Research Articles

Steven L. Lancaster, Sara Kintzle and Carl A. Castro

January 2018 | Identity: An International Journal of Theory and Research

ABSTRACT

The present study examined the psychometric properties of a measure of military identity in a sample of U.S. military members. Confirmatory factor analysis provided additional support for the multidimensional nature of military identity. Correlational analyses indicated that the domains of military identity were strongly related to postdeployment adjustment as well as other indicators of psychosocial health. Of importance, the relationships between the subscales of identity and the outcome variables differed in strength and direction depending on the form of identity, which supports a multidimensional structure of military identity. Additional research is necessary to identify the most salient domains of identity as well as the clinical and theoretical implications of identity in the functioning of veterans.

Ashley C. Schuyler, Sara Kintzle, Carrie Lucas, Hadass Moore and Carl A. Castro

October 2016 | Traumatology

ABSTRACT

This study describes the relationship between military sexual assault (MSA) and various health and behavioral outcomes among a community-based sample of male (n  2,208) and female (n  327) veterans. Logistic regression analyses were conducted to assess the relationship of MSA with physical health symptoms (PHQ-15), probable posttraumatic stress disorder (PTSD; PCL) and depression (PHQ-9), risk-taking behaviors, and alcohol use (AUDIT-C) among men and women. Among the sample, 4.8% of male and 40.6% of female veterans reported experiencing MSA. Men who experienced MSA had approximately 4 times the odds of physical health symptoms, and probable PTSD and depression, compared with those without MSA (p  .001 for all). Male veterans also had significantly increased odds of taking unnecessary health risks (p  .001), risking a sexually transmitted disease (STD; p  .005), driving while intoxicated (p  .022), taking unnecessary life risks (p  .001), and using tobacco (p .012) in the last year if they had experienced MSA. Women who experienced MSA had approximately double the odds of physical health symptoms (p  .002), 3 times the odds of depressive symptoms (p .001), and almost 7 times the odds of probable PTSD (p  .001). Female veterans with MSA also had significantly greater odds of taking unnecessary health risks (p  .003), taking unnecessary life risks (p .001), and using tobacco (p  .003) in the last year than those without MSA. These findings highlight the unique treatment needs of male and female victims of MSA, the potential long-term impact of MSA, and the need for timely assessment of MSA to help mitigate negative health outcomes among veterans.

Jeremy T. Goldbach and Carl Andrew Castro

April 2016 | Current Psychiatry Report

ABSTRACT

Lesbian, gay, and bisexual service members can serve openly in the military with the repeal of the Don’t Ask, Don’t Tell policy. The fate of transgender service members remains uncertain as the policy preventing them from serving in the military remains under review. The health care needs of these populations remain for the most part unknown, with total acceptance and integration in the military yet to be achieved. In this paper, we review the literature on the health care needs of lesbian, gay, bisexual, and transgender (LGBT) service members, relying heavily on what is known about LGBT civilian and veteran populations. Significant research gaps about the health care needs of LGBT service members are identified, along with recommendations for closing those gaps. In addition, recommendations for improving LGBT acceptance and integration within the military are provided.

Kathrine Sullivan, Nicholas Barr, Sara Kintzle, Tamika Gilreath and Carl A. Castro

February 2016 | Marriage & Family Review

ABSTRACT

This study examines the association between veterans’ physical and mental health symptoms and perceptions of adverse child and relationship functioning. Veteran responses to the PHQ-15, assessing physical health; the PCL-C, assessing PTSD symptoms; and reports of family challenges were drawn from a countywide veterans survey. Findings indicate physical health (OR ¼ 1.048; 95% CI, 1.002, 1.098) and post-traumatic stress disorder (PTSD) symptomatology (OR ¼ 1.019; 95% CI, 1.004, 1.034) independently predicted increased child diffi- culties. Similarly, physical health (OR ¼ 1.081; 95% CI, 1.012, 1.154) and PTSD symptoms (OR ¼ 1.043; 95% CI, 1.022, 1.065) independently impacted relationship difficulties. Using stan- dardized coefficients to compare,
PTSD symptoms were a stronger predictor across both models. Results highlight the dual importance of assessing both veterans’ physical and mental health symptoms to understand family functioning. Additionally, these findings underscore the importance of longitudinal research, which can follow families beyond separation from the military.

