ObjectivesDispositional mindfulness has been associated with lower posttraumatic stress disorder (PTSD) and other negative health symptoms in the police population. Of the various mindfulness facets (i.e., non-judging, observing, describing, acting with awareness), non-judging has been demonstrated to be the strongest predictor of lower PTSD symptoms in police academy cadets. The mechanisms by which non-judging may lead to enhanced health outcomes in police officers are poorly understood and require further investigation.MethodThe purpose of the current study was to test a model involving a pathway from pre-trauma mindful non-judging to PTSD symptoms and ultimately posttraumatic growth (PTG) that is mediated by worldviews in a sample of police academy cadets (n = 379). Data were collected via a survey packet distributed at a police academy located in a Southern state of the United States. We examined the relationships among demographic factors, adverse child events, negative life events, mindful non-judgment, world assumptions, PTSD, and PTG using path analysis.ResultsThe results indicated that positive worldviews served as a mediator between dispositional mindful non-judging and lower PTSD symptoms, which ultimately led to lower PTG.ConclusionsThese findings have important implications for the selection and training of police academy cadets with the goal of increasing resilience to occupational trauma exposure. Additionally, these results have clinical implications regarding the treatment of officers experiencing symptoms of PTSD.PreregistrationThis study is not preregistered.

This study aimed to adapt the Compassion Fatigue-Short Scale to Portugal and examine the reliability and validity of the Portuguese version of the scale (Pt-CF-Short Scale) among Portuguese firefighters. The factor structure of the Pt-CF-Short Scale was compared to the one-factor model fit and a two-factor model and second-order factor model in a sample of 512 firefighters. Confirmatory factor analysis procedures confirmed the good fit of a second-order factor model with two first-order factors (secondary trauma and job burnout). The Pt-CF-Short Scale showed good internal consistency evidence. The Kessler Psychological Distress Scale (K-10), the Brief Symptom Inventory (BSI) and WHOQOOL-Bref were used as convergent measures to assess psychological distress, anxiety, depression, and interpersonal sensitivity and quality of life, respectively. The measure presented a strong correlation with psychological distress and weak and negative association with quality of life. The Pt-CF-Short Scale contributes to understanding compassion fatigue and its correlates within the context of emergency workers. Results indicate that this scale is a valid and reliable assessment tool in evaluating compassion fatigue.

The impact of "moral injury" (MI) among deployed veterans, defined as actions in combat that violate a veteran's moral beliefs and result in psychological distress, has increasingly become a significant clinical concern separate from other trauma- and stressor-related disorders. MI involves severe distress over violations of core beliefs often followed by feelings of guilt and conflict and is common among veterans with PTSD. While the psychological impact of PTSD is well-documented among veterans, this has been done less so with respect to MI. We studied MI among 1,032 deployed veterans who were outpatients in a large non-profit multi-hospital system in central Pennsylvania. The study included active duty and Guard/Reserve members, as well as veterans who were not Department of Veterans Affairs (VA) service users. Our hypothesis was that, controlling for other risk factors, veterans with high MI would have current mental disorders. Our secondary hypothesis was that MI would be associated with other psychopathologies, including chronic pain, sleep disorders, fear of death, anomie, and use of alcohol/drugs to cope post deployment. Most veterans studied were deployed to Vietnam (64.1%), while others were deployed to post-Vietnam conflicts in Iraq and Afghanistan and elsewhere. Altogether, 95.1% of the veterans were male and their mean age was 61.6 years (SD = 11.8). Among the veterans, 24.4% had high combat exposure, 10.9% had PTSD, 19.8% had major depressive disorder, and 11.7% had a history of suicidal thoughts. Based on the Moral Injury Events Scale (MIES), 25.8% had high MI post deployment, defined as a score above the 75th percentile. Results show that high MI among veterans was associated with current global mental health severity and recent mental health service use, but not suicidal thoughts. In addition, as hypothesized, MI was also associated with pain, sleep disorders, fear of death, anomie, use of alcohol/drugs to cope post-deployment, and poor unit support/morale during deployment. Deployed veterans with MI are more likely to have current mental health disorders and other psychological problems years after deployment. Further research is advised related to the screening, assessment, treatment, and prevention of MI among veterans and others after trauma exposures.

