Dissertations / Theses on the topic 'Veteran mental health'

The purpose of this project was to design a 2-year program aimed at addressing the mental health needs of veterans transitioning from deployments in support of Operation Enduring Freedom and Operation Iraqi Freedom to civilian life. The program will address prodromal symptoms of psychosis. With the prevalence of psychotic features in Post Traumatic Stress Disorder, the veteran population is particularly at risk. The program will offer individual and group therapies to assist in symptom management and will utilize case management supportive services to assist in addressing additional needs that the participants may have that hinder help seeking activities, such as housing and substance abuse referrals. The National Institute of Mental Health, National Institutes of Health was selected as the funding source for this grant. The actual submission and/or funding of this grant were not a requirement for the successful completion of this project.

Former United States military members have consistently faced mental health concerns post discharge from the military. Some researchers have argued that the use of mental health services by veterans does not parallel the prevalence and need of such services (Hoge, Castro, Messer, McGurk, Cotting, & Koffman, 2004; Milliken, Auchterlonie, & Hoge, 2007; Vogt, 2011). Reasons why veterans do not access mental health care are varied and broad, however, they tend to be consistent with explanations rooted in the stigma of mental health care, and in the barriers that prevent the use of mental health care. The degree of the impact of factors contributing to stigma and barriers to mental health care is not fully understood. Particularly lacking from previous research is an examination of how the education received while in the military about mental health symptoms and treatment impacts the likelihood that a service member will access care. In the current study, I used theories of stigma and barriers to care outlined by Overton and Medina (2008) to examine the relationships among demographic characteristics, self-reported diagnoses of common mental health disorders that veterans experience, and likelihood of accessing mental health care based on the education received while in the military with self-reported levels of stigma and barriers to care in a sample of 355 former military service members from several branches. Multiple regression analyses were used to examine the relationships among these variables. Results revealed statistically significant relationships among gender, age, self-reported diagnosis of depression, the impact of education, and stigma. Results also revealed statistically significant relationships among employment and barriers to care. In addition, stigma was found to have significant relationships with the positive impact of education, and the likelihood of accessing care. Lastly, results revealed that when in the presence of the mediation variable impact of education, stigma was no longer associated with the likelihood veterans would access care post discharge.

The purpose of this research is to inform the understanding of mental health readmissions by identifying associations between individual and environmental attributes and readmissions, with consideration of the impact of time-to-readmission within the Veterans Health Administration (VHA). Mental illness affects one in five adults in the United States (US). Mental health disorders are among the highest all-cause readmission diagnoses. The VHA is one of the largest national service providers of specialty mental health care. VHA's clinical practices and patient outcomes can be traced to US policy, and may be used to forecast national outcomes should these same policies be implemented nationwide. In this research, we applied three different data mining techniques to clinical data from over 200,000 patients across the VHA. Patients in this cohort consisted of adults receiving VHA inpatient mental health care between 2008 and 2013. The data mining techniques employed included k-means cluster analysis, association-rule mining, and decision tree analysis. K-means was used during cluster analysis to identify four statistically distinct clusters based on the combination of admission count, comorbidities, prescription (RX) count, age, casualty status, travel distance, and outpatient encounters. The association-rule mining analysis yielded multiple frequently occurring attribute values and sets consisting of service connection type, diagnoses/problems, and pharmaceuticals. Using the CHAID algorithm, the best decision tree model achieved 80% predictive accuracy when no readmissions were compared to 30-day readmissions. The strongest predictors of readmissions based on this algorithm were outpatient encounters, prescription count, VA Integrated Service Network (VISN), number of comorbidities, region, service connection, and period of service. Based on evidence from all three techniques, individuals with higher rates of system-wide utilization, more comorbidities, and longer medication lists are the most likely to have a 30-day readmission. These individuals represented 25% of this cohort, are sicker in general and may benefit from enrollment in a comprehensive nursing case management program.

Problem Statement: Military members and their family members who are part of the Global War on Terrorism have experienced deployments and war for over sixteen years and with the resulting toll on both the veteran and their intimate partner. As a result, higher levels of pathology, such as PTSD, Anxiety, and Depression have been experienced by this population. While research has studied the effect of combat on military members, very little research has addressed the effects on family members. Further, no research that has been found by this researcher, has addressed the concept of resonating of pathology between the combat veteran and their intimate partner. Resonating of Pathology, or resonating pathology, for the purposes of this study, is the combat veteran and the intimate partner demonstrating the same pathology at similar levels.

The Veteran’s Healthcare Services have begun to treat couples together and may have also witnessed this phenomenon. Understanding the relationship between combat, veteran pathology, and intimate partner pathology will have implications for practitioners and researchers. Understanding the factors that related to this phenomenon will have implications for both clinicians and researchers.

Methods: Veterans and their intimate partners from across the United States, (N = 398), were asked to complete a survey through the internet. The couples were asked to complete the survey separately, however, within the same session so that their results could be tied together. The veterans were asked to complete the Combat Exposure Scale (CES), the PTSD Check List for the DSM 5 (PCL–5), the Patient Health Questionnaire 9 (PHQ–9), and the Generalized Anxiety Disorder 7 (GAD–7). The intimate partners were asked to complete the PCL–5, the PHQ–9, and the GAD–7.

Results: Results suggest that there was a moderate relationship between combat experience and pathology for combat veterans. While other factors were examined to determine what was included to predict pathology within the veteran, combat experience seemed to be the primary factor for predicting PTSD, Anxiety, and Depression in the combat veteran.

Results also suggested that there was a relationship between the pathology of combat veterans and the pathology their intimate partners, as measured in this research. Not only was there resonating, or resonating of pathology, within the couples, but this tended to occur within categories of pathology such as moderate and severe levels of Anxiety and Depression. While multiple factors such as frequency of communications, number of children, and types of communication were examined, combat experiences tended to be the primary factor for predicting pathology in both the veteran and the intimate partner.

Conclusion: Combat veterans and their intimate partners appear to be experiencing the phenomenon of resonating, or resonating, of pathology. Couple-analysis demonstrates that this phenomenon is being experienced as a couple and suggests that could have implications for future research and clinical practice. Demographic factors did not seem to influence the pathology for either the veteran or their partner. Combat experience does, however, seem to be a predictor for pathology in not only the veteran but also for the intimate partner as well.

Mental health stigma has been identified as a barrier to help-seeking in the United States. Research suggests that insecure attachment may contribute to higher mental health stigma and lower help-seeking behavior. This may be particularly salient in military personnel who tend to report higher mental health stigma than the general population. Evidence suggests that both supportive and destructive military leadership are related to service members' attitudes toward seeking help. In the current study, a sample of military service members and veterans (N = 232) completed an online survey regarding mental health stigma, military leadership experiences, attachment strategies, and mental health help-seeking behaviors. Findings indicated that destructive and supportive leadership experiences were significantly related to self and public stigma, and self-stigma mediated the relationship between destructive and supportive leadership experiences and likelihood to seek help. Attachment anxiety predicted higher self and public stigma, while attachment avoidance predicted high self-stigma but low public stigma, with high self-stigma partially mediating the relationship between attachment avoidance and help seeking.

