VETERANetwork Publications

Protective Factors for Military Veteran Fathers’ Parenting Functioning and Satisfaction

Publication Journal:
Journal of Family Issues
Publication Year:
2021
Author(s):
Jennifer K. Karre, Nicole R. Morgan, Julia A. Bleser, & Daniel F. Perkins
Summary or Abstract:

Employing a strengths-based perspective, this study examined protective factors related to fathers’ positive parenting behaviors and parenting satisfaction. The sample included 3,810 active duty veteran fathers who separated from the active component and had at least one child 18 years and younger. Logistic regression analyses indicated that financial status, health functioning, resilience, social support, positive social functioning with community and friends, and positive social functioning with relatives were all associated with parenting functioning. The interaction of the number of deployments and resilience was related to parenting functioning. Furthermore, health functioning, resilience, social support, positive social functioning with community and friends, and positive social functioning with relatives were associated with parenting satisfaction. Among fathers in a romantic relationship, the interaction of the number of deployments and romantic relationship functioning and the interaction of the number of deployments and romantic relationship satisfaction were both related to parenting functioning and parenting satisfaction.

Publication Link:
Learn More

The Interaction of Exposure to Adverse Childhood and Combat Experiences on the Current Mental Health of New Post‐9/11 Veterans

Publication Journal:
Journal of Community Psychology
Publication Year:
2021
Author(s):
Nicole R. Morgan, Keith R. Aronson, Daniel F. Perkins, Carly E. Doucette, Julia A. Bleser, Katie Davenport, Dawne Vogt, Laurel A. Copeland, Erin P. Finely, & Cynthia L Gilman
Summary or Abstract:

Military veterans have greater exposure to adverse childhood experiences (ACEs) than civilians and many also encounter warfare exposures, which can increase the likelihood of mental health problems. The purpose of this study was to test an interaction between childhood traumas and warfare exposures on the mental health of a sample of nearly 10,000 new post‐9/11 veterans. Results revealed that male veterans exposed to one or two ACEs, but no warfare, were more likely to experience anxiety, depression, suicidal thinking, and angry outbursts than the reference group (i.e., no ACEs and no warfare exposure). Female veterans exposed to one or two ACEs, but no warfare, were only more likely to experience suicidal thinking. Male and female veterans exposed to three or more ACEs and no warfare were more likely to experience probable posttraumatic stress disorder (PTSD), anxiety, depression, suicidality, and angry outbursts. Among those veterans who experienced corollaries of combat only (e.g., seeing someone killed or seriously wounded), male, but not female veterans were more likely to have probable PTSD, anxiety, and depression. Veterans exposed to warfare (i.e., combat and the corollaries of combat), irrespective of ACEs exposure, were the most likely to report mental health symptoms. Implications for community‐based mental health services are discussed.

Publication Link:
Learn More

The Impact of Adverse Childhood Experiences (ACEs) and Combat Exposure on Mental Health Conditions Among New Post-9/11 Veterans

Publication Journal:
Psychological Trauma: Theory, Research, Practice, and Policy
Publication Year:
2020
Author(s):
Keith R. Aronson, Daniel F. Perkins, Nicole R. Morgan, Julia A. Bleser, Dawne Vogt, Laurel A. Copeland, Erin P. Finley, & Cynthia l. Gilman
Summary or Abstract:

Adverse childhood experiences (ACEs) are early life experiences of abuse and neglect, and observed violence, among others. For military veterans, both ACEs and combat exposure are associated with mental health problems. Method: This study examines the relationship between ACEs and combat exposure on the current mental health in a large sample of recent post-9/11 U.S. veterans. Results: Fifty-nine percent of female and 39% of male veterans reported exposure to 1 ACE, whereas 44% of female and 25% of male veterans were exposed to multiple ACEs. Female veterans were more likely to experience 4 or more ACEs. ACEs were more consistently associated with mental health problems for male veterans than their female peers. For female veterans, exposure to 1 or 2 ACEs did not increase the odds of having any mental health condition, whereas for males, this level of exposure was associated with probable PTSD and anxiety. Combat patrol events were associated with an increase in the likelihood of having a probable mental health problem, with 2 exceptions—combat patrol events were not associated with depression in male veterans and not associated with alcohol misuse in female veterans. Combat was not associated with alcohol misuse. Experiencing a corollary of combat (e.g., accidents, moral injury) was inconsistently associated with the odds of having a probable mental health problem. Conclusions: This study confirms prior studies demonstrating a relationship between ACEs and combat on subsequent mental health problems. Importantly, 2 different types of combat exposure had differential effects on mental health problems. Adverse childhood experiences (ACEs) are early life experiences of abuse and neglect, and observed violence, among others. For military veterans, both ACEs and combat exposure are associated with mental health problems. Method: This study examines the relationship between ACEs and combat exposure on the current mental health in a large sample of recent post-9/11 U.S. veterans. Results: Fifty-nine percent of female and 39% of male veterans reported exposure to 1 ACE, whereas 44% of female and 25% of male veterans were exposed to multiple ACEs. Female veterans were more likely to experience 4 or more ACEs. ACEs were more consistently associated with mental health problems for male veterans than their female peers. For female veterans, exposure to 1 or 2 ACEs did not increase the odds of having any mental health condition, whereas for males, this level of exposure was associated with probable PTSD and anxiety. Combat patrol events were associated with an increase in the likelihood of having a probable mental health problem, with 2 exceptions—combat patrol events were not associated with depression in male veterans and not associated with alcohol misuse in female veterans. Combat was not associated with alcohol misuse. Experiencing a corollary of combat (e.g., accidents, moral injury) was inconsistently associated with the odds of having a probable mental health problem. Conclusions: This study confirms prior studies demonstrating a relationship between ACEs and combat on subsequent mental health problems. Importantly, 2 different types of combat exposure had differential effects on mental health problems.

