Objective: Despite growing numbers of veteran women, it is unclear whether the impact of common postdeployment mental health concerns on key aspects of family functioning varies by gender. We ...examined whether associations between PTSD, depression, and problematic alcohol use and intimate relationship quality and parenting self-efficacy differed among men and women in a large, gender-balanced sample of post-9/11 veterans. Method: Participants included 2,348 veterans (51.49% women) of the wars in Iraq and Afghanistan who were part of a larger study of gender differences in effects of wartime deployment. Veterans who were married or in a relationship (n = 1,536, 49.09% women) reported overall relationship quality. Veterans with children under age 18 (n = 1,049; 51.57% women) self-reported on their sense of efficacy as parents. All participants reported symptoms of PTSD, depression, and problematic alcohol use. We used a series of hierarchical linear regressions to test gender as a moderator of each postdeployment mental health concern and the family functioning constructs of interest. Results: Each postdeployment mental health concern was associated with reduced relationship quality and parenting self-efficacy, and these associations were largely consistent across gender. However, links between reduced parenting self-efficacy and increased PTSD and depressive symptoms were stronger in women compared with men. Conclusions: Postdeployment mental health concerns are associated with impairment in key family relationships for both veteran men and women. This impact may be particularly profound for parenting self-efficacy among female veterans, highlighting the potential importance of targeted interventions in this domain.
Clinical Impact Statement
The impacts of postdeployment mental health concerns on relationship quality are generally similar among veteran men and women. Associations of postdeployment mental health concerns with parenting may be more problematic for veteran women versus men, suggesting a potential need for gender-based assessment and intervention for these concerns.
Experiences of abuse during childhood or military service may increase women veterans’ risk for intimate partner violence (IPV) victimization. This study examined the relative impact of 3 forms of ...interpersonal violence exposure (childhood physical abuse CPA, childhood sexual abuse CSA, and unwanted sexual experiences during military service) and demographic and military characteristics on past‐year IPV among women veterans. Participants were 160 female veteran patients at Veterans Afffairs hospitals in New England who completed a paper‐and‐pencil mail survey that included validated assessments of past‐year IPV and previous interpersonal violence exposures. Women who reported CSA were 3.06 times, 95% confidence interval (CI) 1.14, 8.23, more likely to report past‐year IPV relative to women who did not experience CSA. Similarly, women who reported unwanted sexual experiences during military service were 2.33 times, 95% CI 1.02, 5.35, more likely to report past‐year IPV compared to women who did not report such experiences. CPA was not associated with IPV risk. Having less education and having served in the Army (vs. other branches) were also associated with greater risk of experiencing IPV in the past year. Findings have implications for assisting at risk women veterans in reducing their risk for IPV through detection and intervention efforts.
Traditional and Simplified Chinese s by AsianSTSS
標題：女性退役軍人中親密伴侶暴力：昔日人際暴力的風險。
撮要：童年或服役期間受虐待經歷可能增加女性退役軍人的親密伴侶暴力(IPV)受害風險。本研究檢視三種不同形式的人際暴力經歷(即兒童身體受害(CPA)，兒童性受虐(CSA)，和服役時非自願性經驗)，對女性退役兵的過去一年IPV方面人口統計學和軍事特徵的相對衝擊。樣本是160名新英倫醫療保健系統的女退役軍病人，而她們完成了一個郵寄書寫調查，包括過往一年IPV和過往人際暴力的有效評核。對比無CSA者報告，有3.06倍CSA婦女報告過去一年有IPV (95% CI﹝1.14, 8.23﹞)。有2.33倍非自願性經驗的婦女(95% CI﹝1.02–5.35﹞)報告過去一年有IPV。CPV則未與IPV風險有關連。較低學歷和在陸軍服役(對比其他軍種)都有較高風險經歷過去一年IPV。結果顯示及早察覺和介入有風險的女性退役軍人有肋減少IPV的風險。
标题：女性退役军人中亲密伴侣暴力：过往人际暴力的风险。
撮要：童年或服役期间受虐待经历可能增加女性退役军人的亲密伴侣暴力(IPV)受害风险。本研究检视三种不同形式的人际暴力经历(即儿童身体受害(CPA)，儿童性受虐(CSA)，和服役时非自愿性经验)，对女性退役军的过去一年IPV方面人口统计学和军事特征的相对冲击。样本是160名新英伦医疗保健系统的女退役军病人，而她们完成了一个邮寄书写调查，包括过往一年IPV和过往人际暴力的有效评估。对比无CSA者报告，有3.06倍CSA妇女报告过去一年有IPV (95% CI﹝1.14, 8.23﹞)。有2.33倍非自愿性经验的妇女(95% CI﹝1.02–5.35﹞)报告过去一年有IPV。CPV则未与IPV风险有相关。较低学历和在陆军服役(对比其他军种)都有较高风险经历过去一年IPV。结果显示及早察觉和介入有风险的女性退役军人有肋减少IPV的风险。
The Veterans Health Administration (VHA) recommends screening female patients for intimate partner violence (IPV), yet few studies inform IPV screening efforts among this population. This study ...examined the proportion of women who experienced IPV within the past year and the associations between IPV and depression, post-traumatic stress disorder (PTSD), alcohol dependence, mental health multimorbidity (ie, 2 or 3 of these conditions), and military sexual trauma (MST) among female veterans.
