probabilities of arrests in-service compared with pre-service showed the highest odds of mental and behavioral health problems and non-routine discharge. [ABSTRACT FROM AUTHOR]

Introduction The value of using trauma-informed approaches in the way services and systems deliver care is well recognised. This evaluation aimed to consider the value of using a structured 'trauma pathway' to improve trauma informed care within a veterans' high intensity service. Method A mixed-methods design was employed. Practitioners completed questionnaires via an online platform and also attended a focus group to share their views. Qualitative data were analysed using inductive thematic analysis. Results A total of 14 team members were eligible to take part. 14 submitted Pre data, and 8 submitted Post data. There were significant differences between pre and post data relating to consideration of trauma-informed care, and confidence in trauma assessment and intervention skills. However, levels of significance were not met for the differences in confidence around identifying pathways of care. From analysis of the qualitative data three main themes were identified 1) Quality of care and Trauma focus, 2) Practitioner experience and 3) Veteran Experience which are explored within the discussion. Conclusions The use of a structured pathway improved the delivery of a trauma-informed care approach within a high intensity service for veterans, with positive changes in both practitioner and veteran experiences [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

What are the driving forces behind the establishment of retired officer associations outside of the corporate military apparatus? This article presents novel insights into such autonomous retired military officer associations and makes a foundational contribution on a severely understudied topic in security studies. Drawing on qualitative field research in Tunisia, the article unpacks the emergence of retired military officer associations in that country and juxtaposes these findings with a comparative overview of veterans’ associations in the Global South. A global perspective supports insights from Tunisia: retired military officer associations enjoying institutional autonomy represent genuinely independent organisations for the representation of social group interests rather than extensions of the corporate military apparatus. Findings reveal how opportunities emerging from periods of political liberalisation explain the timing of the foundation of autonomous retired officer associations, while varied paths of officer socialisation during their military service explains these organisations’ different types of activities. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Some research indicates that public stigma of posttraumatic stress disorder (PTSD) may be relatively benign compared to other psychiatric conditions. However, the severity of PTSD stigma may vary as a function of the setting—military vs. civilian—for a traumatic event and the type of trauma—sexual assault vs. physical assault—that a person experiences. In an online experiment, 870 participants read vignettes in which a woman protagonist experienced a traumatic assault. The vignettes systematically varied as to (1) the military vs. civilian setting of the assault, (2) the type of assault—sexual vs. physical—that she experienced, and (3) whether she was diagnosed with PTSD in the aftermath of the assault. Measures of self-reported social distance and several affective, attitudinal, and behavioral dimensions of stigma were administered. Results indicated that the presence vs. absence of a PTSD diagnosis substantially increased public stigma across several measures. Less consistent but nevertheless noteworthy effects of setting and type of trauma also emerged. The current results valuably add to the small body of knowledge on PTSD stigma and highlight avenues for future research on this damaging phenomenon. [ABSTRACT FROM AUTHOR]

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Private security companies (PSCs) blur the lines between the public and the private sector through the provision of services to state militaries. Based on a multi-modal qualitative content analysis of YouTube recruitment videos aimed at veterans, we show how PSCs also challenge these boundaries through their hiring practices. By relating to veterans' past as hero warriors and by envisioning their future as corporate soldiers, the companies appear as 'like-military' and as allowing ex-militaries to 'continue their mission'. The findings contribute to scholarly debates about the privatization of security. They illustrate that similarly to the public sector, the private is also re-constituted through the military values that veterans introduce. The study adds to the literature on the visualization of war showing how video-based platforms allow security actors such as PSCs to construct their corporate identity in ambivalent ways by appealing to different emotional levels and by giving rise to different narratives. [ABSTRACT FROM AUTHOR]

The transition to veterancy can be psychologically challenging, and although the military provides support, the importance of social connectedness for well‐being is largely unrecognised. The significance of this oversight is highlighted by the Social Identity Model of Identity Change (SIMIC), which conceptualises life change as social identity change. SIMIC has been applied to numerous life transitions, but not to veterancy, although there is evidence that the social and psychological challenges of this transition may be especially profound (e.g., due to the chronically salient, highly structured and largely unique nature of military life and identity). To remedy this, in Study 1 (N = 210), UK‐based veterans completed an online survey. Consistent with SIMIC, social group maintenance and gain predicted mental health via the psychological resources they provided (meaning, self‐esteem, sense of personal control), and group gain was predicted by perceived military support during the transition. Study 2 (N = 14) extended these findings qualitatively through exploration of veterans' transition experiences. These studies are the first to apply aspects of the SIMIC to the veterancy transition, and they show the applicability of SIMIC in this context. They also highlight the need for transition‐related education that includes guidance on group joining and reconnecting. Please refer to the Supplementary Material section to find this article's Community and Social Impact Statement. [ABSTRACT FROM AUTHOR]