Over the past 15 years, mental health professionals have seen an increasing number of Vietnam combat veterans suffering from stress disorders resulting from the trauma of combat and continued exposure to life threatening situations. Prior to 1980, professional repudiation of and hostility toward Vietnam veterans and toward a clinical reality of Post Traumatic Stress Disorder was common while nondiagnosis and nontreatment was prevalent

The veteran population is under-served. Due to the current circumstances of increased deployment and the rate of returning soldiers from current wars (Iraq and Afghanistan); there is an increased demand for competent social workers to provide them with services. Furthermore, the Department of Veteran Affairs is the number one employer of social workers. Hence, measuring the knowledge of social work students is essential to explore their competence of working with the veteran population. The study presents an exploratory research method, using a quantitative approach. Further, students’ knowledge was measured in ten domains: Benefits and Services, Service Related Disabilities, PTSD/Trauma, Childcare, Homelessness/Housing, Military Sexual Trauma, Healthcare, Employment/Unemployment, Education, and General Knowledge. In addition, the sample was compromised of social work students throughout different Southern California Universities. An online survey was administered to participants through Qualtrics website; and statistical analysis conducted by using SPSS version 21. Findings suggest that MSW students have a higher level of knowledge than BASW students in most of the domains. In addition, older participants presented a greater amount of knowledge than younger participants. Due to the results of the study, future research should measure a larger amount of participants that are evenly distributed among all demographics. Further, the study should encompass all universities that offer social work programs.

Posttraumatic stress disorder (PTSD) is a debilitating mental illness that affects thousands of military service members and veterans every year. Strongly associated with PTSD are symptoms of depression, life satisfaction and physical health complaints. Playing video games has been shown in the past to reduce symptoms of PTSD, other mental illnesses, and reduce the experience of pain. The purpose of this study was to examine these relationships, specifically regarding a 3-4 hour per week duration that has been particularly beneficial to military service members in the past. Participants included n = 400 military service members or veterans who had served in a combat zone and was relatively representative of the U.S. military population. Participants completed a number of measures assessing PTSD and depressive symptoms, life satisfaction, physical health, military service, and video game play behaviors. Results indicated that no relationship exists between the duration of video game play PTSD symptoms severity, unless the PTSD symptoms were present first. A linear relationship was also noted between video game play duration and depressive symptoms. No significant relationship was observed between video game play duration and life satisfaction or physical health ailments. These findings seem to contradict some of the previous literature, though may indicate that playing video games as a utilization of an avoidance strategy could be detrimental to one’s mental health.

Objectives: This study sought to determine the relationship between combat experience and mental health outcomes. The study sought to determine whether age was a significant factor in poor mental health outcomes. Methods: Multiple logistic regression (n = 195,048) and multiple linear regression (n = 264,154) were performed on the 2006 Behavioral Risk Factor Surveillance System (BRFSS) survey. Veteran status and a host of demographic and health status questions were analyzed in relation to diagnosis of anxiety or depressive disorder (multiple logistic regression) and to number of days poor mental health (multiple linear regression). Results: Diagnosis of anxiety or depression was not found to be associated with veteran status. Among both veterans and non-veterans, diagnosis was associated with age Conclusions: Contrary to expectations, veteran status was found to be a protective factor for poor mental health outcomes in this analysis. Younger age was found to be associated with poor mental health outcomes, but was an equal association in both veterans and non-veterans, suggesting that mental health outcomes have not been worsened by recent changes in combat characteristics. Denial of mental health status, stoicism within the military community, and limitations of the survey are proposed to explain the unexpected outcome of this analysis.