A cross-sectional mail survey of 160 female VHA patients with an intimate partner within the past year was conducted in 2012 in New England. Self-reported IPV was assessed using the Hurt, Insult, Threaten, Scream screening tool. The survey also included validated screening measures of depression (Center for Epidemiologic Studies Depression Scale), PTSD (PTSD Checklist-Civilian), alcohol misuse (10-item Alcohol Use Disorders Identification Test), and MST.
Approximately 37% of women reported IPV within the past year on the Hurt, Insult, Threaten, Scream tool. Odds ratios for the associations between reporting IPV and mental health outcomes ranged between 2.75 and 3.67. With the exception of alcohol dependence, IPV remained strongly associated with mental health conditions when adjusting for MST.
These findings can increase provider knowledge of the strong connection between past-year IPV and mental health conditions among female veterans. This may encourage IPV screening and facilitate appropriate referrals, treatment conceptualization, and planning within the VHA and other health care settings.
Military sexual trauma (MST) is a pervasive problem among veterans, and is associated with a host of deleterious outcomes. It is, therefore, imperative to identify individuals who have experienced ...MST so that they can be offered appropriate treatment. To determine how to best identify MST survivors, the current study examined how different assessment modalities might affect MST endorsement, and whether endorsement varied as a product of demographic group membership.
Data from 697 male and female veterans participating in the Veterans’ After-Discharge Longitudinal Registry (Project VALOR) were used to examine how three different MST assessment modalities—the Veterans Health Administration screen, a study interview, and a study questionnaire measure—might affect MST endorsement across five different demographic variables (gender, ethnicity, sexual orientation, race, and age). Each participant was evaluated for MST exposure using each of the three assessment modalities.
Both assessment modality and demographic membership influenced MST endorsement. MST endorsement on the study measures was consistently twice as large as on the Veterans Health Administration screen, across demographic groups. For men, MST endorsement varied by a factor of 11 across measures, with endorsement being lowest on the Veterans Health Administration screen and highest on the study questionnaire. Although differences were also detected for sexual minority and Black participants, these findings may have been better explained by gender differences.
Both assessment modality and demographic membership substantially influenced MST endorsement. Providing a clear rationale for screening and increasing privacy around screening results, particularly for male veterans, may help to facilitate MST disclosure.
There is a growing concern about suicide among Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF) veterans. We examined the role of postdeployment mental health in associations ...between deployment stressors and postdeployment suicidal ideation (SI) in a national sample of 2,321 female and male OEF/OIF veterans. Data were obtained via survey, and path analysis was used. For women and men, mental health symptoms largely accounted for associations between deployment stressors and SI; however, they only partly accounted for the sexual harassment and SI association among women. These findings enhance the understanding of the mental health profile of OEF/OIF veterans.
In response to growing concerns about sexual violence as an underrecognized traumatic consequence of military service, Veterans Health Administration policy requires universal screening for sexual ...trauma sustained during military service. This prospective study, the first to evaluate national efforts to screen for military sexual trauma, investigated whether sexual trauma screening is associated with increased utilization of mental health services.
This study examined data for all male (N=540,381) and female (N=33,259) veterans who had valid responses to screens for military sexual trauma in 2005. The use of mental health services during the three months after screening was examined for persons who screened positive for military sexual trauma and for those who screened negative. Findings were stratified by use of mental health services in the six months before the screening.