Over 36% of post–9/11 era veterans have a disability, but little research has examined wounded veterans' finances. We investigated main and interaction effects of income sources and demographic, military, and mental health characteristics on household poverty and deep poverty to better understand wounded veterans' financial outcomes. Data were drawn from the 2018 Wounded Warrior Survey (n = 33,067). Two logistic regression models investigated direct associations between independent variables and poverty outcomes; predictive margins and average marginal effects were calculated for employment and cash transfers on outcomes. 56% of respondents reported full- or part-time employment, and 17% met criteria for household poverty. Of those, 75% met criteria for deep poverty. Cash transfers were negatively associated with poverty and deep poverty, and part-time employment was positively associated with poverty compared with not working. Employment was insufficient protection against poverty in this sample of wounded veterans—transfers were a critical bulwark. [ABSTRACT FROM AUTHOR]

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. 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 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). 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. [ABSTRACT FROM AUTHOR]

While the well-being of the Swedish peacekeepers deployed to Bosnia in the 1990s has received a great deal of attention over the years, very little is known about how these military veterans have fared on the labour market after returning home. In this paper, I provide novel evidence on the relationship between military deployment to Bosnia and adverse outcomes on the labour market. The analysis is based on longitudinal administrative data for a sample of 2,275 young Swedish veterans who served as peacekeepers in Bosnia at some point during the years 1993–1999. I follow these veterans for up to 20 years after deployment. Using propensity score matching based on a rich set of covariates, I estimate the effects of deployment on three broad measures of labour market marginalisation: long-term unemployment, work disability, and social welfare assistance. I find no indication of long-term labour market marginalisation for the veterans. Even though the veterans experienced an increase in the risk of unemployment in the years immediately following their return from service, in the long run their attachment to the labour market is not affected negatively. [ABSTRACT FROM AUTHOR]

While the well-being of the Swedish peacekeepers deployed to Bosnia in the 1990s has received a great deal of attention over the years, very little is known about how these military veterans have fared on the labour market after returning home. In this paper, I provide novel evidence on the relationship between military deployment to Bosnia and adverse outcomes on the labour market. The analysis is based on longitudinal administrative data for a sample of 2,275 young Swedish veterans who served as peacekeepers in Bosnia at some point during the years 1993–1999. I follow these veterans for up to 20 years after deployment. Using propensity score matching based on a rich set of covariates, I estimate the effects of deployment on three broad measures of labour market marginalisation: long-term unemployment, work disability, and social welfare assistance. I find no indication of long-term labour market marginalisation for the veterans. Even though the veterans experienced an increase in the risk of unemployment in the years immediately following their return from service, in the long run their attachment to the labour market is not affected negatively.

Background: Military Veterans (MVs) face unique challenges that are important to recognize when building supportive academic environments. There is a need to broaden our understanding of the diverse student population within academia, requiring us to hear their voices and deduce facilitators and barriers to their academic transition and success. Aim: The aim of this study was to explore the unique needs of MV students and understand obstacles and facilitators for successful transition and completion for MV students entering a civilian baccalaureate program. Method: This study was guided by a phenomenological approach; we conducted three focus group interviews with Veteran students (n = 17) and conducted verbatim transcription thematic analysis. Results: Three themes were identified that impacted student success: (1) military experience prepared me for academic challenges, (2) defining my new role, and (3) no one left behind. Specific exemplars for thematic components to support transitioning into a civilian academic program included incorporating a military liaison for academic guidance and mentoring, acknowledging baseline skills using competency-based cohorts, and facilitating opportunities for connecting with other Veterans. Conclusion: Preparation of faculty and staff to better understand MV’s specific needs in civilian academic environments is needed.