Distinct challenges exist in the delivery of medical services in correctional facilities, yet little is known about the sources of health information incarcerated patients rely upon to understand and manage their health. Using a nationally representative sample of U.S. incarcerated adults (N = 1,319) from the Programme for the International Assessment of Adult Competencies, we examine patterns in health information seeking behavior. We find incarcerated persons report television (72.9%) and social contacts (61.8%) as their most common sources of health information and use of magazines and books/brochures is significantly related to better health. We argue that asking incarcerated patients how they get health information and using this knowledge to provide them with health information in formats they will use are important steps toward reducing incarcerated individuals' health disparities.

INTRODUCTION:Since veteran suicide is a concern and our knowledge of predictive factors is still limited, our objective was to assess risk factors for suicide, including genetic factors, among deployed veterans. METHODS:For this study, we surveyed 1730 veterans who were outpatients in a multi-hospital system in Pennsylvania. Altogether, 1041 veterans (60%) provided a DNA sample. The genetic risk variants investigated were within loci previously associated with PTSD and substance misuse, including CRHR1, CHRNA5, RORA, and FKBP5 genetic variations, which were used to calculate a polygenic risk score (range=0-8, mean=3.6, SD=1.4). RESULTS:Most veterans (56.2%) were deployed to Vietnam while significant numbers were deployed to Iraq, Afghanistan, and other post-Vietnam conflicts. Overall, 95.1% of the veterans were male, their mean age was 56.2 (SD=12), and 95.6% were Caucasian. Among the veterans, 24% had high combat exposure. The prevalence of lifetime suicidal thoughts was 11.3%. Additionally, 5.7% ever developed a suicide plan or attempted suicide in their lifetimes. Among those with a history of a lifetime suicide attempt or suicide plan, the PTSD genetic risk score was significantly higher (OR=3.96 vs 3.55, p=0.033), but for suicidal thoughts, this association was not significant (p=0.717). In multivariable analysis (MVA) logistic regression, significant predictors of attempting suicide or having a suicide plan were history of depression (OR=5.04, p<0.001), PTSD genetic risk score (OR=1.25, p=0.036), history of childhood abuse/neglect (OR=2.24, p=0.009), and lifetime marijuana use (OR= 1.56, p=0.020). Conversely, rural residence was protective for suicide risk (OR=0.49; p=0.031). For suicidal thoughts, in the MVA genetic risk score was not significant (p=0.697), but history of child abuse/neglect (p<0.001), history of depression (p>0.001), low psychological resilience (p=0.004), and lifetime marijuana use (p=0.022) were significant. DISCUSSION:In this study, we identified genetic risk variants and other predictors for suicide among veterans that may have implications for future screening and clinical care. Further research is advised.

Mindfulness-based treatments have been increasingly noted in the professional literature as a possible means to reduce posttraumatic stress disorder (PTSD) symptoms and promote well-being, especially among law enforcement officers. Scant research, however, has been conducted to study dispositional mindfulness and health outcomes in police cadets. The current exploratory study examined the association between the various facets of dispositional mindfulness (i.e., observing, describing, acting with awareness, nonjudging, and nonreactivity) and PTSD symptoms, posttraumatic growth (PTG), and other variables, including world assumptions, in police cadets (N = 379). Consistent with findings from previous studies of experienced officers, the results indicate that (a) mindful nonjudging is a salient trait in police cadets, which uniquely predicted lower PTSD symptoms, β = -.31, p < .001, and was related to lower levels of PTG, r = -.12, p = .025, and (b) mindful observing was related to higher levels of PTSD symptoms, r = .14, p = .009 and higher levels of PTG, r = .26, p < .001, in the present sample. In addition, the findings demonstrate that nonjudging is an important trait in police cadets regarding world assumptions such that nonjudging was a significant, unique predictor of world assumption facets, including controllability of events, β = .15, p = .025, and trustworthiness and goodness of people, β = .18, p = .004. Clinical implications, including the importance of understanding the association between mindful nonjudging and the shattering and rebuilding of worldviews and following trauma reactions, are discussed.