Compared with negative screens, positive screens were associated with significantly increased rates of postscreen mental health treatment. A more than twofold increase was observed for patients without previous use of mental health treatment (women: relative risk RR=2.52, 95% confidence interval CI= 2.38-2.66; men: RR=2.47, 95% CI=2.34-2.61). In this group, the number of positive screens needed for one additional patient to access treatment was 5.5 for women and 7.2 for men.
Our findings suggest that detection via screening is associated with increased rates of mental health treatment. An effective screening program that promotes detection of sexual trauma and access to mental health care can help to reduce the burden of psychiatric illness for those who have experienced military sexual trauma.
Establishing whether men and women tend to express different symptoms of posttraumatic stress in reaction to trauma is important for both etiological research and the design of assessment ...instruments. Use of item response theory (IRT) can reveal how symptom reporting varies by gender and help determine if estimates of symptom severity for men and women are equally reliable. We analyzed responses to the PTSD Checklist (PCL) from 2,341 U.S. military veterans (51% female) who completed deployments in support of operations in Afghanistan and Iraq (Operation Enduring Freedom/Operation Iraqi Freedom OEF/OIF), and tested for differential item functioning by gender with an IRT‐based approach. Among men and women with the same overall posttraumatic stress severity, women tended to report more frequent concentration difficulties and distress from reminders whereas men tended to report more frequent nightmares, emotional numbing, and hypervigilance. These item‐level gender differences were small (on average d = 0.05), however, and had little impact on PCL measurement precision or expected total scores. For practical purposes, men's and women's severity estimates had similar reliability. This provides evidence that men and women veterans demonstrate largely similar profiles of posttraumatic stress symptoms following exposure to military‐related stressors, and some theoretical perspectives suggest this may hold in other traumatized populations.
Traditional and Simplified Chinese s by AsianSTSS
標題：孩童面對家長離世的HPA軸功能與心理及環境因素的關鍵：初步研究結果
撮要：本文檢視孩童喪親後HPA軸功能(包括皮質醇睡醒反應；CAR) 與心理困擾、應對、和另一尚存家長的悲傷反應之間的關係。樣本包括38名孩童(20名女童曾在過去6個月有家長離世)和28名尚存的孩童家長(23名女性)，他們會接受自我答問工具和半結構面談，而面談包括討論孩童對喪親的想法及感受，面談後連續三日，受訪者會提供3個在家唾液樣本(睡醒時，30分鐘後和黃昏時)。結果顯示孩童第1天CAR減退與更多焦慮症狀(r= ‐.45) 、 抑鬱症狀(r= ‐.40) 、 創傷後壓力症狀(r= ‐.45) 、不適應哀悼症狀(r= ‐.43) 和迴避性應對水平(r= ‐.53)有顯著關連。家長的更高不適應哀悼水平(r= ‐.47) 亦與孩童第1天CAR減退有關連。這些數據突出了減弱的CAR可能是累積穩態負荷和(又或)情緒上刺激的事件(與死者相關的討論)，及在家庭中相關的後續處理(或缺少處理)而導致的。這些可能對喪親兒童(已經歷高度心理困擾、迴避應對和家長的不適應哀悼)來說已是特別壓力。
标题：孩童面对家长离世的HPA轴功能与心理及环境因素的关键：初步研究结果
撮要：本文检视孩童丧亲后HPA轴功能(包括皮质醇睡醒反应；CAR) 与心理困扰、应对、和另一尚存家长的悲伤反应之间的关系。样本包括38名孩童(20名女童曾在过去6个月有家长离世)和28名尚存的孩童家长(23名女性)，他们会接受自我答问工具和半结构面谈，而面谈包括讨论孩童对丧亲的想法及感受，面谈后连续三日，受访者会提供3个在家唾液样本(睡醒时，30分钟后和黄昏时)。结果显示孩童第1天CAR减退与更多焦虑症状(r= ‐.45) 、 抑郁症状(r= ‐.40) 、 创伤后压力症状(r= ‐.45) 、不适应哀悼症状(r= ‐.43) 和回避性应对水平(r= ‐.53)有显著关连。家长的更高不适应哀悼水平(r= ‐.47) 亦与孩童第1天CAR减退有关连。这些数据突出了减弱的CAR可能是累积稳态负荷和(又或)情绪上刺激的事件(与死者相关的讨论)，及在家庭中相关的后续处理(或缺少处理)而导致的。这些可能对丧亲儿童(已经历高度心理困扰、回避应对和家长的不适应哀悼)来说已是特别压力。
Sexual trauma is prevalent among military women, but data on potential effects are needed. The association of sexual trauma with health and occupational outcomes was investigated using longitudinal ...data from the Millennium Cohort Study. Of 13,001 U.S. service women, 1,364 (10.5%) reported recent sexual harassment and 374 (2.9%) recent sexual assault. Women reporting recent sexual harassment or assault were more likely to report poorer mental health: OR = 1.96, 95% CI 1.71, 2.25, and OR = 3.45, 95% CI 2.67, 4.44, respectively. They reported poorer physical health: OR = 1.39, 95% CI 1.20, 1.62, and OR = 1.39, 95% CI 1.04, 1.85, respectively. They reported difficulties in work/activities due to emotional health: OR = 1.80, 95% CI 1.59, 2.04, and OR = 2.70, 95% CI 2.12, 3.44, respectively. They also reported difficulties with physical health: OR = 1.55, 95% CI 1.37, 1.75, and OR = 1.52 95% CI 1.20, 1.91, respectively, after adjustment for demographic, military, health, and prior sexual trauma characteristics. Recent sexual harassment was associated with demotion, OR = 1.47, 95% CI 1.12, 1.93. Findings demonstrated that sexual trauma represents a potential threat to military operational readiness and draws attention to the importance of prevention strategies and services to reduce the burden of sexual trauma on military victims.