Nicholas Upton Barr, Kathrine Sullivan, Sara Kintzle and Carl A. Castro

January 2016 | Social Work in Mental Health

ABSTRACT

This study investigated relationships between symptom clusters of posttraumatic stress disorder (PTSD), suicidal ideation, suicide plan, and non-suicidal risk to life behavior (NSRB) behavior in a sample of 1,356 pre- and post-9/11-era military veterans. After controlling for a positive PTSD screen, results indicated that suicidal ideation was significantly associated with re-experiencing symptoms (OR = 1.12), White race (OR = 1.82) and use of pain medication (COR = 1.62). Suicide plan was associated with avoidance symptoms (OR = 1.08), and NSRB with hyperarousal symptoms (OR = 1.11) and severe alcohol use (OR = 2.10). Standardized coefficients indicated that re-experiencing symptoms (b = .38) were a stronger predictor of suicidal ideation than White race (b = .16) or pain medication (b = .12) and that hyperarousal symptoms (b = .36) were a stronger predictor of NSRB than severe alcohol use (b = .15). The interpersonal–psychological theory of suicide was used to frame a discussion of military specific suicide risk as well as the risk of premature death among veterans who endorse NSRB but not suicidality. We suggest that this subset of veterans may be overlooked by traditional screening methods while nonetheless presenting with great risk for premature death.

Carl A. Castro, Sara Kintzle and Anthony M. Hassan

December 2015 | Traumatology

ABSTRACT

The combat veteran paradox proposes that most changes individuals experience resulting from combat exposure are normal, and not indicative of a mental health disorder. Yet, because of the number and complexities of these changes, the combat veteran paradox states that combat veterans who are healthy can benefit from counseling. Counseling should focus on helping the combat veteran understand how combat experiences might influence their thoughts, emotions and behaviors. Counseling can also help combat veterans understand the numerous paradoxes often experienced during and after deployment. Combat veterans also encounter numerous dilemmas, most prominent being the military mental health dilemmas, consisting of multiple double binds imposed on the combat veteran by their partner, the military culture, and him/herself; all of which impede the combat veteran from receiving much needed mental health care support. If left unchecked, these can lead to more significant mental health issues requiring professional intervention. Veteran helping organizations also face dilemmas and paradoxes, which are important to understand to ensure veterans receive maximum care and assistance. Although many dilemmas are unavoidable and many paradoxes unsolvable, a holistic approach to understanding and ameliorating veteran paradoxes and dilemmas is necessary to optimize the veterans transition home. There are also similarities between combat trauma and other types of trauma, and between the military and other occupations with inherent danger. Recognizing these will further aid in the development of interventions that will allow trauma survivors to thrive and grow after traumatic events.

Sara Kintzle, Ashley C. Schuyler, Diana Ray-Letourneau, Sara M. Ozuna, Christopher Munch, Elizabeth Xintarianos, Anthony M. Hassan and Carl A. Castro

November 2015 | American Psychological Association

ABSTRACT

Sexual trauma remains a pervasive problem in the military. The deleterious mental health outcomes related to incidents of sexual assault have been well-documented in the literature, with particular attention given to the development of posttraumatic stress disorder (PTSD) and utilization of mental health services. Much effort has focused on addressing issues of sexual trauma in the military. The purpose of this study was to examine the incidences of sexual assault in female veterans, the relationship to PTSD and mental health care utilization. The research explored differences in pre- and post-9/11 veterans. Data were collected using a six-prong recruitment strategy to reach veterans living in Southern California. A total of 2,583 veterans completed online and in-person surveys, of which 325 female veterans were identified for inclusion in the analysis. Forty percent of the sample reported experiencing sexual assault during their military service. A history of military sexual trauma was found to be a substantial contributor to symptoms of PTSD. A majority of female veterans who indicated being sexually assaulted during their military service met the cutoff for a diagnosis of PTSD. Although only a minority of participants who indicated being a victim of sexual assault reported receiving immediate care after the incident, most had received mental health counseling within the past 12 months. Findings point to the need for additional prevention programs within the military and opportunities for care for victims of military sexual assault.