More than 2.6 million troops have deployed in support of the wars in Iraq and Afghanistan. Still, surveys reveal that more than half feel “disconnected” from their civilian counterparts, and this feeling persists despite ongoing efforts, in the academy and elsewhere, to help returning veterans overcome physical and mental wounds, seek an education, and find meaningful ways to contribute to society after taking off the uniform. This dissertation argues that Iraq and Afghanistan War veterans struggle with reassimilation because they lack healthy, complete models of veteran identity to draw upon in their postwar lives, a problem they’re working through collectively in literature and artwork. The war veteran—returning home transformed by the harsh realities of military training and service, having seen humanity at its extremes, and interacting with a society apathetic toward his or her experiences—should engage in the act of storytelling. This act of sharing experiences and crafting-self subverts stereotypes. Storytelling, whether in a book read by millions, or in a single conversation with a close family member, should instruct civilians on the topic of human resiliency; it should instruct veterans on the topic of homecoming. But typically, veterans do not tell stories. Civilians create barriers to storytelling in the form of hollow platitudes—“thank you for your service” or “I can never understand what you’ve been through”—disconnected from the meaning of wartime service itself. The dissonance between veteran and civilian only becomes more complicated when one considers the implicit demands and expectations attached to patriotism. These often well-intentioned gestures and government programs fail to convey a message of appreciation because they refuse to convey a message of acceptance; the exceptional treatment of veterans by larger society implies also that they are insufficient, broken, or incomplete. So, many veterans chose conformity and silence, adopting one of two identities available to them: the forever pitied “Wounded Warrior” or the superficially praised “Hero.” These identities are not complete. They’re not even identities as much as they are collections of rumors, misrepresentations, and expectations of conformity. Once an individual veteran begins unconsciously performing the “Wounded Warrior” or “Hero” character, the number of potential outcomes available in that individual’s life is severely diminished. Society reinforces a feeling among veterans that they are “different.” This shared experience has resulted in commiseration, camaraderie, and also the proliferation of veterans’ creative communities. As storytellers, the members of these communities are restoring meaning to veteran-civilian discourse by privileging the nuanced experiences of the individual over stereotypes and emotionless rhetoric. They are instructing on the topics of war and homecoming, producing fictional and nonfictional representations of the veteran capable of competing with stereotypes, capable of reassimilation. The Introduction establishes the existence of veteran culture, deconstructs notions of there being a single or binary set of veteran identities, and critiques the social and cultural rhetoric used to maintain symbolic boundaries between veterans and civilians. It begins by establishing an approach rooted in interdisciplinary literary theory, taking veteran identity as its topic of consideration and the American unconscious as the text it seeks to examine, asking readers to suspend belief in patriotic rhetoric long enough to critically examine veteran identity as an apparatus used to sell war to each generation of new recruits. Patriotism, beyond the well-meaning gestures and entitlements afforded to veterans, also results in feelings of “difference,” in the veteran feeling apart from larger society. The inescapability of veteran “difference” is a trait which sets it apart from other cultures, and it is one bolstered by inaccurate and, at times, offensive portrayals of veterans in mass media and Hollywood films such as The Manchurian Candidate (1962), First Blood (1982), or Taxi Driver (1976). To understand this inescapability the chapter engages with theories of race, discussing the Korean War veteran in Home (2012) and other works by Toni Morrison to directly and indirectly explore descriptions of “difference” by African Americans and “others” not in positions of power. From there, the chapter traces veteran identity back to the Italian renaissance, arguing that modern notions of veteran identity are founded upon fears of returning veterans causing chaos and disorder. At the same time, writers such as Sebastian Junger, who are intimately familiar with veteran culture, repeatedly emphasize the camaraderie and “tribal” bonds found among members of the military, and instead of creating symbolic categories in which veterans might exist exceptionally as “Heroes,” or pitied as “Wounded Warriors,” the chapter argues that the altruistic nature which leads recruits to war, their capabilities as leaders and educators, and the need of larger society for examples of human resiliency are more appropriate starting points for establishing veteran identity. The Introduction is followed by an independent “Example” section, a brief examination of a student veteran named “Bingo,” one who demonstrates an ability to challenge, even employ veteran stereotypes to maintain his right to self-definition. Bingo’s story, as told in a “spotlight” article meant to attract student veterans to a college campus, portrays the veteran as a “Wounded Warrior” who overcomes mental illness and the scars of war through education, emerging as an exceptional example—a “Hero”—that other student veterans can model by enrolling at the school. Bingo’s story sets the stage for close examinations of the “Hero” and the “Wounded Warrior” in the first and second chapters. Chapter One deconstructs notions of heroism, primarily the belief that all veterans are “Heroes.” The chapter examines military training and indoctrination, Medal of Honor award citations, and film examples such as All Quiet on the Western Front (1930), Heroes for Sale (1933), Sergeant York (1941), and Top Gun (1986) to distinguish between actual feats of heroism and “Heroes” as they are presented in patriotic rhetoric. The chapter provides the Medal of Honor citations attached to awards presented to Donald Cook, Dakota Meyer, and Kyle Carpenter, examining the postwar lives of Meyer and Carpenter, identifying attempts by media and government officials to appropriate heroism—to steal the right to self-definition possessed by these men. Among these Medal of Honor recipients one finds two types of heroism: Sacrificing Heroes give something of themselves to protect others; Attacking Heroes make a difference during battle offensively. Enduring Heroes, the third type of heroism discussed in the chapter, are a new construct. Colloquially, and for all intents and purposes, an Enduring Hero is simply a veteran who enjoys praise and few questions. Importantly, veterans enjoy the “Hero Treatment” in exchange for silence and conforming to larger narratives which obfuscate past wars and pave the way for new ones. This chapter engages with theorists of gender—such as Jack Judith Halberstam, whose Female Masculinities (1998) anticipates the agency increasingly available to women through military service; like Leo Braudy, whose From Chivalry to Terrorism (2003) traces the historical relationship between war and gender before commenting on the evolution of military masculinity—to discuss the relationship between heroism and agency, begging a question: What do veterans have to lose from the perpetuation of stereotypes? This question frames a detailed examination of William A. Wellman’s film, Heroes for Sale (1933), in the chapter’s final section. This story of stolen valor and the Great Depression depicts the homecoming of a WWI veteran separated from his heroism. The example, when combined with a deeper understanding of the intersection between veteran identity and gender, illustrates not only the impact of stolen valor in the life of a legitimate hero, but it also comments on the destructive nature of appropriation, revealing the ways in which a veteran stereotypes rob service men and women of the right to draw upon memories of military service which complete with those stereotypes. The military “Hero” occupies a moral high ground, but most conceptions of military “Heroes” are socially constructed advertisements for war. Real heroes are much rarer. And, as the Medal of Honor recipients discussed in the chapter reveal, they, too, struggle with lifelong disabilities as well as constant attempts by society to appropriate their narratives. Chapter Two traces the evolution of the modern “Wounded Warrior” from depictions of cowardice in Stephen Crane’s The Red Badge of Courage (1895), to the denigration of World War I veterans afflicted with Shell Shock, to Kevin Powers’s Iraq War novel, The Yellow Birds (2012). As with “Heroes,” “Wounded Warriors” perform a stereotype in place of an authentic, individualized identity, and the chapter uses Walt Kowalski, the protagonist of Clint Eastwood’s film, Gran Torino (2008), as its major example. The chapter discusses “therapeutic culture,” Judith Butler’s work on identity-formation, and Eva Illouz’s examination of a culture obsessed with trauma to comment on veteran performances of victimhood. Butler’s attempts to conceive of new identities absent the influence of systems of definition rooted in the state, in particular, reveal power in the opposite of silence, begging another question: What do civilians have to gain from the perpetuation of veteran stereotypes? Largely, the chapter finds, the “Wounded Warrior” persists in the minds of civilians who fear the veteran’s capacity for violence. A broken, damaged veteran is less of a threat. The story of the “Wounded Warrior” is not one of sacrifice. The “Wounded Warrior” exists after sacrifice, beyond any measure of “honor” achieved in uniform. “Wounded Warriors” are not expected to find a cure because the wound itself is an apparatus of the state that is commodified and injected into the currency of emotional capitalism. This chapter argues that military service and a damaged psyche need not always occur together. Following the second chapter, a close examination of “The Bear That Stands,” a short story by Suzanne S. Rancourt which confronts the author’s sexual assault while serving in the Marines, offers an alternative to both the “Hero” and the “Wounded Warrior” stereotypes. Rancourt, a veteran “Storyteller,” gives testimony of that crime, intervening in social conceptions of veteran identity to include a female perspective. As with the example of Bingo, the author demonstrates an innate ability to recognize and challenge the stereotypes discussed in the first and second chapters. This “Example” sets the stage for a more detailed examination of “Veteran Storytellers” and their communities in the final chapter. Chapter Three looks for examples of veteran “difference,” patriotism, the “Wounded Warrior,” and the “Hero” in nonfiction, fiction, and artwork emerging from the creative arts community, Military Experience and the Arts, an organization which provides workshops, writing consultation, and publishing venues to veterans and their families. The chapter examines veteran “difference” in a short story by Bradley Johnson, “My Life as a Soldier in the ‘War on Terror.’” In “Cold Day in Bridgewater,” a work of short fiction by Jerad W. Alexander, a veteran must confront the inescapability of that difference as well as expectations of conformity from his bigoted, civilian bartender. The final section analyzes artwork by Tif Holmes and Giuseppe Pellicano, which deal with the problems of military sexual assault and the effects of war on the family, respectively. Together, Johnson, Alexander, Holmes, and Pellicano demonstrate skills in recognizing stereotypes, crafting postwar identities, and producing alternative representations of veteran identity which other veterans can then draw upon in their own homecomings. Presently, no unified theory of veteran identity exists. This dissertation begins that discussion, treating individual performances of veteran identity, existing historical, sociological, and psychological scholarship about veterans, and cultural representations of the wars they fight as equal parts of a single text. Further, it invites future considerations of veteran identity which build upon, challenge, or refute its claims. Conversations about veteran identity are the opposite of silence; they force awareness of war’s uncomfortable truths and homecoming’s eventual triumphs. Complicating veteran identity subverts conformity; it provides a steady stream of traits, qualities, and motivations that veterans use to craft postwar selves. The serious considerations of war and homecoming presented in this text will be useful for Iraq and Afghanistan War veterans attempting to piece together postwar identities; they will be useful to scholars hoping to facilitate homecoming for future generations of war veterans. Finally, the Afterword to the dissertation proposes a program for reassimilation capable of harnessing the veteran’s symbolic and moral authority in such a way that self-definition and homecoming might become two parts of a single act.