Background Maladaptive drinking is an increasing concern among military policy makers and healthcare providers. The goal of this study was to assess how social and psychological factors relate to alcohol problems among post-deployed US veterans and how problematic drinking is associated with well-being.Methods Data were collected via a telephone survey from a random sample of veterans receiving their healthcare from a large non-VA hospital system in central Pennsylvania (N = 1730). Interviewers inquired about participants’ current alcohol consumption, using the CAGE and AUDIT-C scales, and health-related outcomes (general psychological distress, major depression, and self-reported health status). Analyses included demographic, military and nonmilitary stressful events, use of alcohol or drugs to cope post-deployment, use of psychiatric services, and personality characteristics as independent variables. Our sample was 95% male, 96% White, and had a mean age of 59 years old (SD = 12 years).Results Analyses included demographic, military and nonmilitary stressful events, use of alcohol or drugs to cope post-deployment, use of psychiatric services, and personality characteristics as independent variables. Our sample was 95% male, 96% White, and had a mean age of 59 years old (SD = 12 years). Analyses for our drinking measures show that those who used drugs or alcohol to cope post-deployment were more likely to be problematic drinkers, while positive personality characteristics such as agreeableness and conscientiousness were related to fewer drinking problems. Multivariate logistic regressions for our well-being measures found that alcohol misuse was not related to distress or depression, but that a positive score on the AUDIT-C was associated with a lower likelihood of poor self-rated health. Using alcohol or drugs to cope was related to higher distress.Discussion We conclude that service providers might consider using post-deployment AUDIT-C and the drugs and alcohol coping questions when screening for possible alcohol and mental health problems among veterans.

Background : This study focuses on factors that may disproportionately affect female veterans’ mental health, compared to men, and is part of a larger study assessing the prevalence of mental health disorders and treatment seeking among formerly deployed US military service members. Methods : We surveyed a random sample of 1,730 veterans who were patients in a large non-VA hospital system in the US. Based on previous research, women were hypothesized to be at higher risk for psychological problems. We adjusted our results for confounding factors, including history of trauma, childhood abuse, combat exposure, deployments, stressful life events, alcohol misuse, psychological resources, and social support. Results : Among the veterans studied, 5% were female (n=85), 96% were White (n=1,161), 22.9% were Iraq/Afghanistan veterans (n=398), and the mean age was 59 years old (SD=12). Compared to males, female veterans were younger, unmarried, college graduates, had less combat exposure, but were more likely to have lifetime PTSD (29% vs. 12%.), depression (46% vs. 21%), suicidal ideation (27% vs. 11%), and lifetime mental health service use (67% vs. 47%). Females were also more likely to have low psychological resilience and to have used psychotropic medicines in the past year. Using multivariate logistic regression analyses that controlled for risk and protective factors, female veterans had greater risk for lifetime PTSD, depression, suicidal thoughts, and for lifetime use of psychological services, compared to males. Since 95% of the population in this study were male and these results may have been statistically biased, we reran our analyses using propensity score matching. Results were consistent across these analyses. Conclusion : Using a sample of post-deployment veterans receiving healthcare services from a large non-VA health system, we find that female veterans are at greater risk for lifetime psychological problems, compared to male veterans. We discuss these findings and their implications for service providers.