The purpose of this study was to examine neurobehavioral symptom reporting in a large sample of military veterans (N = 12,144) who completed the Comprehensive Traumatic Brain Injury Evaluation (CTBIE) and enrolled in the VA's Million Veteran Program (MVP). The CTBIE is a clinician-administered interview that assesses for historical, deployment-related traumatic brain injury (TBI) and evaluates symptoms using the Neurobehavioral Symptom Inventory (NSI). Clinicians completing the CTBIE made clinical determinations about participants' (1) TBI diagnostic status (i.e., CTBIE+ or CTBIE-) and (2) current symptom etiology (i.e., Symptom Resolution, TBI, Behavioral Health, Comorbid TBI + Behavioral Health [Comorbid], or Other). We evaluated the association of TBI diagnostic status and symptom etiology group with neurobehavioral symptoms. Results showed a significant association between TBI diagnostic status and all NSI variables, with CTBIE+ veterans endorsing greater symptoms than CTBIE- veterans. There was also a significant association between symptom etiology group and all NSI variables; specifically, the Comorbid and Behavioral Health groups generally endorsed significantly greater symptoms compared to the other groups. Follow-up analyses showed that relative to the Symptom Resolution group, the Comorbid and Behavioral Health groups had increased odds of severe/very severe cognitive and affective symptoms, whereas the TBI and Other groups did not. Finally, presence of psychiatric symptoms, pain, post-traumatic amnesia, loss of consciousness, and blast exposure significantly predicted Comorbid symptom etiology group membership. Findings from this large epidemiologic MVP study have relevant clinical implications and further highlight the importance of prioritizing integrated behavioral health interventions for this vulnerable population.

BackgroundPeople 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.MethodsSemi-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.ResultsCare 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.ConclusionsFindings 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.

AbstractObjectiveMethodResultsConclusionsTo examine relationships between performance validity testing (PVT), neurobehavioral symptom endorsement, and symptom attribution in Veterans with a history of mild traumatic brain injury (mTBI).Participants included treatment-seeking Veterans (n = 37) with remote mTBI histories who underwent a neuropsychological assessment and completed a modified version of the Neurobehavioral Symptom Inventory (NSI) to assess symptom endorsement and symptom attribution (the latter evaluated by having Veterans indicate whether they believed each NSI symptom was caused by their mTBI). Veterans were divided into two subgroups, PVT-Valid (n = 25) and PVT-Invalid (n = 12).Independent samples t-tests showed that two of five symptom endorsement variables and all five symptom attribution variables were significantly different between PVT groups (PVT-Invalid > PVT-Valid; Cohen’s d = 0.67–1.02). Logistic regression analyses adjusting for PTSD symptoms showed that symptom endorsement (Nagelkerke’s R2 = .233) and symptom attribution (Nagelkerke’s R2 = .279) significantly distinguished between PVT groups. According to the Wald criterion, greater symptom endorsement (OR = 1.09) and higher attribution of symptoms to mTBI (OR = 1.21) each reliably predicted PVT-failure.While both symptom endorsement and symptom attribution were significantly associated with PVT-failure, our preliminary results suggest that symptom attribution is a stronger predictor of PVT-failure. Results highlight the importance of assessing symptom attribution to mTBI in this population. [ABSTRACT FROM AUTHOR]

Nonsuicidal self-injury (NSSI) is a well-established risk factor for suicidal behavior, with certain NSSI characteristics being associated with increased risk. In the United States (U.S.), the veteran suicide rate is elevated, though lifetime prevalence rates of NSSI appear similar between veterans and civilians. There is limited research that directly compares veterans and civilians across multiple NSSI characteristics to examine between-group differences in NSSI behavior and provide important context for the application of NSSI research with the veteran population. This study examined differences between U.S. veterans and civilians with a history of suicidal ideation across several NSSI characteristics, including method, severity, age of onset, shame, distress, and reason for initial NSSI engagement. A sample of 527 veterans and civilians completed measures of direct and indirect NSSI behaviors along with supplemental questions designed to further assess endorsed NSSI behaviors. Additionally, respondents provided written responses to an open-ended question about their reasons for initial engagement in NSSI, which were coded for post-hoc analysis. Chi-square difference tests and t- tests were conducted, revealing significant group differences between veterans and civilians in NSSI method, lifetime versatility, age of onset, age at last occurrence, and reasons for initial engagement. No significant differences were found in NSSI frequency, severity, shame, or distress. These findings provide valuable information on similarities and differences in NSSI behavior characteristics between U.S. veterans and civilians with lifetime suicidal ideation to inform future research and the assessment of NSSI in these populations. • Veterans' and civilians' nonsuicidal self-injury (NSSI) behavior was compared. • On average, civilians were more likely to use direct NSSI behaviors and more methods. • Veterans were older at age of NSSI onset and more likely to use indirect behaviors. • Wall/object punching, an indirect behavior, was the most common in both groups. • Intrapersonal reasons for NSSI initiation were more common among civilians. [ABSTRACT FROM AUTHOR]