Symptom severity among veteran survivors with partial or full posttraumatic stress disorder (PTSD) continues to increase, with approximately 40% of U.S. veterans reporting significant symptomology 10 years after initial onset of the condition. Veteran survivors often struggle to find therapeutic interventions that meet their specific needs and have a difficult time maintaining a therapy that is both equitable and evidenced based. Grounded in the Rogerian, client-centered theory, the purpose of this qualitative collective exploratory case study was to explore the effects of equine-facilitated psychotherapy with 3 veteran survivors with partial or full PTSD. A 4-stage process was used to collect data, including initial semistructured interviews, observations, photo-interviews, and researcher interpretations of photo-interviews. Data were transcribed, analyzed, and coded into within-case themes and cross case-themes. The principle findings revealed that veteran survivors with partial or full PTSD engaged in an equine-facilitated psychotherapy program had both here-and-now experiences and relational connection experiences with the horse. Many other significant details provided insight into the veteran participants' experiences with equine-facilitated psychotherapy, such as trust, connection, nonverbal communication, awareness, peace, decompression, communication, empathic reflection, congruence, reciprocity, concern, respect, and selflessness. These findings provide social change implications that may inform mental health professionals and counselor educators about the benefits of equine-facilitated psychotherapy with veteran survivors with partial or full posttraumatic stress disorder; the findings also provide structure to the use of equine-facilitated psychotherapy as an adjunct and/or alternative to traditional posttraumatic stress disorder treatments.

Background: Concern has been voiced over the needs of ex-military personnel following their discharge from military service and subsequent transition to community living. This concern has extended to include veterans, particularly those who have mental health, drug or alcohol problems, who come into contact with criminal justice services and are imprisoned. Research examining the experiences of military veterans prior to and during their incarceration in Scottish prisons was carried out. This study sought to examine whether veteran prisoners form a unique prison sub-group with different health, social and criminogenic needs when compared to non-veteran prisoners, and how veteran prisoners differ from non-prisoner veterans. Additionally an exploration of veterans’ experiences of prison, and what they believed caused or contributed to their imprisonment, was conducted. This sought to identify whether veterans in prison had unique vulnerability/ risk factors and whether they had a common or idiographic pathway that led to their incarceration. Methods and design: This study comprised of three separate but linked parts. It adopted a mixed-method approach combining quantitative analysis of survey data (Part 1) with qualitative interpretative phenomenological analysis of focus group (Part 2) and interview data (Part 3). Survey data examined, through the use of standardised questionnaires, a range of themes; including, mental health and wellbeing, substance and alcohol use, childhood experiences, offending histories, and military experience. In Part 1 participants were recruited into three separate groups. Group 1 consisted of veterans in prison, while Group 2 consisted of prisoners who had no military experience and Group 3 comprised of Scottish Prison Service staff who had previous military experience. In Parts 2 and 3 participants were recruited from the veteran prisoner population, with participants in Part 3 having declared current mental health and/or substance use problems. Findings: Analysis of survey data identified many differences in health and wellbeing, and some differences in length of, and discharge from, military service, when comparing veteran prisoners with a non-imprisoned veteran group. Both groups, however, appeared to have similar levels of combat exposure. Comparison between veteran prisoners and non-veteran prisoners identified more similarities than differences across most of the measures. Many of the mental health drug or alcohol problems experienced by veteran prisoners were also experienced by non-veteran prisoners. Post-traumatic stress disorder did appear to be a specific problem for veteran prisoners but this did not appear to be attributable to their military experience. Additionally, veterans being raised by a mother-figure other than their birth-mother appeared to be a unique risk factor for veteran imprisonment but this finding should be viewed with caution as the number of participants raised by a mother-figure other than their birth mother was small. Findings were mixed regarding how veterans described their experience of imprisonment: some found it unchallenging yet unstimulating while others described feelings of ongoing punishment and a sense of being embattled. Reciprocal processes of dehumanising both prisoners and staff were also evident, as were contradictory experiences on the availability and quality of care provision in prison. Veteran prisoners appeared to identify with their prisoner identity rather than their veteran identity, believing that they were the same as other prisoners and had the same needs. This was evident when veterans described their experiences of forming and maintaining interpersonal relationships, albeit within-prison relationships appeared superficial in nature. While some veterans appeared reluctant to ask for assistance in prison, concerns about the inadequacies or availability of support services appear valid. Gaps in provision of care, particularly mental health care, existed at the time of the study. Lastly, some participants appeared to feel unprepared for their release from prison back to the community. This may stem from their previous experience of transitioning from the military to civilian living but it is more likely the recognition that many prisoners leave prison only to return back to custody. For some veteran prisoners this is because they believe community services are unavailable or unable to help as they struggle to cope with community living. As such, some may consider prison living the easier option. Conclusions and implications: Many of the findings suggested that veteran and non-veteran prisoners had, or were believed to have had, by veteran prisoners, similar ‘needs’ and reasons for offending. Veteran prisoners should, therefore, not be regarded as a specific sub-group of the prison population, and addressing prisoner needs should not be prioritised according to their pre-prison occupational status. Lastly, where gaps in service provision exist, the SPS and its partner agencies, including the NHS, should continue to address these. This should include giving consideration to the adoption of a trauma-informed approach within the prison environment.

Background. The current study was conducted to increase understanding of factors that promote or deter post-combat adaptation. In total, five research questions were posed and tested, leading to examination of how difficulties with emotion regulation, post-deployment coping self-efficacy (PDCSE), and disrupted worldview work in-concert to influence post-combat adaptation (as measured by PTSD severity, depression severity, and quality of life perceptions). Methods. The final sample included cross-sectional data for 123 OEF/OIF veterans who were referred for assessment and/or treatment in an outpatient clinic in a Veterans Affairs Medical Center. Path analysis, employing bootstrapping re-sampling, was used to test hypotheses, yielding metrics for model fit, direct effects, and hypothesized indirect effects. Results. Overall findings demonstrated that each of the models tested were a good fit for explaining post-combat adaptation outcomes, with the final integrated model (including combat exposure, difficulties with emotion regulation, PDCSE, and negative worldview) explaining 49% of the variance in PTSD, 60% of the variance in depression severity, and 42% of the variance in quality of life, respectively. Findings across all models demonstrated that emotion dysregulation played a significant role in promoting worse post-combat adaptation, and that this effect primarily worked through alterations in PDCSE and negative worldview. Conclusions. This study concludes with interpretation of findings via theory and the extant literature. Future research and intervention implications are discussed, including the need to focus post-combat therapies on altering PDCSE and negative worldview, and more broadly, on factors that diminish meaningful life for combat veterans.
Ph. D.

The current study examined the impact of resilience and self-compassion on the relationship between combat exposure and psychological outcomes, specifically post-traumatic stress and post-traumatic growth. Service members and veterans with combat exposure (N = 143) completed an online survey, through which they were administered a Background Questionnaire, the Combat Exposure Scale, the PTSD Checklist for DSM-5, the Posttraumatic Growth Inventory, the Connor-Davidson Resilience Scale, and the Self-Compassion Scale. Results of a path analysis revealed a positive direct effect of combat exposure on post-traumatic stress symptoms and post-traumatic growth and a negative direct effect of self-compassion on post-traumatic stress symptoms. Furthermore, self-compassion moderated the relationship between combat exposure and post-traumatic growth. Implications of these findings and future directions for research are discussed.