Resumen
Salud de las mujeres militares y vida laboral post trauma sexual
El trauma sexual es prevalente entre las mujeres militares, pero se necesita información acerca de sus potenciales efectos. Se investigó la asociación de trauma sexual con sus consecuencias laborales y en la salud, usando datos longitudinales del Estudio de Cohorte Millenium. De 1.300 mujeres norteamericanas en servicio, 1.364 (10.5%) reportó acoso sexual reciente y 374 (2.9%) abuso sexual reciente. Las mujeres que reportaron acoso sexual o abuso reciente fueron las que con mayor probabilidad reportaron salud mental más deteriorada (OR = 1.96 95% CI 1.71, 2.25; y OR = 3.45 95% CI 2.67,4.44, respectivamente), Salud física más deteriorada(OR = 1.39 95% CI 1.20,1.62, y OR = 1.39 95% CI 1.04, 1.85, respectivamente), y dificultades en el trabajo/ actividades debido a la Salud emocional (OR = 1.80 95% CI 1.59, 2.04; y OR = 2.70 95% CI 2.12–3.44, respectivamente) después del ajuste por características demográficas, militares, salud y trauma sexual previo. El acoso sexual reciente se asoció con descenso de categoría (OR = 1.47 95% CI 1.12, 1.93. Los hallazgos demuestran que el trauma sexual representa una amenaza potencial para la preparación operación militar y llama la atención sobre la importancia de las estrategias y los servicios de prevención para reducir la carga de trauma sexual en víctimas militares.
抽象
Traditional and Simplified Chinese s by AsianSTSS
標題 : 美國女軍人的近期性創傷與惡劣的健康狀況和職業後果
撮要: 性創傷在女軍人當中普遍，但仍需更多有關其潛在效應的數據。研究透過從千禧世代研究取得的縱貫數據，檢視性創傷跟健康和職業後果的關聯。在13,001名美國女軍人中，1,364人(10.5%)近期經歷性騷擾，374人(2.9%)近期經歷性侵犯。經過對人口、軍事、健康和過往性創傷的特徵作調整後，研究發現報有近期性騷擾或性侵犯的女性，更大可能報有較差的心理健康(分別為 OR = 1.96 95% CI 1.71, 2.25 和 OR = 3.45 95% CI 2.67, 4.44)和較差的身體健康(分別為 OR = 1.39 95% CI 1.20, 1.62 和 OR = 1.39 95% CI 1.04, 1.85)，並更大可能因情緒問題(分別為 OR = 1.80 95% CI 1.59, 2.04 和 OR = 2.70 95% CI 2.12–3.44)和健康問題(分別為 OR = 1.55 95% CI 1.37–1.75 和 OR = 1.52 95% CI 1.20–1.91)而在工作或活動裡面對困難。近期性騷擾跟降職有關聯(OR = 1.47 95% CI 1.12, 1.93)。研究結果顯示，性創傷對軍事行動的敏捷度是個潛在威脅，強調為減輕軍隊裡性創傷受害者的負擔，提供預防策略和治療實為重要。
标题 : 美国女军人的近期性创伤与恶劣的健康状况和职业后果
撮要: 性创伤在女军人当中普遍，但仍需更多有关其潜在效应的数据。研究透过从千禧世代研究取得的纵贯数据，检视性创伤跟健康和职业后果的关联。在13,001名美国女军人中，1,364人(10.5%)近期经历性骚扰，374人(2.9%)近期经历性侵犯。经过对人口、军事、健康和过往性创伤的特征作调整后，研究发现报有近期性骚扰或性侵犯的女性，更大可能报有较差的心理健康(分别为 OR = 1.96 95% CI 1.71, 2.25 和 OR = 3.45 95% CI 2.67, 4.44)和较差的身体健康(分别为 OR = 1.39 95% CI 1.20, 1.62 和 OR = 1.39 95% CI 1.04, 1.85)，并更大可能因情绪问题(分别为 OR = 1.80 95% CI 1.59, 2.04 和 OR = 2.70 95% CI 2.12–3.44)和健康问题(分别为 OR = 1.55 95% CI 1.37–1.75 和 OR = 1.52 95% CI 1.20–1.91)而在工作或活动里面对困难。近期性骚扰跟降职有关联(OR = 1.47 95% CI 1.12, 1.93)。研究结果显示，性创伤对军事行动的敏捷度是个潜在威胁，强调为减轻军队里性创伤受害者的负担，提供预防策略和治疗实为重要。
•Degenerative lumbar spondylolisthesis (DLS) is more symptomatic in upright posture.•Conventional MRI is underestimating the severity of neural compression in DLS.•The open MRI can acquire images in ...the most symptomatic posture in DLS patients.•In DLS, the height of the lateral recess is reduced by 50% in the standing posture.•The cross-sectional area of the thecal sac is reduced by 30% in standing posture.