Veterans with histories of incarceration are at greater risk for poor physical and mental health outcomes, yet prior research in this population has focused on specific subsets of veterans or a narrow range of predictors. We utilized the Bronfenbrenner Socioecological Model as the framework to evaluate correlates of incarceration history in a large sample of Iraq and Afghanistan-era veterans at four levels: demographic, historical, clinical, and contextual. Participants were 2,904 veterans (76.9% male; 49.5% White and 46.5% Black; mean age 38.08, SD = 10.33), 700 of whom reported a history of incarceration. Four logistic regression models predicting history of incarceration were tested, adding demographic, historical, clinical, and contextual variables hierarchically. In the final model, younger age (OR = 0.99, 95% CI = 0.98–1.00), male gender (OR of being female = 0.28, 95% CI = 0.21–0.38), belonging to a historically marginalized group (OR of being White = 0.69, 95% CI = 0.56–0.84), family history of incarceration (OR = 1.47, 95% CI = 1.10–1.94), adult interpersonal trauma (OR = 1.39, 95% CI = 1.28–1.51), problematic alcohol use (OR = 1.03, 95% CI = 1.02–1.05), drug abuse (OR = 1.15, 95% CI = 1.11–1.19), and unemployment (OR for being employed = 0.76, 95% CI = 0.62–0.92) were significantly associated with a history of incarceration. Implications of these findings for developing interventions and supporting systems to effectively target this high-risk population of veterans are discussed. [ABSTRACT FROM AUTHOR]

Posttraumatic stress disorder (PTSD) is prevalent in military veterans. Although exposure to trauma is subsumed under the diagnostic criteria for PTSD, there is great variability in index traumatic events, and the clinical presentation of PTSD may vary in individuals depending on the type of event experienced. We examined the relationship between different index traumas and PTSD symptoms in 3507 trauma-exposed U.S. military veterans who participated in the National Health and Resilience in Veterans Study. Results showed that interpersonal violence and combat/captivity was associated with greater overall severity of PTSD symptoms relative to illness/injury and disaster/accident. Interpersonal violence and combat/captivity were also associated with greater severity of intrusive, avoidance, negative affect, anhedonia, externalizing behaviors, and anxious and dysphoric arousal symptoms, relative to the other two categories. Implications of these findings for tailoring treatment approaches for PTSD in veterans are discussed. • Trauma exposure is subsumed under the diagnostic criteria for PTSD. • The clinical presentation of PTSD varies depending on the type of index traumatic event. • The personalization of treatment for PTSD should consider the index trauma. [ABSTRACT FROM AUTHOR]

Research data have consistently shown that military veterans are more likely than the general U.S. population to experience mental health problems, as well as homelessness and unemployment. Additionally, data show exceptionally high attrition rates from mainstream mental health treatments for veterans. While several emerging, alternative programs have great potential to support veterans in dealing with trauma and with the transition to civilian life, there is a paucity of research documenting the effectiveness of these programs. This lack of data prevails partly because of biases within the scientific community, which remains largely ignorant of the pervasive difficulties confronting veterans. Our antidote to this problem is a model of veteran-led research. In this article, we outline a set of principles of veteran-led research that we have developed through our ongoing empirical investigation of the DE-CRUIT treatment program, which uses theatre to address traumatic stress and related problems encountered by veterans. We describe the challenges involved in prioritizing the veteran perspective in conducting research within a mainstream scientific context as well as ways of meeting these challenges in order to use the tools of science to better serve our nation's veterans. [ABSTRACT FROM AUTHOR]