Risk factors for psychological insult following deployment to Operation Enduring Freedom or Operation Iraqi Freedom among veterans: A systematic review: The systematic review aimed to establish more clearly the risk factors for mental health problems in the veteran population. Five databases were searched. Included studies (n = 10) required that veterans served in Operation Enduring Freedom (OEF) and/or Operation Iraqi Freedom (OIF) and included risk factors of mental health problems among the veteran population. Data from included studies were extracted and critically appraised based on critical appraisal tools following a narrative approach to synthesise data. All of the studies reviewed identified risk factors, although due to their heterogeneous nature key findings varied considerably. However, it was consistently reported that combat exposure and deployment experiences were associated with emergence of post operational mental health problems. The current review provides preliminary evidence that there are a number of specific risk factors that may increase susceptibility to mental health problems subsequent to military deployment. It is suggested that interventions are needed in order to mitigate risk factors and bolster protective factors. A cross-sectional study investigating the impact of disease activity and disease related cognitions on adjustment in Inflammatory Bowel Disease: The research journal aimed to investigate the degree to which psychological illness related cognitions will mediate the effect of disease activity on Quality of Life (QoL). In addition, to assess the impact of disease activity, and several psychological factors, in several adjustments outcomes in IBD to see whether the adjustment variables are significant predictors of multiple outcomes. Mediation was used followed by an exploratory cross-sectional correlational design. Three hundred and thirty eight participants were recruited through an IBD charity and invited to respond to a self-report questionnaire online. Measures targeted different aspects of the IBD profile to give an indication of adjustment associated with IBD diagnosis, psychological factors and Quality of Life (QoL). Mediation analysis found support for significant indirect effects on the relationship between disease activity and QoL through Gastrointestinal (GI) anxiety, perceived disability and illness representations. The subsidiary analysis indicated that pain catastrophising, disease activity, stigma, illness representations and GI anxiety were found to be significant predictors of adjustment in IBD. The results indicate that there is an important relationship with the adjustment factors, QoL, and psychological functioning. In addition, stress, depression, anxiety and QoL were found to be predicted by the adjustment factors. The current study has provided insight into psychological factors and adjustment indicators from a multi-faceted perspective, which will facilitate advancement of managing IBD from a biopsychosocial framework with a view to enable more effective disease management.

The purpose of this study was to provide a clear conceptualization of how Vietnam veterans who have previously been diagnosed with PTSD (Post Traumatic Stress Disorder) respond and cope with the emotional and psychological effects presented by the present war in Iraq.

Post-Traumatic Stress Disorder (PTSD) has affected millions of veterans who have served in the United States Military. PTSD causes severe impairments in one's mental health, and is correlated with homelessness, substance abuse, and unemployment. Recently, the United States Department Veterans Affairs has been funded more to improve services of mental health and other health care services. Specifically, this study was interested in exploring the perceptions that veterans have of the quality of services that have been provided for PTSD. Results indicated that the participants who utilized services felt individual and family therapy services were most helpful in reducing PTSD symptoms. Medication was less helpful suggesting further research on what types of medication are helpful. Participants also reported group therapy and service connected disability financial assistance were not helpful even though a majority of participants did not access it. Research indicates that veterans do not perceive services to be helpful; therefore they do not utilize them. Additional research can focus on exploring why veterans have not utilized services. Social workers can intervene by educating veterans about PTSD and the services that are provided in addition to other community agencies. Furthermore, social workers can evaluate returning veterans and their perception of the quality of services they have received to further improve services.

Thesis: S.M. in Technology and Policy, Massachusetts Institute of Technology, School of Engineering, Institute for Data, Systems, and Society, Technology and Policy Program, 2016.
This electronic version was submitted by the student author. The certified thesis is available in the Institute Archives and Special Collections.
Cataloged from student-submitted PDF version of thesis.
Includes bibliographical references (pages 85-88).
In this thesis, I created a tool for a particular VA clinic to simulate the delays veterans face in a network of mental health programs. Based on queueing theory, including blocking and reneging, different operations management strategies are compared using this discrete event simulation tool. To simulate wait times, users input arrival rates, service times, patience, probabilities of relapses and probabilities to go from one program to another. We determine that blocking is one of the main drivers of the delays. This model is not only useful for direct decision making, such as increasing capacity in one of the programs, but also to enable systems thinking in the VA. Indeed, if more quantitative methods were used at different levels of the organization, managers could take more informed decisions faster. This also prompts for rigorous data collection, which is something the VA needs, especially wait times for mental health clinics.
by Anne Collin.
S.M. in Technology and Policy

Clinicians have a challenge of discovering and implementing new ways to address their patients' health concerns. Some healthcare needs are not completely managed with pharmacotherapy and invasive procedures alone. Military veterans compose a special group due to multiple needs related to physical and emotional symptoms resulting from exposure to trauma. This project explored the benefits of a Tai Chi recreational therapy program. The goal of this trial was to examine gentle movement routines of Tai Chi for emotional benefits for veterans. The literature review provided insight from current evidence into the probable outcome of including alternative medicine options into regular practice for veterans coping with mental health illness. Veterans can find Tai Chi effective for self-management of anxiety, simple strength building and positive social interactions. With better management of mood symptoms from the practice of Tai Chi, pharmacotherapy use may be reduced. The Kirkpatrick model was used to evaluate the effectiveness of training. Although a small sample (n = 9), the results from patients via open ended questionnaire about their Tai Chi experience confirmed its benefit for better management of anxiety symptoms, as well as increased stamina and reduced back pain. Tai Chi has the potential to offer an independent method for managing various symptoms. Complementary alternative medicine such as Tai Chi should be seriously encouraged for self-management of various emotional and physical symptoms. Tai Chi practice incorporated into treatment plans contribute to social change by reducing medicinal use, symptoms exacerbation and financial cost for treating symptoms.

Approximately three percent of incarcerated individuals in Canada are veterans with unique mental health needs. The purpose of the current study was to examine incarcerated Canadian veterans’ mental health challenges and understand their perceptions of these challenges including perceived barriers and potential solutions. Each interview involved a demographic questionnaire, semi-structured interview, and the SCID-5-CV. Sixteen male inmates participated in the study, five identified as Aboriginal and eleven identified as Caucasian. Eleven served in the Army, three in the Navy, and two in the Air Force. Sixty eight percent were serving time for a violent offence, 62% reported a TBI, 18% had seen combat and 43% had completed peacekeeping tours. PTSD, mood disorders, and substance abuse were the most reported mental health difficulties. Themes that emerged include: adjustment difficulties, mental health difficulties-related to military service and familial/early influences, masculinity, stigmatization, and peer support. Proposed solutions to barriers included: mandatory treatment, integration of mental health into military activities, increasing anonymity, promotion of services, accessible services, and peer-based interventions. These results suggest that incarcerated veterans have unique mental health needs which may be contributing to their incarceration. Integrating veterans’ views into programming is a potential area of further study.

Mental health services are greatly underutilized by military service members and veterans. Among the reasons for this underutilization is that the services offered may not be a good fit for the specific problems facing service members/veterans and/or their families. The current study presented service members with descriptions of several approaches to treatment and asked them to indicate the likelihood of using each. Service members indicated the highest likelihood for using self-directed services, followed by individual treatment with a professional. They reported being least likely to use group approaches. These results may inform decisions about the implementation and dissemination of information about existing and new services.