Background The majority of Veterans Affair (VA) hospitals are in urban areas. We examined whether veterans residing in rural areas have lower mental health service use and poorer mental health status. Methods Veterans with at least 1 warzone deployment in central and northeastern Pennsylvania were randomly selected for an interview. Mental health status, including PTSD, major depression, alcohol abuse and mental health global severity, were assessed using structured interviews. Psychiatric service use was based on self-reported utilization in the past 12 months. Results were compared between veterans residing in rural and non-rural areas. Data were also analyzed using multivariate logistic regression to minimize the influence by confounding factors. Results A total of 1730 subjects (55% of the eligible veterans) responded to the survey and 1692 of them had complete geocode information. Those that did not have this information (n = 38), were excluded from some analyses. Veterans residing in rural areas were older, more often of the white race, married, and experienced fewer stressful events. In comparison to those residing in non-rural areas, veterans residing in rural areas had lower global mental health severity scores; they also had fewer mental health visits. In multivariate logistic regression, rural residence was associated with lower service use, but not with PTSD, major depression, alcohol abuse, and global mental health severity score after adjusting confounding factors (e.g., age, gender, marital status and education). Conclusions Rural residence is associated with lower mental health service use, but not with poor mental health in veterans with former warzone deployment, suggesting rural residence is possibly protective.

Yirui Hu 1 Xin Chu Thomas G Urosevich Stuart N Hoffman H Lester Kirchner 1 Richard E Adams 5 Ryan J Dugan 6 Joseph J Boscarino Weixing Shi Carrie A Withey 6 Charles R Figley 8 Joseph A Boscarino 1Biomedical and Translational Informatics, Geisinger Clinic, Danville, PA, USA; 2Obesity Institute, Geisinger Clinic, Danville, PA, USA; 3Ophthalmology Service, Geisinger Clinic, Mount Pocono, PA, USA; 4Sleep Disorders Center, Geisinger Clinic, Danville, PA, USA; 5Department of Sociology, Kent State University, Kent, OH, USA; 6Department of Population Health Sciences, Geisinger Clinic, Danville, PA, USA; 7Department of Clinical Psychology, William James College, Newton, MA, USA; 8Department of Social Work, Tulane University, New Orleans, LA, USA Background: Previously we reported a genetic risk score significantly improved PTSD prediction among a trauma-exposed civilian population. In the current study, we sought to assess this prediction among a trauma-exposed military population. Methods: We examined current PTSD diagnosis and PTSD symptom severity among a random sample of 1042 community-based US military veterans. Main effects and interaction effects were assessed for PTSD genetic risk by trauma exposure using cross-product terms for PTSD x trauma exposures, including combat, lifetime trauma, and adverse childhood exposures. The PTSD risk variants studied were within genetic loci previously associated with PTSD, including CRHR1, CHRNA5, RORA, and FKBP5 genetic variants, which were used to calculate a total PTSD genetic risk score (range=0–8, mean=3.6, SD=1.4). Results: Based on DSM-5 PTSD criteria, 7.1% of veterans (95% CI=5.6–8.8) met criteria for current PTSD. The PTSD genetic risk count was significantly higher among PTSD cases vs noncases (3.92 vs 3.55, p=0.027). Since the PTSD genetic risk score was not significant in the PTSD diagnosis model, we assessed this association using PTSD symptom severity. Because these symptom data were skewed (mean=9.54, SD=12.71, range=0–76), we used negative binomial regression to assess this outcome. This symptom model included a PTSD genetic risk score, demographic factors, trauma exposures, current insomnia, current depression, concussion history, and attention-deficit disorder, expressed as incident rate ratios (IRR), which is an estimate of oneunit increase in PTSD severity, given other variables are held constant. Variables in the final model included age and sex (both p<0.001), PTSD genetic risk (IRR=1.02, p=0.028), warzone tours (IRR=0.94, p=0.003), childhood abuse (IRR=1.50, p<0.0001), current depression (IRR=1.89, p<0.0001), current insomnia (IRR=2.58, p<0.0001), low social support (IRR=1.19, p<0.0001), attention-deficit disorder (IRR=1.51, p<0.0001), agreeable personality (IRR=0.77, p<0.0001), and concussion (IRR=1.38, p<0.0001). Significant interactions were detected for combat and lifetime trauma exposure by PTSD genetic risk (both p<0.0001), suggesting that the impact of trauma exposures on PTSD severity was lower when the PTSD genetic risk was higher. Conclusion: Both warzone and non-warzone factors predicted current PTSD symptoms among veterans, including a PTSD genetic risk score. Interaction effects were detected for combat exposure and lifetime trauma by genetic risk score for PTSD symptoms, suggesting that PTSD symptom manifestation was more dependent on PTSD risk variants than the level of trauma or combat exposure. This suggests that controlling for other factors, the absence of genetic risk variants may confer PTSD resilience. Further research is planned.