Background: Exposure to blasts is common among service members and history of these exposures has been associated with chronic psychiatric and health outcomes. Evidence suggests that distress tolerance (DT) may moderate this relationship and be a valuable treatment target in this population. The purpose of this manuscript was to evaluate DT as a modifying factor in the association between posttraumatic stress disorder (PTSD), mild traumatic brain injury (TBI), blast exposure, and functional indicators. Method: Participants were 275 (86.55% male) combat veterans who served in Iraq or Afghanistan after September 11, 2001. Clinical interviews for PTSD diagnosis, TBI history, and blast exposure were administered, and participants completed self-report questionnaires (DT, PTSD symptom severity, depressive symptom severity, neurobehavioral symptom severity, sleep quality, pain interference, and quality of life). Results: DT was significantly associated with all functional indicators beyond PTSD diagnosis, mild TBI, and blast severity. There were significant interaction effects between DT and PTSD diagnosis for posttraumatic stress symptom severity, sleep quality, and quality of life. Specifically, there were significant differences in these reported functional indicators between individuals with and without a PTSD diagnosis as DT increases, such that reported symptoms were lower (quality of life better) for individuals without PTSD as DT improved. Conclusion: Our results demonstrate that DT might be a key factor in postdeployment function for military service members. Treatments targeting DT may be particularly effective in individuals who attribute psychiatric symptoms to history of blast exposure. Impact and Implications: Distress tolerance (DT) mitigated the relationship between posttraumatic stress disorder (PTSD) and functional outcomes of posttraumatic stress symptoms, sleep quality, and quality of life. Effects of DT were exacerbated in veterans without a PTSD diagnosis, suggesting that DT may be a key protective factor against the development of PTSD, and individuals with a higher baseline level of DT may be less likely to develop clinical symptomology in response to stressors. Addressing DT in treatment may lead to better functional outcomes, especially in veterans without a PTSD diagnosis and/or subclinical PTSD symptoms. [ABSTRACT FROM AUTHOR]

Background: There is evidence to suggest that the experience of complex post-traumatic stress disorder (C-PTSD) may be commonly associated with elevated risk for several mental ill-health comorbidities. Objective: The current study seeks to contribute to the growing literature on C-PTSD comorbidity by examining the relationship between C-PTSD and other mental health disorders in a UK Armed Forces veteran sample. Method: This study used data from the Northern Ireland Veterans' Health and Wellbeing Study (NIVHWS). The effective sample consisted of 638 veterans (90.0% male). Tetrachoric correlations examined the relationship between C-PTSD caseness and other mental health outcomes. Latent class analysis was then conducted, determining the optimal number and nature of classes in the sample in relation to C-PTSD, depression, anxiety, and suicidality. Results: C-PTSD caseness (i.e. probable diagnosis) was found to be significantly associated with positive caseness of depression, anxiety, and suicidality. Overall, four latent classes emerged, with each of these classes characterized by varying degrees of comorbidity: a 'Resilient/Low Comorbidity' class, a 'Lifetime Suicidal' class, a 'PTSD Polymorbid' class, and a 'C-PTSD Polymorbid' class. Conclusions These findings support and extend previous results indicating the highly comorbid nature of C-PTSD. C-PTSD may be considered a highly polymorbid condition, increasing the risk for multiple mental health pathologies concurrently. The results showed that probable complex PTSD was associated with depression, anxiety, and suicidality in this military veteran sample. Latent class analysis revealed that probable complex PTSD was associated with multiple conditions concurrently, suggesting that complex PTSD is not only highly comorbid but polymorbid. The findings highlight the importance of screening for multiple pathologies, particularly in cases of probable complex PTSD. [ABSTRACT FROM AUTHOR]

Military veterans have been shown to differ demographically from non-veterans in the criminal justice system. However, relatively little is known about their psychological adjustment, institutional misbehavior, and the efficacy of programing received while incarcerated. Using data taken from a national sample of prison inmates, this study investigates how traumatic events experienced during military service can impact the intensity of negative affect among veterans. Additionally, we examine whether prison misconduct is influenced by military service history and the receipt of substance abuse treatment. Controlling for a host of relevant variables, our results indicate that traumatic events show a significant effect on psychological adjustment only indirectly through veterans who developed post-traumatic stress disorder and that misconduct is lower among those who received an honorable discharge. Overall, these findings suggest that the ability of veterans to resist adverse outcomes may depend on a variety of factors both within and outside the prison environment. [ABSTRACT FROM AUTHOR]