Sara Kintzle, Hyunsung Oh, Sherrie Wilcox, Anthony Hassan, Kathy Ell and Carl Castro

September 2015 | Military Medicine

ABSTRACT

Postdeployment civilian unemployment has become a common problem and source of additional stress for National Guard (NG) personnel. This study evaluated 126 California NG members, exploring the relationship between immediate postdeployment employment status and self-reported mental health symptoms, including evidence of alcohol misuse. Participants were recruited from a NG unit within the first 3 months after returning home in August 2011. Over one-third of participants reported being unemployed beyond the part-time NG commitment. Mental health symptoms were greater in those participants without civilian employment. Additionally, those participants with comorbid alcohol misuse with either depression or post-traumatic stress disorder were significantly more likely to lack civilian employment. Interaction testing revealed a significant interaction between employment status and alcohol misuse for both depression and post-traumatic stress disorder. Alcohol use was concluded to moderate the relationship between civilian unemployment and mental health symptoms. Results suggest that the part-time employment provided through NG service may serve as a protective factor in the development of negative psychological outcomes, except for cases where alcohol misuse is present.

Carl Andrew Castro, Sara Kintzle, Ashley C. Schuyler, Carrie L. Lucas and Christopher H. Warner

May 2015 | Current Psychiatry Reports

ABSTRACT

Military sexual assault is a pervasive problem throughout the military services, despite numerous initiatives to end it. No doubt the military’s lack of progress stems from the complexity of sexual assaults, yet in order to develop effective strategies and programs to end sexual assault, deep understanding and appreciation of these complexities are needed. In this paper, we describe the root causes and numerous myths surrounding sexual assault, the military cultural factors that may unintentionally contribute to sexual assault, and the uncomfortable issues surrounding sexual assault that are often ignored (such as the prevalence of male sexual assault within the military). We conclude by offering a broad, yet comprehensive set of recommendations that considers all of these factors for developing effective strategies and programs for ending sexual assault within in the military.

Sherrie L. Wilcox, PhD, CHES, Sarah Redmond, BA, Teaniese L. Davis, PhD

April 2015 | The Journal of Sexual Medicine

ABSTRACT

INTRODUCTION
More than a third of young military personnel report experiencing some level of erectile dysfunction (ED). Preoccupation with body image, particularly genitals, is a distraction that can influence sexual anxiety (SA) and sexual functioning problems (SFPs), particularly ED.

AIMS
This study assessed the relationships between male genital self-image (MGSI), SA, and ED in a sample of male military personnel age 40 or younger.

METHODS
Data were from a larger study on SFPs in military populations. This sample consisted of 367 male military personnel age 40 or younger. Hierarchical regression analyses and process modeling using mediation analysis were performed to examine the effects of MGSI on ED with SA as an intermediate variable. We predicted that SA would mediate the relationship between MGSI and ED.

MAIN OUTCOME MEASURES
ED severity was assessed with the International Index of Erectile Function. MGSI was assessed using the MGSI Scale. SA was assessed with the SA subscale of the Sexual Needs Scale.

RESULTS
As hypothesized, greater satisfaction with MGSI was predictive of significantly lower SA (F[8, 352] = 4.07, P = 0.001) and lower ED (F[8, 352] = 13.20, P = 0.001). Lower levels of SA were predictive of lower levels of ED (F[8, 354] = 21.35, P < 0.001). Additionally, results also revealed a significant indirect effect of MGSI on ED through SA (b = −0.07, standard error = 0.03, confidence interval = [−0.14,−0.02], P < 0.05), indicating mediation of MGSI on ED via SA.

CONCLUSIONS
This study underscores the complex etiologic basis of SFPs, particularly ED, and highlights the importance of considering psychologic contributors to ED, such as SA and MGSI. Strategies aimed at reducing SA may be useful in improving ED in young military populations and are worth considering as complements to strategies that improve SFPs.

Sarah A. Redmond, Sherrie L. Wilcox, Shawna M. Campbell, Alice Kim, Kim Finney, K. Barr and Anthony Hassan

2015 | WORK: A Journal of Prevention, Assessment & Rehabilitation

ABSTRACT

BACKGROUND
Military culture and workplace are areas of interest for researchers across disciplines. However, few publications on military culture exist.

OBJECTIVE
The purpose of this article is to introduce general concepts regarding the structure and culture of the United States Military and discuss how this creates challenges for reintegrating into the civilian world.