The purpose of this exploratory study is to: (1) assess prevalence of childhood adversities and posttraumatic stress disorder (PTSD); (2) assess their association, and; (3) explore whether proximal sources of stress affect this relationship and/or have an association with PTSD among people with severe and persistent psychological disorders. Using data from 141 respondents, we assess the extent to which individuals in this population experienced 17 PTSD symptoms, various correlates to probable PTSD, and the most relevant of these factors in a multivariate logistic regression. Overall, 27% of the participants met study criteria for probable PTSD and each symptom was reported by at least 18% of the sample. Multivariate logistic regression models indicated that interpersonal conflict and being a victim of a crime were significantly related to probable PTSD. We discuss these findings in relation to treatment and course of disease for people suffering from severe and persistent mental illness experiencing a traumatic event.

Background: Previously we reported a genetic risk score significantly improved PTSD prediction among a trauma-exposed civilian population. In the current study, we sought to assess this prediction among a trauma-exposed military population. Methods: We examined current PTSD diagnosis and PTSD symptom severity among a random sample of 1042 community-based US military veterans. Main effects and interaction effects were assessed for PTSD genetic risk by trauma exposure using cross-product terms for PTSD x trauma exposures, including combat, lifetime trauma, and adverse childhood exposures. The PTSD risk variants studied were within genetic loci previously associated with PTSD, including CRHR1, CHRNA5, RORA, and FKBP5 genetic variants, which were used to calculate a total PTSD genetic risk score (range=0-8, mean=3.6, SD=1.4). Results: Based on DSM-5 PTSD criteria, 7.1% of veterans (95% CI=5.6-8.8) met criteria for current PTSD. The PTSD genetic risk count was significantly higher among PTSD cases vs non-cases (3.92 vs 3.55, p=0.027). Since the PTSD genetic risk score was not significant in the PTSD diagnosis model, we assessed this association using PTSD symptom severity. Because these symptom data were skewed (mean=9.54, SD=12.71, range=0-76), we used negative binomial regression to assess this outcome. This symptom model included a PTSD genetic risk score, demographic factors, trauma exposures, current insomnia, current depression, concussion history, and attention-deficit disorder, expressed as incident rate ratios (IRR), which is an estimate of one-unit increase in PTSD severity, given other variables are held constant. Variables in the final model included age and sex (both p<0.001), PTSD genetic risk (IRR=1.02, p=0.028), warzone tours (IRR=0.94, p=0.003), childhood abuse (IRR=1.50, p<0.0001), current depression (IRR=1.89, p<0.0001), current insomnia (IRR=2.58, p<0.0001), low social support (IRR=1.19, p<0.0001), attention-deficit disorder (IRR=1.51, p<0.0001), agreeable personality (IRR=0.77, p<0.0001), and concussion (IRR=1.38, p<0.0001). Significant interactions were detected for combat and lifetime trauma exposure by PTSD genetic risk (both p<0.0001), suggesting that the impact of trauma exposures on PTSD severity was lower when the PTSD genetic risk was higher. Conclusion: Both warzone and non-warzone factors predicted current PTSD symptoms among veterans, including a PTSD genetic risk score. Interaction effects were detected for combat exposure and lifetime trauma by genetic risk score for PTSD symptoms, suggesting that PTSD symptom manifestation was more dependent on PTSD risk variants than the level of trauma or combat exposure. This suggests that controlling for other factors, the absence of genetic risk variants may confer PTSD resilience. Further research is planned.