Publication Link:
Learn More

Use of Health Services Among Post-9/11 Veterans With Mental Health Conditions Within 90 Days of Separation From the Military

Publication Journal:
Psychiatric Services
Publication Year:
2020
Author(s):
Keith R. Aronson, Daniel F. Perkins, Nicole R. Morgan, Julia A. Bleser, Dawne Vogt, Laurel A. Copeland, & Erin P. Finley
Summary or Abstract:

The Veterans Metrics Initiative is a longitudinal survey study examining the military-to-civilian transition of a cohort of new post-9/11 veterans. This study identified the programs and services used by new post-9/11 veterans who screened positive for mental health problems (N=3,295) and factors that predicted use. The population of veterans who separated from active duty service in the 90 days prior to August–November 2016 (N=48,965) was identified and invited to participate in the study. This study reports results from the first wave of data collected. Complete data were provided by 9,566 veterans. Of these, 34% (N=3,295) screened positive for one or more probable mental health problems. A substantial majority of these veterans also reported having a general medical problem. Results revealed that veterans from junior enlisted ranks were significantly less likely than those from higher ranks to use programs and services. Use of programs and services by male and female veterans was similar. Several racial-ethnic differences also emerged. There was some evidence that veterans may under recognize their own mental health problems. Veterans who were exposed to combat, had a medical discharge, or reported an ongoing general medical condition were all significantly more likely to report using U.S. Department of Veterans Affairs (VA) health care services. These findings suggest that veterans, particularly those from the junior enlisted ranks—who are most at risk for poor transitions—should be encouraged to use programs and services provided by both the VA and non-VA health care alternatives.

Publication Link:
Learn More

Moral Injury and Social Well-Being: A Growth Curve Analysis

Publication Journal:
Journal of Traumatic Stress
Publication Year:
2020
Author(s):
Ryan P. Chesnut, Cameron B. Richardson, Nicole R. Morgan, Julia A. Bleser, Daniel F. Perkins, Dawne Vogt, Laurel A. Copeland, & Erin Finley
Summary or Abstract:

Moral injury (MI) may occur in the context of committing transgressions (i.e., self‐directed MI reactions), witnessing transgressions, or being the victims of others’ transgressions (i.e., other‐directed MI reactions) that violate an individual’s moral principles. Veterans with MI may experience impaired social well‐being (SWB). Studies on MI and veterans’ SWB have focused almost exclusively on social support and used cross‐sectional data. The present study used growth curve analyses to examine the associations between self‐ and other‐directed MI reactions and veterans’ levels of social support, social functioning, social activities, and social satisfaction over the first 18 to 21 months of their transition to civilian life (N = 9,566). The results demonstrated declines in all SWB outcomes, with self‐ and other‐directed MI reactions having differential effects. Higher versus lower levels of other‐directed MI reactions were related to lower baseline scores on all SWB outcomes, βs = −.06 to −.20, and steeper declines over time in social functioning, β = −.09, and social satisfaction, β = −.10. Higher versus lower levels of self‐directed MI reactions were related to lower baseline levels of social functioning, β = −.07, but higher baseline levels of social activity, β = .04. Higher versus lower levels of self‐directed MI reactions were related to a steeper decline in social activity over time, β = −.10. These findings present a more nuanced picture than that depicted by current MI theoretical frameworks and support further research to uncover moderators of the associations between self‐ and other‐directed MI reactions and SWB outcomes.