With the wars in Iraq and Afghanistan lasting over a decade, hundreds of military mental health providers have deployed to hostile environments and some on multiple occasions. Military mental healthcare providers can experience symptoms of acute and chronic stress resulting from exposures to horrific events while caring for soldiers in a deployed environment. Indeed, in treating these soldiers, clinicians may continue to experience the same traumatic events as their clients. The purpose of this phenomenological study was to understand and describe shared trauma and resilience for military mental health professionals who have deployed. The concept of shared trauma was defined as the experiences providers faced as they attempted to deliver clinical services while simultaneously addressing the same issue within their own lives. The concept of resilience was explored as how stressful situations were interpreted in relation to individuals' overall life experiences. The principle research question for this study examined how military mental health providers described dilemmas faced as they attempted to navigate the personal and professional aspects of shared trauma. This study utilized a purposive sample of 7 military mental health veterans who deployed during Operation Iraqi Freedom and Operation Enduring Freedom. Data were collected through semi-structured interviews and analyzed using Moustakas's 5 steps of heuristic analysis. Key findings indicated participants' interpretations of experiences involved posttraumatic growth, lessons learned, and changes in belief systems. Findings of this study can assist military mental health leaders in developing support and protection programs to assist this overwhelmed population, ensuring service members receive the proper care they are entitled.

Background: Recent Canadian Armed Forces operations involved multiple deployments and exposure to traumatic events that are associated with post-traumatic stress disorder, depression and substance abuse. Despite efforts to facilitate mental health care, some soldiers do not get the help they need. Objective: To understand soldiers’ experiences and explore barriers and facilitators they encountered accessing mental health care. Results: Qualitative descriptive interviews with 11 Canadian Armed Forces members revealed six major categories that provide insights into their experiences accessing mental health care. Participants’ revealed significant barriers to care including fear of damaging their career or being released, stigma beliefs and actions from peers and leaders, and physical and organizational barriers to care. Social support from family, military co-workers, and unit leaders facilitated care. Conclusions: Notwithstanding efforts to facilitate access to mental health care, some soldiers still perceive significant barriers to care.

Nearly two million combat veterans are now in various stages of the process of returning from service and entering higher education using the post-9/11 GI Bill. Who is guiding and advising them in the process of this transition, and how are they doing it? To help answer this question, this qualitative phenomenological study examines the narratives of successful student veterans for ways that mentors played a role in their transition from military service to academia. The study was informed by an examination of relevant literature, including individual mentoring and group mentoring; medical and non-medical readjustment counseling for returning combat veterans; various branches of psychology, communication, social construction, and warrior mythology and storytelling. Narrative data were examined using a composite metatheoretical model drawing on domains of human experience (Shay, 2010), integral theory and the all quadrants, all levels (AQAL) model (Wilber, 2006), and the coordinated management of meaning theory of social construction in communication (Pearce, 2008). This analysis revealed patterns of multiple mentor interaction across various social worlds that helped them to make meaning from their experiences in transition, and bridge between different social contexts of home, military, and school. An unexpected but significant finding was the presence and role of traumatic experiences fitting the description of “moral injury” (Drescher et al., 2011) or “psychic wounding” (Malabou, 2012) as linked to the episodes of being mentored while making meaning of these experiences. This suggests the relationship of coordinated mentor communications to the phenomenon of posttraumatic growth, and the particular attunement of adult education (andragogy) as enabling context. Applying these findings to the composite four-quadrant model resulted in an integrated conceptual model of “contextual mentoring,” which provides a framework to consider the way coordinated mentor influences may act as mediating structures to support the development or transformation of returning veterans during their transition in higher education.

Keywords: veterans, mentoring, group mentoring, posttraumatic growth, moral injury, phenomenology, communication, coordinated management of meaning (CMM), social construction of reality, adult learning, andragogy, mediating structures.

Conventional studies of veterans’ longitudinal mental health approach the topic through the post-traumatic stress disorder (PTSD) lens. This qualitative study shifts the focus from a PTSD psychosomatic-centric approach to a psycho-spiritual examination of the sequela of war in the veteran psyche: this approach has been named in recent literature, moral injury. Utilizing a methodological approach situated in the philological region of hermeneutics, a Reductionist dialectic was selected. This study illustrates that the quotidian war poetry read by this researcher exhibits psycho-spiritual moral injury. The relevant emergent themes of the study include: (a) the function of memory, of not-forgetting, (b) the psychological torment of psychic dismemberment, (c) the acknowledgment of suffering in archetypal salt, and (d) the not-forgetting component of psychic re-memberment necessary for resolving moral injury. Reorienting the focus from PTSD to moral injury, this study finds critical implications to helping war veterans with their sequela of war. For instance, conventional treatments for PTSD such as prolonged exposure (PE) or cognitive behavior therapy (CBT), while effective for treating the co-morbid symptoms of PTSD, do not address the profound insights which can be gleaned from re-examination of the phenomena in terms of moral injury. Most importantly, moral injury as a psycho-spiritual dilemma is something for which the veteran must embrace primacy in seeking resolution, working outside of the typical evidenced-based therapies. This comports with the alchemists who cautioned: Only by working with intense focus on self-transformation can the lapis philosophorum be achieved.

Active duty personnel as well as combat veterans of the United States often engage in military operations during their service that require deployments to participate in missions, which may lead to extended periods away from home. When active duty men and women are appointed to combat zones, they may return with psychological burdens such as post traumatic stress disorder, which can complicate their reintegration into civilian life. This study explored the experiences of combat veterans who faced challenges when returning home from a war zone, along with the experiences of their family members. The study involved 26 combat veterans, spouses, significant others, and parents. In data analysis, semistructured interview responses were given concerning personal experiences. The interviews produced a vast amount of information with manual notes. Participants discussed treatment, interventions, and strategies for family reintegration. Many of the veteran participants shared that family members did the 'best they could' to help them reintegrate. The themes received for the study were family reintegration, command strategies and intervention, community services, and mental health services. The study showed how combat veterans and family members can successfully complete family reintegration with social support as well as support from mental health professionals. In association with social change, psychologists, psychiatrists, mental health practioners, and licensed professional counselors may benefit from the findings of this study. Professionals involved with mental health treatments and assessments would learn how to connect with combat veterans and family members. This study supports the recommendation that combat veterans and family members receive services from mental health professionals.

The purpose of this project was to create program to identify funding sources, and write a grant to fund a support group for veterans who suffer from Post Traumatic Stress Disorder (PTSD) at the Department of Veterans Affairs of, Long Beach. The literature allowed this write to find the main causes of PTSD in this case being exposed to combat, Traumatic Brain Injury (TBO), and the consequences to PTSD (substance abuse, commit suicide, experience family conflicts). This writer also found Cognitive Processing Therapy (CPT), Prolonged Exposure Therapy (PET), and Eye Movement Desensitization and Reprocessing (EMDR) to be effective intervention in treating veterans with PTSD. The proposed program is aimed at providing psychoeducation to veterans and to help improve the lives of our service men and women who suffer from PTSD. The program includes group counseling, and individual counseling for veterans, family counseling. Providing the proper training will help social worker better assess and serve our veterans who return from combat with PTSD. Actual submission and/or funding of the grant were not required for the completion of this project.