METHOD
Topics that will be covered in this article include an overview of the Department of Defense (DoD) and Department of Veterans Affairs (VA), socialization to military culture, the unique features of the military as a workplace, the cultural experiences of military personnel reintegrating back into the community, and the challenges faced by military members and their spouses.

RESULTS
The provided information on military culture will expand military cultural competency so that civilian employers can enhance their ability to create supportive workplaces for veterans and military spouses during times of transition and reintegration.

DISCUSSION
The unique characteristics of the military culture should be understood by those who work with or plan to work with military populations.

Sherrie L. Wilcox, Hyunsung Oh, Sarah A. Redmond, Joseph Chicas, Anthony M. Hassan, Pey-Jiuan Lee and Kathleen Ell

2015 | WORK: A Journal of Prevention, Assessment & Rehabilitation

ABSTRACT

BACKGROUND
More Reserve and Guard members have been activated in the past few years than in any other time in history. In addition to the high rates of psychological and behavioral challenges among military personnel, there are other equally important post-deployment reintegration challenges. Post-deployment reintegration challenges are particularly important to Reserve and Guard members, who transition rapidly from civilian-military-civilian.

OBJECTIVE
This study aims to describe the scope of challenges that a battalion of National Guard members (NGM) report experiencing after returning from a one-year deployment to Iraq.

METHOD
This article reports data from a sample of 126 NGM who recently returned from a one-year deployment to Iraq. The scope of post-deployment problems at baseline, 3- and 6-month post-deployment are presented.

RESULTS
Overall, the rates of post-deployment psychological and behavioral problems were elevated upon returning from deployment and remained fairly constant for up to 6 months post-deployment. Approximately 30% of respondents were unsatisfied with their relationship and upwards of 30% reported family reintegration challenges.

CONCLUSIONS
Comparisons with similar research and implications for prevention and improvement of post-deployment quality of life are addressed.

Carl A. Castro

August 2014 | European Journal of Psychotraumatology

ABSTRACT

This paper reviews the psychological health research conducted in the United States in support of combat veterans from Iraq and Afghanistan, using the Military Psychological Health Research Continuum, which includes foundational science, epidemiology, etiology, prevention and screening, treatment, follow-up care, and services research. The review is limited to those studies involving combat veterans and military families. This review discusses perplexing issues regarding the impact of combat on the mental health of service members such as risk and resilience factors of mental health, biomarkers of posttraumatic stress syndrome (PTSD), mental health training, psychological screening, psychological debriefing, third location decompression, combat and suicide, the usefulness of psychotherapy and drug therapy for treating PTSD, role of advanced technology, telemedicine and virtual reality, methods to reduce stigma and barriers to care, and best approaches to the dissemination of evidence-based interventions. The mental health research of special populations such as women, National Guardsmen and reservists, and military families is also presented. The review concludes by identifying future areas of research.

Eric Vermetten, Neil Greenberg, Manon A. Boeschoten, Roos Delahaije, Rakesh Jetly, Carl A. Castro and Alexander C. McFarlane

August 2014 | European Journal of Psychotraumatology

ABSTRACT

BACKGROUND
For years there has been a tremendous gap in our understanding of the mental health effects of deployment and the efforts by military forces at trying to minimize or mitigate these. Many military forces have recently systematized the mental support that is provided to support operational deployments. However, the rationale for doing so and the consequential allocation of resources are felt to vary considerably across North Atlantic Treaty Organisation (NATO) International Security Assistance (ISAF) partners. This review aims to compare the organization and practice of mental support by five partnering countries in the recent deployment in Afghanistan in order to identify and compare the key methods and structures for delivering mental health support, describe bottlenecks and illustrate new developments.

METHOD
Information was collected through document analysis and semi-structured interviews with key military mental healthcare stakeholders. The review resulted from close collaboration between key military mental healthcare professionals within the Australian Defense Forces (ADF), Canadian Armed Forces (CAF), United Kingdom Armed Forces (UK), Netherlands Armed Forces (NLD), and the United States Army (US). Key stakeholders were interviewed about the mental health support provided during a serviceperson’s military career. The main items discussed were training, prevention, early identification, intervention, and aftercare in the field of mental health.