Publication Link:
Learn More

Reducing Barriers to Post-9/11 Veterans’ Use of Programs and Services as They Transition to Civilian Life

Publication Journal:
BMC Health Services Research
Publication Year:
2020
Author(s):
Nicole R. Morgan, Keith R. Aronson, Daniel F. Perkins, Julia A. Bleser, Katie Davenport, Dawne Vogt, Laurel A. Copeland, Erin P. Finley, & Cynthia L. Gilman
Summary or Abstract:

This study identified barrier reduction strategies offered by programs that new post-9/11 veterans reported using, determined which strategies veterans use and value, and examined veteran characteristics that impact their odds of using programs that offer barrier reduction strategies. This study reflects findings from the first wave of data collection of The Veterans Metrics Initiative (TVMI), a longitudinal study examining the military-to-civilian reintegration of new post-9/11 veterans. The websites of programs used by respondents were coded for barrier reduction components. Veterans also indicated which barrier reduction components they found most helpful in meeting their reintegration goals. Of 9566 veterans who participated in Wave 1 data collection, 84% reported using a program that offered at least one barrier reduction component. Barrier reduction components included tangible supports (e.g., scholarships, cash), increased access to programs, decreased stigma, and encouraged motivation to change. Although only 4% of programs that were used by veterans focused on helping them obtain Veterans Administration benefits, nearly 60% of veterans reported that this component was helpful in reaching their goals. Access assistance to other resources and supports was also reported as a helpful barrier reduction component. For instance, approximately 20% of veterans nominated programs that offered transportation. The study also found evidence of a misalignment between the kinds of barrier reduction components veterans valued and those which programs offered. Veterans from the most junior enlisted ranks, who are at most risk, were less likely than those from other ranks to use barrier reduction components. Despite the evidence that barrier reduction components enhance access to programs and contribute to program sustainability, many programs used by post-9/11 veterans do not offer them. There was also a misalignment between the barrier reduction strategies that veterans value and the strategies offered by programs. Veteran serving organizations should increasingly implement barrier reduction strategies valued by veterans.

Publication Link:
Learn More

Going It Alone: Post-9/11 Veteran Nonuse of Healthcare and Social Service Programs During Their Early Transition to Civilian Life

Publication Journal:
Journal of Social Service Research
Publication Year:
2019
Author(s):
Keith R. Aronson, Daniel F. Perkins, Nicole Morgan, Julia Bleser, Katie Davenport, Dawne Vogt, Laurel A. Copeland, Erin P. Finley, & Cynthia L. Gilman
Summary or Abstract:

Transitioning from military to civilian life is challenging for a substantial number of veterans. Successful transitions require veterans to function well in various well-being domains including employment, education, financial, health, and social relationships. There are many programs and services designed to assist veterans transition to civilian life. However, veterans rarely avail themselves of supportive resources. This study examined veteran nonuse of programs and services within the first three months of their transition to civilian life. Results revealed that male veterans often reported that they did not need programs. Female veterans and veterans from the lowest enlisted ranks were more likely to report that they did not know if they were eligible for support programs. A small percentage of veterans indicated they had not found the right program or did not know where to go to get help. Veterans need clear information about available programs, eligibility requirements, where to locate them, and how to identify which programs will benefit them. Future research should focus on what predicts veteran use of programs and services, how use changes over time, and how programs and services should be advertised/marketed to different veteran populations, particularly those at risk for poor transition outcomes.

Publication Link:
Learn More

Post-9/11 Veteran Transitions to Civilian Life: Predictors of the Use of Employment Programs

Publication Journal:
Journal of Veterans Studies
Publication Year:
2019
Author(s):
Keith R. Aronson, Daniel F. Perkins, Nicole R. Morgan, Julia A. Bleser, Dawne Vogt, Laurel Copeland, Erin Finley, & Cynthia Gilman
Summary or Abstract:

Post-9/11 veterans indicate that obtaining employment is both a priority and a challenge. Numerous federal, state, community, foundation-funded and corporate programs have been created to assist veterans; however, there is little empirical evidence to know what programming is effective and for whom. This study examined predictors of employment program use among new post-9/11 veterans. Male veterans were less likely to utilize online job databases and resume writing assistance than female veterans. Veterans from the junior enlisted paygrades (E1 to E4) were less likely to use online job databases, career fairs, resume writing assistance, job placement, career counseling, and training or certification programs than more senior enlisted paygrades or officers. Veterans from racial or ethnic minority groups (e.g., Black non-Hispanic, Asian) were more likely to utilize a variety of employment programs than their White non-Hispanic peers. Veterans who were exposed to warfare and those with a current physical health condition were more likely to use employment programs. Moreover, veterans with an ongoing mental health problem were no more likely to use any employment programs than veterans without such problems. To increase the use of employment programs, accessibility and targeted engagement strategies should be developed for veterans of different backgrounds and circumstances. Future directions for the longitudinal analysis of veteran’s utilization of employment programs and their effectiveness in obtaining employment are discussed.