Studies explicitly examining the antecedents of prison victimization are rare relative to other institutional outcomes (e.g., misconduct) and are virtually nonexistent for incarcerated military veterans. In the current study, we employed Firth regression models to predict victimization among a subsample of military veterans housed by the Minnesota Department of Corrections (MnDOC) using a target congruence approach. Inconsistent with prior theory and research, we observed no differences among veterans on the basis of race and physical or mental health disorders. We did, however, observe a relationship between an individual's risk of recidivism as measured by the MnSTARR 2.0 and victimization whereby higher scores corresponded with greater odds of victimization. Implications for theory and correctional policy are discussed and directions for future research are given. [ABSTRACT FROM AUTHOR]

Military veterans often transition into the civilian workforce after serving in a nation's armed forces. The process of integrating this unique class into organizations is directly affected by the social exchanges and interactions in the organization. Utilizing an in-depth interviews-based qualitative study of 40 veterans across 12 different organizations, and integrating social identity theory, we use template analysis to identify a paradox existent in social exchanges with other organizational members where veterans are simultaneously stigmatized and socially aggrandized. These paradoxical experiences interact with veterans' self-conceptualization and social identities to reinforce expectations, cause culture shock and eventual turnover. We present a model of this tension, contributing to literatures on veterans in the workforce, paradox, and social identity theory as well as offering HR perspectives on this phenomenon. [ABSTRACT FROM AUTHOR]

Heroes on the Water is a nonprofit organization providing kayak fishing programs to veterans and their families. The purpose of this study was to explore the impact kayak fishing programs, provided by Heroes on the Water, had on posttraumatic growth in military veterans in the United States. The concept of posttraumatic growth suggests that individuals may experience positive psychological changes after severe traumatic events. Research suggests posttraumatic growth can occur in the form of recognizing personal strengths, new possibilities, relating to others, an appreciation for life, and spiritual changes. Studies also suggest that recreation can aid in facilitation of growth. Additionally, recreation has been considered a complementary form of treatment for veterans, specifically the use of nature-based and outdoor recreation programs. For this study, participants reflected on their experiences before and after engaging in Heroes on the Water using the Posttraumatic Growth Inventory. Though the results cannot be generalized, participants reported an increase in score after participating in Heroes on the Water kayak fishing programs. This study adds to the knowledge about the use of recreation to facilitate growth in veterans and encourages continued research on this topic. [ABSTRACT FROM AUTHOR]

Background: There is evidence to suggest that the experience of complex post-traumatic stress disorder (C-PTSD) may be commonly associated with elevated risk for several mental ill-health comorbidities. Objective: The current study seeks to contribute to the growing literature on C-PTSD comorbidity by examining the relationship between C-PTSD and other mental health disorders in a UK Armed Forces veteran sample. Method: This study used data from the Northern Ireland Veterans’ Health and Wellbeing Study (NIVHWS). The effective sample consisted of 638 veterans (90.0% male). Tetrachoric correlations examined the relationship between C-PTSD caseness and other mental health outcomes. Latent class analysis was then conducted, determining the optimal number and nature of classes in the sample in relation to C-PTSD, depression, anxiety, and suicidality. Results: C-PTSD caseness (i.e. probable diagnosis) was found to be significantly associated with positive caseness of depression, anxiety, and suicidality. Overall, four latent classes emerged, with each of these classes characterized by varying degrees of comorbidity: a ‘Resilient/Low Comorbidity’ class, a ‘Lifetime Suicidal’ class, a ‘PTSD Polymorbid’ class, and a ‘C-PTSD Polymorbid’ class. Conclusions These findings support and extend previous results indicating the highly comorbid nature of C-PTSD. C-PTSD may be considered a highly polymorbid condition, increasing the risk for multiple mental health pathologies concurrently.

Veteran women are better represented in Congress than non-veteran women, but the reasons for this are unclear. Veteran women may be better represented because they run at higher rates and in more winnable races or because their military service leaves them uniquely qualified to overcome gender and partisan stereotypes. Voters often perceive women as lacking leadership ability and ill-suited to handling national security. However, female veterans have experience that may help them overcome gendered beliefs about their abilities. Using election data from the 2012–2020 U.S. congressional elections, we test whether veteran women gain greater voter support compared to non-veteran candidates and whether veteran women running as Democrats outperform male veteran Democrats. We find only limited evidence that military service wins more votes for candidates of either gender. Among Democrats, prior military service levels the playing field between male and female candidates, but veteran women only outperform veteran men in 2018. [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]