Research has indicated that OEF/OIF veterans are experiencing mental health concerns following deployment. While there are increasing numbers of veterans returning to higher education institutions after discharging from the military, there is a scarcity of empirical research investigating student veterans’ experiences as they transition into college. The purpose of the current study was to examine whether social support moderates the effects of psychological distress on college adjustment among a sample of student veterans. Participants were administered a Background Information Questionnaire, measures of psychological distress (i.e., GAD-7, PHQ-9, IES-R), Multidimensional Scales of Perceived Social Support, and the Student Adjustment to College Questionnaire. Multiple regressions revealed significant main effects for the variables of interest, but analyses failed to support the hypothesis that perceived social support would moderate the effects of psychological distress on college adjustment.

The US wields the most powerful military in the history of the world, and deploys military personnel throughout the globe to fight, kill and die in atoned conflict. US veterans number around 22.5 million or about 14% of the US population. Some veterans, troubled by violence, enroll in the Veterans Health Administration (VHA) and receive care from mental health providers who have developed, through their particular framework, the medical constructs of post-traumatic stress disorder (PTSD) and moral injury (MI) to diagnose and/or "treat" these veterans as "patients." The PTSD construct casts veterans as "patients with a disorder," minimizes legitimate moral pain, and enables the US public to avoid the work of reckoning with harmful consequences of US military action for which they hold ultimate responsibility. MI, a more recent and fluid construct, occurs at the intersection of religion and violence and thus invites the contribution of chaplains. A focused MI group for combat veterans within the VHA co-facilitated by a chaplain and psychologist provides veterans the opportunity for frame breaking and reframing and holds the possibility of systemic change in a response grounded not in individual therapy or treatment but rather in shared spiritual and moral community. A public ceremony with ritual and spiritual discipline creates sanctuary for veterans to provide adaptive leadership, as they transform themselves from patient to prophet, bearing witness to unsanitized and inglorious truths while the US public listens and wrestles with issues of culpability, obligation, and moral responsibility. The outcome is post-traumatic growth and spiritual development—indicated by greater moral engagement, awareness, forgiveness, and compassion. Such adaptive change may lead to increased resistance to militarism and greater reverence for all life on this fragile earth.

Since September 11, 2001, U.S. servicemen and women, having served in Iraq and Afghanistan, are returning home having suffered and survived catastrophic and disabling physical, neurological, psychological, and moral injuries. By every measure, the casualty statistics are staggering. Perhaps even more alarming is the reality that we have yet to see the full extent of the psychological and neurological injury-related complications that will emerge in the months and years to come. War exacts a heavy burden not only on the service member, but their families as well. Divorce affects female troops 3 times that of their male counterparts. During post-deployment health screenings, 12% of troops report substance abuse problems, while only 0.2% are referred for further evaluation and treatment. On any given night in America, about 154,000 veterans are homeless. Nearly half of those homeless have a mental health diagnosis and more than 70% struggle with substance abuse. Unfortunately, and too often, the burdens these servicemen and women carry become too heavy as suicide becomes an exercised option. Between 2004 and 2008, the rate at which active duty army soldiers took their own lives doubled.

The evidence strongly suggests that significant numbers of recent veterans are not successfully reintegrating back into society by virtue of high incidence rates of suicide, substance abuse, family problems, divorce, unemployment, homelessness, and incarceration. Unfortunately, that reintegration journey is seldom supported by the U.S. Department of Defense (DoD) or the U.S. Department of Veterans Affairs (VA) in any consistent meaningful manner beyond the date that the veteran is discharged from active duty.

This narrative inquiry explored the community reintegration experiences of ill, injured, and disabled U.S. servicemen and women that served in the global war on terrorism in Iraq and Afghanistan since September 11, 2001. More specifically, the service member’s experiences and perspectives around engagement in adventure-based activities, the supportive communities that manifest around those activities, and the role or value of that experience in the reintegration process. Through narrative inquiry, this study gives voice and adds deep contour and rare perspective to this typically isolated, humbly silent, and understudied population, informing greater understanding of the warfighter experience and the elements of their journeys that support successful rehabilitation and reintegration.

The findings of this study suggest that adventure-based activity and the communities that manifest around those activities played a vital role in the successful rehabilitation and reintegration journey of each of the research participants. Through surfing, rock climbing, and mountaineering, each was able to satisfy needs at all levels of Maslow’s hierarchy, facilitating the ability to redefine their sense of identity, reestablish a sense of purpose, and reconnect and reintegrate into a welcoming and supportive community apart from the military.

Findings from this study also inform policy, practice, and future research that can positively influence and improve the experience of current and future casualties of war. Honoring a commitment made by President Lincoln over 152 years ago and in keeping with the VA’s mission, the federal government must fund future research that has the capacity to influence expansion of the VA’s current narrow scope of practice. It must also vet and fund community-based programs that demonstrate the ability to positively influence the rehabilitation and reintegration journey. The findings of this study also inform practice in both the community and VA. Educators, clinicians, program providers, volunteers, and donors serving this population now have a more complete image of the veterans’ experience and the immense value of their contribution to the journey. Future research that includes a multicultural voice, the voice of women, inclusion of other adventure-based activities, and a variety of methodological approaches is imperative if the research community is to play a role in positively influencing the rehabilitation and reintegration journey of veterans that are ill, injured, and disabled.

This qualitative research study explores what veterans living in the Appalachian region experience in receiving care for Posttraumatic Stress Disorder through personal interviews. These interviews will give insight into how veterans in Appalachia perceive their care through specific questions pertaining to healthcare for Posttraumatic Stress Disorder. A convenient sample of veterans attending the specific study site was used for this study. An email, which contained information about the background and nature of the study was used for participant recruitment of veterans. In addition, flyers with the same information were posted throughout the study site. This study will highlight specific details of veterans’ care for Posttraumatic Stress Disorder that will help to accumulate information on the care given to veterans in Appalachia. The Appalachian region is described by the Appalachian Regional Commission as "a 205,000 square mile region that follows the spine of the Appalachian Mountains from southern New York to northern Mississippi"(The Appalachian region- Appalachian Regional Commission, n.d.).

Encounters between civilian law enforcement (CLE) and combat veterans may end in incarceration. Police Chiefs should consider this when allocating resources. The Sequential Intercept Model (SIM) is a conceptual framework designed to provide a guide to Police Chiefs for decision-making particularly for the benefit of combat veteran encounters. The qualitative method with case study research design utilized for this study was intended to examine the decision-making processes of law enforcement leaders regarding resource allocation. The University of Phoenix Library was the primary source for research of scholarly work. The target audience for the research was 26% of the Police Chiefs in police agencies with 25 members or less in Beaver County, Western Pennsylvania. The perception of Police Chiefs was examined in individual telephone interviews. The data collected during interviews were analyzed for trends in perception and decision-making processes. Data included interviews, training records and budgetary documents. The results are intended as a resource for police leaders for decision-making processes and for the benefit of public safety, officer safety and the individual combat veterans. Field notes and transcribed interviews were downloaded into NVivo software for analysis and emerging themes. Four emerging themes were: Need for decision-making processes, more funding is needed for training, training for police related to combat veteran encounters may help with jail diversion for combat veterans, and organizational efficiency through maintaining training records of police officers is necessary. Without changes based on emerging themes, a reduction in the veteran incarceration rate may not occur.