Publication Link:
Learn More

Veterans’ Use of Programs and Services as They Transition to Civilian Life: Baseline Assessment for the Veteran Metrics Initiative

Publication Journal:
Journal of Social Service Research
Publication Year:
2019
Author(s):
Daniel F. Perkins, Keith R. Aronson, Nicole R. Morgan, Julia A. Bleser, Dawne Vogt, Laurel A. Copeland, Erin P. Finley, & Cynthia Gilman
Summary or Abstract:

A substantial minority of veterans struggle as they reintegrate into civilian life, reporting problems with vocational attainment, legal/financial/housing challenges, physical and mental health conditions, and social/interpersonal issues. While there are thousands of programs and services offered to veterans, little is known about which ones they use. In the current exploratory study, veterans separated from active duty in the prior three-months (48,965) were invited to complete a survey. Two primary questions were addressed: What programs/ services did veterans use to assist in their reintegration to civilian life? What specific components/ attributes of those programs did veterans report using? A total of 9566 veterans completed the survey. Approximately, two-thirds of veterans used at least one program to enhance their well-being, while one-third reported using multiple programs across multiple domains. Veterans primarily sought assistance for employment and educational advancement. Fewer veterans sought assistance for legal/financial/housing, health, and social functioning challenges. Social service providers and policy makers should be aware of the resources veterans use as they reintegrate into civilian life. Future research should examine factors that predict the use and nonuse of veteran reintegration programs, how use changes over time, and what factors predict program/service use, particularly among veterans at risk for poor transition outcomes.

Publication Link:
Learn More

A Novel Approach for Evaluating Programs Designed to Serve Military Veterans: Using an Adapted Common Components Analysis

Publication Journal:
Evaluation and Program Planning
Publication Year:
2019
Author(s):
Cameron B. Richardson, Nicole R. Morgan, Julia A. Bleser, Keith R. Aronson, & Daniel F. Perkins
Summary or Abstract:

Evaluators are challenged to keep pace with the vast array of Veteran support programs operating in the United States, resulting in a situation in which many programs lack any evidence of impact. Due to this lack of evidence, there is no efficient way to suggest which programs are most effective in helping Veterans in need of support. One potential solution to this dilemma is to reconceptualize program evaluation, by moving away from evaluating programs individually to evaluating what is common across programs. The Common Components Analysis (CCA) is one such technique that aggregates findings from programs that have undergone rigorous evaluation at the level of program components (e.g., content, process, barrier reduction). Given that many Veteran programs lack outcome evidence from rigorous studies, an adaptation to CCA is needed. This report examines cross-sectional data from a pilot study using an adapted CCA across five domains of well-being (i.e., employment, education, legal/financial/housing, mental/physical health, and social/personal relationships). The purpose of this preliminary study is to determine the feasibility of eliciting program nominations and program components from Veterans via an online survey. When coupled with a longitudinal research design, this adaptation to CCA will allow for stronger causal claims about the expected impact of different program components within and across a variety of domains.

Publication Link:
Learn More

Examining the Factor Structure of the Moral Injury Events Scale in a Veteran Sample

Publication Journal:
Military Medicine
Publication Year:
2019
Author(s):
Cameron B. Richardson, Ryan P. Chesnut, Nicole R. Morgan, Julia A. Bleser, Daniel F. Perkins, Dawne Vogt, Laurel A. Copeland, & Erin Finley
Summary or Abstract:

Interest in moral injury has burgeoned over the last decade as an increasing number of professionals recognize that current conceptualizations of trauma are not sufficient to explain some of the challenges that military service members face. The Moral Injury Events Scale (MIES) was the first instrument developed to measure exposure to military events that could produce moral injury (Nash et al., 2013). With an interest in further scale validation, the present study utilized survey data from a group of veterans recently separated from service, to test the fitness of the two- or three-factor model and to examine the invariance of the scale across gender and branch. Findings revealed a two-factor structure that differed from previous factor solutions (transgressions-self and transgressions-others) and was invariant across gender and branch. High intercorrelations among the MIES items that addressed exposure and reaction to events suggested that these experiences tend to co-occur. Removal of the event items did not significantly impact model fit. The factor structure identified in the present study aligns with current theoretical conceptualizations of moral injury. The inability to distinguish between event and reaction items and the lack of impact on the factor structure when event items were removed from the model suggest the MIES is more accurately described as a measure of moral pain as compared to a measure of potentially morally injurious experiences (PMIEs). Given that all events associated with moral injury have impinged upon welfare, justice, rights, and fairness considerations, one could argue that little would be gained by focusing attention on the development of a measure of PMIEs. Given the lack of convergence in factor structure across samples, future directions may profit from a focus on further clarifying the temporal stability of the MIES factor structure.