The objectives of this study were to (a) develop a standing MRI imaging protocol, tolerable to symptomatic patients with degenerative spondylolisthesis (DLS), and (b) to evaluate the morphometric changes observed in DLS patients in both supine and standing postures. Patients with single level, Meyerding grade 1 DLS undergoing surgery at a single institution between November 2015 to May 2017 were consented. Patients were imaged in the supine and standing positions in a 0.5 T vertically open MRI scanner (MROpen, Paramed, Genoa, Italy) with sagittal and axial T2 images. The morphometric parameters measured were: cross-sectional area of the thecal sac (CSA), lateral recess height, disc height, degree of anterolisthesis, disc angle, lumbar lordosis, the presence of facet effusion and restabilization signs. Measures from both postures were compared using paired T-test. Associations of posture with the magnitude of change in the various measurements was determined using Pearson correlation or paired T-test when appropriate. All fourteen patients (mean age 64.4 years) included tolerated standing for the time required for image acquisition. All measurements with the exception of lumbar lordosis and disk height showed a statistically significant difference between the postures (p < 0.05). In the standing position, CSA and lateral recess height were reduced by 28% and 50%, respectively. There was no relationship between the change in CSA of the thecal sac and any measures. Standing images acquired in an upright MRI scanner demonstrated postural changes associated with Meyerding grade 1 DLS and images acquisition was tolerated in all patients.
Given the number of veterans who have experienced military sexual trauma (MST) and the impact of these experiences on veteran health, Veterans Health Administration (VHA) providers frequently ...communicate with patients about these experiences, either as part of the VHA's universal MST screening program or more comprehensive clinical care. The purpose of this study was to understand veterans' perceptions of communication related to MST disclosures with VHA providers. We conducted qualitative interviews, including a numeric rating question, with 55 veterans whose medical records indicated recent MST-related interactions with VHA providers. The sample included men and women, with and without histories of MST. We analyzed interview transcripts using matrices and identified themes related to satisfaction with communication. Veterans from all groups reported generally high satisfaction with MST-related communication, although men, as a group, reported a much larger range of satisfaction ratings than women. Key provider-related indicators of satisfaction included providers' communication mechanics and nonspecific patient-centered skills and characteristics. One patient-related indicator of lower satisfaction-inherent discomfort discussing MST experiences-was particularly represented among men with MST histories. These data from veteran patients will be reassuring to providers whose concerns about patient reactions to these conversations may inhibit them from raising this important issue. Understanding variables that promote patient satisfaction with MST disclosure communication is critical for promoting sensitive patient-provider interactions about MST. This ultimately can have important downstream effects on veteran health, allowing veterans to forge satisfying relationships with providers and ultimately facilitate recovery from traumatic experiences.
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