RESULTS
All forces reported that much attention was paid to mental health during the individual’s military career, including deployment. In doing so there was much overlap between the rationale and applied methods. The main method of providing support was through training and education. The educative focus was to strengthen the mental resilience of individual soldiers while providing a range of mental healthcare services. All forces had abandoned standard psychological debriefing after critical incidents. Instead, by default, mental healthcare professionals acted to support the leader and peer led ‘‘after action’’ reviews. All countries provided professional mental support close to the front line, aimed at early detection and early return to normal activities within the unit. All countries deployed a mental health support team that consisted of a range of mental health staff including psychiatrists, psychologists, social workers, mental health nurses, and chaplains. There was no overall consensus in the allocation of mental health disciplines in theatre. All countries (except the US) provided troops with a third location decompression (TLD) stop after deployment, which aimed to recognize what the deployed units had been through and to prepare them for transition home. The US conducted in-garrison ‘decompression’, or ‘reintegration training’ in the US, with a similiar focus to TLD. All had a reasonably comparable infrastructure in the field of mental healthcare. Shared bottlenecks across countries included perceived stigma and barriers to care around mental health problems as well as the need for improving the awareness and recognition of mental health problems among service members.

CONCLUSION
This analysis demonstrated that in all five partners state-of-the-art preventative mental healthcare was included in the last deployment in Afghanistan, including a positive approach towards strengthening the mental resilience, a focus on self-regulatory skills and self-empowerment, and several initiatives that were well-integrated in a military context. These initiatives were partly/completely implemented by the military/colleagues/supervisors and applicable during several phases of the deployment cycle. Important new developments in operational mental health support are recognition of the role of social leadership and enhancement of operational peer support. This requires awareness of mental problems that will contribute to reduction of the barriers to care in case of problems. Finally, comparing mental health support services across countries can contribute to optimal preparation for the challenges of military deployment.

Sherrie L. Wilcox, PhD, CHES, Sarah Redmond, BA, Anthony Hassan, EdD, LCSW

July 2014 | The Journal of Sexual Medicine

ABSTRACT

INTRODUCTION
Although the military is a young and vigorous force, service members and veterans may experience sexual functioning problems (SFPs) as a result of military service. Sexual functioning can be impaired by physical, psychological, and social factors and can impact quality of life (QOL) and happiness.
AIMS
This study aims to estimate rates and correlates of SFPs in male military personnel across demographic and psychosocial characteristics, to examine the QOL concomitants, and to evaluate barriers for treatment seeking.

METHODS
This exploratory cross-sectional study was conducted using data from a larger nationwide study conducted between October 2013 and November 2013. This sample consists of 367 male active duty service members and recent veterans (military personnel) age 40 or younger.

MAIN OUTCOME MEASURES
Erectile dysfunction (ED) was determined using the five-item International Index of Erectile Function, sexual dysfunction (SD) was determined using the Arizona Sexual Experiences Scale, Male, and QOL was determined using the World Health Organization Quality of Life, Brief.

RESULTS
SFPs were associated with various demographic, physical, and psychosocial risk factors. The rates of SD and ED were 8.45% and 33.24%, respectively, for male military personnel aged 21–40. Those who were 36–40, nonmarried, nonwhite, and of lower educational attainment reported the highest rates of SFPs. Male military personnel with poor physical and psychosocial health presented the greatest risk for ED and SD. SFPs were associated with reduced QOL and lower happiness, and barriers for treatment were generally related to social barriers.

CONCLUSIONS
SFPs in young male military personnel are an important public health concern that can severely impact QOL and happiness.

Carl A. Castro, PhD and Sara Kintzle, PhD

June 2014 | Current Psychiatry Reports

ABSTRACT

Suicides in the military have increased over the last ten years. Much effort has been focused on suicide prevention and treatment, as well as understanding the reasons for the sharp increase in military suicides. Despite this effort, the definitive causes of military suicides remain elusive. Further, highly effective suicide prevention and treatment approaches have not yet been developed. The purpose of this article is to present a short review of the current state of suicide prevention interventions within the context of the military. The root causes of suicidal behavior and the role of combat in the military are each discussed. Interpersonal-psychological theory of suicide and the military transition theory are introduced as guiding frameworks for understanding suicides and suicidal behavior amongst active military personnel and military veterans. The article concludes with a set of recommendations for moving forward in understanding and addressing suicides in the military.