Publication Link:
Learn More

Common Components Analysis: An Adapted Approach for Evaluating Programs

Publication Journal:
Evaluation and Program Planning
Publication Year:
2018
Author(s):
Nicole R. Morgan, Kelly D. Davis, Cameron Richardson, & Daniel F. Perkins
Summary or Abstract:

Common Components Analysis (CCA) summarizes the results of program evaluations that utilize randomized control trials and have demonstrated effectiveness in improving their intended outcome(s) into their key elements. This area of research has integrated and modified the existing CCA approach to provide a means of evaluating components of programs without a solid evidence-base, across a variety of target outcomes. This adapted CCA approach (a) captures a variety of similar program characteristics to increase the quality of the comparison within components; (b) identifies components from four primary areas (i.e., content, process, barrier reduction, and sustainability) within specific programming domains (e.g., vocation, social); and (c) proposes future directions to test the extent to which the common components are associated with changes in intended program outcomes (e.g., employment, job retention). The purpose of this paper is to discuss the feasibility of this adapted CCA approach. To illustrate the utility of this technique, researchers used CCA with two popular employment programs that target successful Veteran reintegration but have limited program evaluation – Hire Heroes USA and Hire Our Heroes. This adapted CCA could be applied to longitudinal research designs to identify all utilized programs and the most promising components of these programs as they relate to changes in outcomes.

Publication Link:
Learn More

Partner Publications

Identifying Factors That Contribute to Military Veterans’ Post-Military Well-Being

Publication Journal:
Applied Psychology: Health and Well-Being
Publication Year:
2021
Author(s):
Dawne Vogt, Matthew W. King, Shelby Borowski, Erin P. Finley, Daniel F. Perkins, & Laurel A. Copeland
Summary or Abstract:

Prior research has examined the independent effects of demographic and military characteristics, trauma history, and coping resources on military veterans’ health. However, there is limited knowledge of how these factors intersect with one another and with veterans’ health to impact their broader well-being as they readjust to civilian life. Data for this study were drawn from a longitudinal investigation of the health and broader well-being of U.S. veterans (N = 7150) who had recently left military service. Machine learning analyses (random forests of regression trees) were used to examine how factors assessed shortly after military separation were associated with veterans’ well-being approximately a year later. Veterans who endorsed the combination of low depression, high social support, and high psychological resilience were most likely to report high well-being a year later. Neither demographic and military characteristics nor trauma history emerged as strong predictors of veterans’ well-being when considered in the context of other factors. Although most predictors were similar for women and men, depression was a stronger predictor of women’s well-being. Results highlight the importance of screening for and intervening with veterans who report high depression, low social support, and low psychological resilience when leaving military service. These findings can inform efforts to promote veterans’ post-military well-being.

Publication Link:
Learn More

The Impact of Discriminatory Stress in Changes in Posttraumatic Stress Severity at the Intersection of Race/Ethnicity and Gender

Publication Journal:
Journal of Trauma & Dissociation
Publication Year:
2021
Author(s):
Juliette McClendon, Nancy Kressin, Daniel F. Perkins, Laurel A. Copeland, Erin P. Finley, & Dawne Vogt
Summary or Abstract:

Given the diversity of military veterans and growing evidence of ethnoracial disparities in posttraumatic stress disorder (PTSD) within this population, elucidating the role of discrimination-related stress in contributing to these disparities is crucial. We examined the relative impact of discriminatory stress (i.e., due to race/ethnicity, religion, nationality, gender, sexual orientation, or physical appearance) on 6-month changes in PTSD symptom severity among trauma-exposed White (74%), Black (11%) and Hispanic/Latino/a/x (15%) veterans (17% female). PTSD symptoms were measured with the 8-item PTSD Checklist for DSM-5. A measure of the extent to which discrimination has caused stress for the respondent assessed discriminatory stress. Hierarchical regression analyses examined interactions among race/ethnicity, gender and discriminatory stress in predicting six-month changes in PTSD severity. Black and Hispanic/Latino/a/x veterans reported higher baseline PTSD severity and discriminatory stress than White veterans, with some variation by gender. Three-way interactions of race/ethnicity by discriminatory stress by gender were significant, controlling for income, education and age. The relationship between discriminatory stress and increases in PTSD severity was significantly stronger for Black women compared with Black men and did not differ between White men and women. There was also a stronger relationship between discriminatory stress and increases in PTSD severity for Hispanic/Latino/x men as compared to Black men. These findings suggest that discriminatory stress impacts PTSD severity differentially for various ethnoracial/gender groups and highlight the value of applying an intersectional framework that accounts for the synergistic connections among multiple identities to future screening, intervention, and research efforts.