The purpose of this study was to compare spirituality and subjective sense of time passage between Vietnam combat veterans diagnosed with post traumatic stress disorder (PTSD) and those without PTSD. Rogers' Principle of Helicy provided a theoretical perspective for the study. The abrupt interactive repatterning that may occur under the extreme conditions of combat can be translated into compromised abilities of the combat veteran to assume an acceptable lifestyle once he is out of the combat situation. A population of 32 Vietnam combat veterans answered questionnaires regarding their perspectives on spirituality and subjective sense of time. It was hypothesized that these variables may differ significantly among Vietnam combat veterans with and without PTSD. Findings revealed a statistically significant difference in sense of time in Vietnam combat veterans with PTSD compared to those without PTSD. There was, however, no significant difference in spiritual perspective when these same groups were compared.

The purpose of this project was to write a grant proposal seeking funds for a program that utilizes service dogs as a supplementary intervention for veterans diagnosed with posttraumatic stress disorder (PTSD). The literature review addressed the prevalence of PTSD in the United States and among our veterans. In addition, PTSD challenges, risk factors, and direct consequences were explored. Pet therapy, service animals, and animal companionship were researched and reviewed to further analyze the effectiveness of their support with humans.

The service dog program will be implemented at The Veterans Affair (VA) Health Care System in Long Beach, California. The program seeks to provide additional support to veterans who are utilizing mental health services at the VA. The intervention is projected to have the following outcomes, decreased PTSD symptoms, increased community integration, and decreased feelings of suicidal ideation. The actual submission and/or funding of this grant were not a requirement for the successful completion of this project.

In this study, 5 women with co-occurring DSM-IV-TR diagnoses in a residential treatment center for homeless veterans and their families received group mindfulness oriented art therapy during an 8-week intervention. Two of the participants were utilized in this case study research to explore how a mindfulness can be implemented in group art therapy and what impact this may have for the female veterans. The study included a qualitative analysis of the veteran’s artwork and the participants’ account of their own behavior. The findings revealed that participants used the art process to express a developing awareness of avoidance and denial often associated with both substance abuse and PTSD. The participants’ artwork and self-reports indicated enhanced flexibility in focus of attention, self-awareness, and self-regulation. The study demonstrated the potential of mindfulness oriented art therapy for enhancing healthy coping strategies.

Prior research has pointed to an association between a history of traumatic events and premenstrual syndrome (PMS) in women. The objective of this study was to further investigate the relationship between trauma and PMS among female veterans, a population with high rates of sexual and physical abuse, as well as combat-related exposures. We conducted a case-control study of 502 women veterans under the age of 52 who were associated with the Iowa City Veterans Affairs Medical Center. Trauma history, gynecological health, mental health (including posttraumatic stress disorder), and other variables were obtained through telephone interview. Cases were women who had moderate to severe PMS as defined by validated criteria and controls were women without PMS. The prevalence of PMS was 14.3%. Thirty-three percent of subjects reported a completed sexual assault, 29% a combat-related trauma, and 86% a non-combat related trauma. Factors significantly associated with PMS (p<0.05) in the univariate analysis were: attempted, completed, and number of rapes during a woman's lifetime; rape before age 18; rape during military service; childhood sexual abuse; and number of non-combat related traumas. Childhood physical abuse and combat-related trauma were not associated with PMS in univariate analyses. In our final multivariate model, lifetime completed sexual assault was associated with PMS (odds ratio =2.42, 95% confidence interval = 1.33-4.40). Findings from this study among female veterans indicate that a history of trauma, particularly sexual trauma, is associated with moderate to severe PMS. Further study is warranted to confirm temporal relationships and causal mechanisms.

Medical experts claim that Posttraumatic Stress Disorder among United States military service personnel, who served in Iraq and Afghanistan has contributed to an “epidemic of suicide” in the U.S. However, veterans, military commanders, and mental health providers argue that feelings of grief, guilt, mistrust, rage, and alienation are actually normal moral reactions to the abnormal situations that war creates. Furthermore, they argue that these normal reactions are currently transformed into a psychiatric diagnosis that promises clinical solution – a cure. Recent epidemiologic studies suggest that evidence-based clinical treatments are ineffective for a majority of veterans with PTSD and that the main barrier to seeking treatment is self-stigma by veterans. This ethnography interrogates the failure in care and vectors of blame that surround it by documenting veterans’ own critical reactions to being diagnosed and/or labeled with PTSD. These narratives provide a moment to critically examine the medicalization and commodification of trauma, as well as the bureaucratization of care, that continue to negatively impact what I describe as veteranhood – a deep constellation of personal and military values. Everyday life for veterans becomes a clash of cultural models, worldviews and various stakeholders of their care. The lack of common ground or “cultural consonance” (versus PTSD/stigma) lies behind the social processes that contribute to veterans’ uneven reintegration into civilian life. This ethnography provides counter-narratives of emergent veteranhood that challenge the dominant cultural script of “stigma as the main barrier to care.” These narratives dismantle concepts of self-stigma by shifting the focus from the standard trauma model of victimization towards a productive veteranhood, where agency remains essential to identity and everyday life. Veterans that reframe the post-effects of war as an issue of cultural dissonance, as opposed to a mental disorder, are creating new personal scripts for healing that a medical anthropology and caregivers must account for. Veterans desire solutions for their distress within their communities, their culture(s), not within the confines of a medical clinic or within the categorical parameters of PTSD.

The Global War on Terror has routinely exposed military personnel to PTSD qualifying traumatic events. Scant research has included a military training and occupational context among combat Veteran populations who leave military service. This retrospective cohort study explored the influence of pre-exposure training on the relationship between combat exposure, posttraumatic stress symptoms (PTSS) and functioning impairments after discharge from military service. The results confirmed an occupational associated exposure risk for approximately 15% of the US military. Despite the combative specialty Veteran experiencing more combat in frequency and intensity, there were no differences in PTSS or functioning impairment any time after discharge or within the last thirty days between occupational cohorts. The study concluded that combative occupational training is protective against the effects of battle exposure experiences, but not post battle experiences. The study results suggest that military organizational resilience training is not effective in bolstering hardiness after discharge and transitioning into the civilian population. These findings support the creation of a military occupational mental health model for future PTSD diagnosis and treatment for combat Veteran populations.

xi, 56 p. : ill. (some col.)
To investigate resilience against combat stress, 175 interviews from the Veterans' History Project were coded using the Deployment Risk and Resiliency Inventory and analyzed using the Linguistic Inventory and Word Count. Contrary to hypotheses, higher levels of social support did not predict psychological outcomes, nor did social support differ between wars. Low variance in the social support measure likely contributed to the null results. The amount of combat experiences the veteran discussed did significantly predict psychological outcomes, replicating previous findings. This indicates that the LIWC measures are good indicators of psychological outcome.
Committee in charge: Holly Arrow, Chairperson; Jennifer Freyd, Member; Phil Fisher, Member