Publication Link:
Learn More

Exploring Moral Injury: Theory, Measurement, and Applications

Publication Journal:
Military Behavioral Health
Publication Year:
2020
Author(s):
Hazel R. Atuel, Ryan Chesnut, Cameron Richardson, Daniel F. Perkins & Carl A. Castro
Summary or Abstract:

This research brief summarizes and highlights presentations on moral injury related to theory, measurement, and applications. The overall aim was to identify current gaps and propose next steps to advance the science of moral injury.

Publication Link:
Learn More

Gender Differences in Newly Separated Veterans’ Use of Healthcare

Publication Journal:
American Journal of Managed Care
Publication Year:
2020
Author(s):
Laurel A. Copeland, Erin P. Finley, Dawne Vogt, Daniel F. Perkins, & Yael I. Nillni
Summary or Abstract:

The Veterans Health Administration is adapting to a new model of care in the wake of the Veterans Choice Act of 2014. A longitudinal study, The Veterans Metrics Initiative (TVMI), captured multiple domains of psychosocial health and healthcare use as veterans moved through the first 15 months of transition from military to civilian life. This study examined gender differences and clinical, social and lifestyle correlates in healthcare use. The multi-wave web-based survey collected self-reported measures from a national sample of newly separated military veterans. Multivariable analysis weighted to represent the sampling frame and account for attrition at follow-up examined the association between gender and self-reported healthcare utilization overall and in the Veterans Health Administration (VA). In fall 2016, veterans within approximately 90 days post-military separation provided baseline data and completed a follow-up survey a year later, representing a cohort of 49,865. Sleep problems, anxiety, and depression were associated with healthcare use for both men and women following transition. Women were twice as likely as men to use healthcare in general but equally likely to use VA care. For women veterans, unstable housing at separation was associated with less healthcare use a year later, especially for the subgroup with mental/behavioral health issues. U.S. veterans separating from military service need expert care for anxiety, depression, and sleep disturbance both in the VA and elsewhere. Women veterans may be underserved by the VA and may benefit from housing assistance programs to enable ongoing healthcare use.

Publication Link:
Learn More

Gender Differences in Prevalence and Outcomes of Exposure to Potentially Morally Injurious Events Among Post-9/11 Veterans

Publication Journal:
Journal of Psychiatric Research
Publication Year:
2020
Author(s):
Shira Maguen, Brandon J. Griffin, Laurel A. Copeland, Daniel F. Perkins, Erin P. Finley, & Dawne Vogt
Summary or Abstract:

Our goal was to identify gender differences in the prevalence and outcomes of exposure to potentially morally injurious events (PMIEs) in a sample of U.S. military veterans. In a national sample of post-9/11 veterans (n = 7200) weighted to reflect the larger population of newly separated U.S. veterans, we conducted gender-stratified analyses of the prevalence of exposure to PMIEs and their associations with psychological and functional problems. Veterans reported exposures stemming from witnessing (27.9%), perpetrating (18.8%), and being betrayed (41.1%). Women more frequently reported witnessing- and betrayal-based PMIEs, but no gender differences were observed for perpetration-based PMIEs. Psychological distress was associated with witnessing and betrayal among women and with witnessing, betrayal, and perpetration among men. Whereas betrayal was most consistently associated with functional impairment across domains for women, perpetration was most consistently associated with functional impairment for men. Moral injury contributes to psychological and functional problems among a significant minority of military veterans, although effects vary based on PMIE type and gender. Implications for veterans and other populations who experience moral injury are discussed.

Publication Link:
Learn More

The Impact of Posttraumatic Stress Disorder and Moral Injury on Women Veterans’ Perinatal Outcomes Following Separation From Military Service

Publication Journal:
Journal of Traumatic Stress
Publication Year:
2020
Author(s):
Yael I. Nillni, Danielle R. Shayani, Erin Finley, Laurel A. Copeland, Daniel F. Perkins, & Dawne S. Vogt
Summary or Abstract:

Posttraumatic stress disorder (PTSD) has been found to lead to several adverse perinatal outcomes in the general population. Preliminary research has found that women veterans with PTSD have an increased prevalence of preterm birth, gestational diabetes, and preeclampsia. Less research has examined the role of moral injury (MI) in perinatal outcomes. This longitudinal survey study examined the impact of PTSD symptoms and MI on prospectively assessed adverse perinatal outcomes among women who became pregnant in the first 3 years after separating from U.S. military service (N = 318). The Moral Injury Events Scale was used to assess the degree to which individuals experienced distress related to transgressions of deeply held moral beliefs, and the Primary Care PTSD Screen for DSM‐5 (PC‐PTSD) was used to assess PTSD symptoms. Perinatal outcomes included experiencing an adverse pregnancy outcome (e.g., preterm birth, gestational diabetes), postpartum depression and/or anxiety, and perceived difficult pregnancy. Although both PTSD symptoms, adjusted odds ratio (aOR) = 1.16, 95% CI [1.00, 1.35]; and MI, aOR = 1.27, 95% CI [1.06, 1.41], emerged as significant predictors of adverse pregnancy outcomes, only PTSD symptoms were a significant predictor of postpartum depression and/or anxiety, aOR = 1.43, 95% CI [1.22, 1.68], and perception of a difficult pregnancy, β = .31, when controlling for lifetime trauma exposure, age, socioeconomic status, and ethnic/racial minority status. The results indicate that both PTSD symptoms and MI are associated with adverse perinatal outcomes, supporting the potential need to screen for both PTSD and MI during the perinatal period.

Publication Link:
Learn More

U.S. Military Veterans’ Health and Well-Being in the First Year After Service

Publication Journal:
American Journal of Preventative Medicine
Publication Year:
2020
Author(s):
Dawne S. Vogt, Fanita A. Tyrell, Emily A. Bramande, Yael I. Nillni, Emily C. Taverna, Erin P. Finley, Daniel F. Perkins, & Laurel A. Copeland
Summary or Abstract:

This study examined the health and well-being of U.S. veterans during the first year after military service and tested several hypotheses regarding differences in veterans’ well-being over time, across life domains, and based on sex, military rank, and deployment history. A national sample of 9,566 veterans was recruited from a roster of all separating U.S. service members in the fall of 2016. Veterans’ status, functioning, and satisfaction with regard to their health, work, and social relationships were assessed within 3 months of separation and then 6 months later. Analyses were completed in 2019. Health concerns were most salient for newly separated veterans, with many veterans reporting that they had chronic physical (53%) or mental (33%) health conditions and were less satisfied with their health than either their work or social relationships. By contrast, most veterans reported relatively high vocational and social well-being and only work functioning demonstrated a notable decline in the first year following separation. Enlisted personnel reported consistently poorer health, vocational, and social outcomes compared with their officer counterparts, whereas war zone–deployed veterans reported more health concerns and women endorsed more mental health concerns compared with their nondeployed and male peers. Although most newly separated veterans experience high vocational and social well-being as they reintegrate into civilian life, findings point to the need for additional attention to the health of separating service members and bolstered support for enlisted personnel to prevent the development of chronic readjustment challenges within this population.

Publication Link:
Learn More

Trajectories of Functioning in a Population-Based Sample of Veterans: Contributions of Moral Injury, PTSD, and Depression

Publication Journal:
Psychological Medicine
Publication Year:
2020
Author(s):
Shira Maguen, Brandon J. Griffin, Laurel A. Copeland, Daniel F. Perkins, Cameron B. Richardson, Erin P. Finley, & Dawne Vogt
Summary or Abstract:

A population-based sample of post-9/11 veterans completed measures of intimate relationship, health, and work functioning at approximately 9, 15, 21, and 27 months after leaving service. Moral injury, posttraumatic stress, and depression were assessed at ~9 months post-separation. Latent Growth Mixture Models were used to identify discrete classes characterized by unique trajectories of change in functioning over time and to examine predictors of class membership. Veterans were assigned to one of four functioning trajectories: high and stable, high and decreasing, moderate and increasing, and moderate and stable. Whereas posttraumatic stress, depression, and moral injury associated with perpetration and betrayal predicted worse outcomes at baseline across multiple functioning domains, moral injury associated with perpetration and depression most reliably predicted assignment to trajectories characterized by relatively poor or declining functioning. Moral injury contributes to functional problems beyond what is explained by posttraumatic stress and depression, and moral injury due to perpetration and depression most reliably predicted assignment to trajectories characterized by functional impairment over time.

Publication Link:
Learn More

Patterns and Correlates of Racial/Ethnic Disparities in Posttraumatic Stress Disorder Screening Among Recently Separated Veterans

Publication Journal:
Journal of Anxiety Disorders
Publication Year:
2019
Author(s):
Juliette McClendon, Daniel Perkins, Laurel A. Copeland, Erin P. Finley, & Dawne Vogt
Summary or Abstract:

This study describes patterns and correlates of PTSD screening across race/ethnicity and gender in a sample of 9420 veterans recently separated from the military. Veterans who identified as White (n=6222), Hispanic/Latinx (n=1313), Black (n=1027), Asian/Hawaiian/Pacific Islander (n=420) and multiracial (n=438) were included. Trauma exposure and PTSD were assessed with the Primary Care PTSD Screen for DSM-5. Contextual factors examined included the intensity of ongoing stressful events, perceived social support, and sociodemographic variables (e.g., income). Weighted analyses were conducted to account for differential sample response rates. Regression analyses examining correlates of racial/ethnic differences in PTSD screening were stratified by gender. Among men and women, positive PTSD screening rates were significantly elevated among Black, multiracial, and Hispanic/Latinx veterans compared with White veterans. Sociodemographics, trauma exposure, stress and social support accounted for elevated positive screening rates among all racial/ethnic groups except Black men and multiracial women. Findings suggest that Black, Hispanic/Latinx and multiracial veterans may be at higher risk for PTSD shortly following separation from the military. Contextual factors examined explain the excess risk among some, but not all, subgroups. Further specifying disparities in PTSD diagnostic rates and risk factors will enable targeted and tailored intervention among veteran subgroups.

Publication Link:
Learn More

Development and Validation of a Tool to Assess Military Veterans’ Status, Functioning, and Satisfaction with Key Aspects of their Lives

Publication Journal:
Applied Psychology: Health and Well-Being
Publication Year:
2019
Author(s):
Dawne Vogt, Yael I. Nillni, Emily C. Taverna, Fanita A Tyrell, Bradford Booth, Daniel F. Perkins, Laurel A. Copeland, Erin P. Finley, & Cynthia L. Gilman
Summary or Abstract:

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

Publication Link:
Learn More

The Veterans Metrics Initiative Study of US Veterans’ Experiences During Their Transition from Military Service

Publication Journal:
BMJ Open
Publication Year:
2018
Author(s):
Dawne Vogt, Daniel F. Perkins, Laurel A. Copeland, Erin P. Finley, Christopher S. Jamieson, Bradford Booth, Suzanne Lederer, & Cynthia L Gilman
Summary or Abstract:

Efforts to promote the health and well-being of military veterans have been criticized for being inadequately informed of veterans’ most pressing needs as they separate from military service, as well as the programs that are most likely to meet these needs. This article summarizes limitations of the current literature and introduces The Veterans Metrics Initiative (TVMI) study, a longitudinal assessment of US veterans’ well-being and programme use in the first three years after they separate from military service. Veterans were assessed within 3 months of military separation and will complete five additional assessments at 6-month intervals during the subsequent period. The TVMI study cohort consists of a national sample of 9566 newly separated US veterans that were recruited in the fall of 2016. The TVMI sample includes representation from all branches of service, men and women, and officers and enlisted personnel. Although representative of the larger population on many characteristics, differential response rates were observed for some subgroups, necessitating the development of non-response bias weights.

Publication Link:
Learn More

Other Relevant Clearinghouse Publications

Treating PTSD in Active Duty Service Members Using Cognitive Processing Therapy or Prolonged Exposure Therapy: Examining Everyday Practice at a Military Outpatient Clinic

Publication Journal:
Military Psychology
Publication Year:
2018
Author(s):
Keith R. Aronson, Janet A. Welsh, Anna Fedotova, Nicole R. Morgan, Daniel F. Perkins, & Wendy Travis
Summary or Abstract:

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

Publication Link:
Learn More

Spouse and Family Functioning Before and After a Marine’s Suicide: Comparisons to Deaths by Accident and in Combat

Publication Journal:
Military Psychology
Publication Year:
2017
Author(s):
Keith R. Aronson, Sandee J. Kyler, Nicole R. Morgan, Daniel F. Perkins, & Linda Love
Summary or Abstract:

The impact of service member suicides on families is not well understood. Civilian studies have demonstrated that family survivors of suicide deaths experience complicated grief, feel guilt and shame, and often do not receive sufficient social support. In this exploratory study, spouse survivors of Marines who died by suicide (N = 17), accident (N = 19), and in combat (N = 34) retrospectively reported on their immediate pre-and postmortem and current personal and family functioning. Nonparametric analyses revealed that several between-group differences existed. Observation of the means suggested that the spouses and families of Marines who died by suicide exhibited significantly poorer pre-and postmortem functioning compared with those whose spouses died in combat. Specific challenges included low family cohesion, high family conflict, perceived stigma, and shame. There were no differences in current spouse or family functioning, and there was weak evidence for posttraumatic growth among surviving spouses of those dying by suicide.

Publication Link:
Learn More