We use social learning, self-control, and social disorganization theories to develop hypotheses related to tobacco and alcohol use among a racially diverse sample of Chicago adolescents. Data from the Project on Human Development in Chicago Neighborhoods were used to test models that examine relationships between neighborhood-level and individual-level attributes on tobacco-use and alcohol-use frequencies. Our primary goal was to test hypotheses about the invariance of statistical relationships over three waves of data by using equality of regression coefficients tests. We found that the effect of deviant peers decreased over time for alcohol use but was invariant for tobacco use. The effect of self-control on alcohol use was invariant, yet its effect on tobacco use was not invariant and increased significantly by the third wave. Contextual variables were not, for the most part, significantly related to tobacco and alcohol use, and, contrary to our expectations, the effects were invariant over time.

To examine the feasibility, acceptability, preliminary effect, and durability of a mind-body videoconferencing program for youth with neurofibromatosis (Resilient Youth with NF; RY-NF) against an experimental educational control (Health Education for NF; HE-NF) via a single-blind pilot RCT.Adolescents with NF (N = 51; age 12–17) completed baseline assessments and were randomized (1:1/ to intervention or experimental educational control). The multiple primary outcomes were physical health and psychological quality of life (QoL). Secondary outcomes were social relations QoL, environmental QoL, depression, anxiety, pain intensity and pain interference. Posttreatment and at 6-month follow-up assessments were collected.Forty-five adolescents (88%) completed posttreatment, and 37 (82%) completed 6-month follow-up. Satisfaction was high in both conditions. The RY-NF showed greater baseline to posttreatment improvements in physical health QoL (10.18; 95% CI: 0.47–19.90; p = .040), psychological QoL (9.45; 95% CI: 0.78–18.11; p = .033), social relations QoL (13.19; 95% CI: 1.87–24.50; p = .023), and environmental QoL (9.26; 95% CI: 3.49–15.49; p = .002), compared to the HE-NF (between group effects). Improvements were clinically meaningful and maintained through follow-up.The RY-NF was well accepted, highly feasible and resulted in sustained improvement in QoL, demonstrating adolescents are receptive to and benefit from learning resiliency skills in groups via live video.

Post-traumatic stress disorder (PTSD) is related to alteration in neuropsychological functioning, including visual and other cognitive processes. Grapheme-color synesthesia is a phenomenon in which a letter or number elicits response of a concurrent image or color perception. Since we earlier reported an association between grapheme-color synesthesia and PTSD, our objective in the current study was to validate this association among a new study group and assess risk factors. For this, we surveyed 1,730 military veterans who have been outpatients in the Geisinger Clinic, a multi-hospital system in Pennsylvania, USA. All the study veterans served in a warzone deployment. The association between PTSD and Grapheme-color synesthesia was evaluated. The average age of veterans was 59.6 years among whom 95.1% were male. Current PTSD prevalence rate was observed to be 7.6% (95% C.I. = 6.5-9.0) and in 3.4% of veterans (95% C.I. = 2.7-4.4) grapheme-color synesthesia was found to be positive. Initial bivariate analyses suggested that synesthesia was associated with current PTSD [odds ratio (OR) = 3.3, p<0.001]. Multivariable stepwise logistic regression evaluating the age, sex, education, trauma exposure, current psychological stress, psychotropic medication use, combat exposure, history of concussion, and current depression, confirmed this association (OR = 2.33, p = 0.019). The present study corroborated that Grapheme-color synesthesia was linked to PTSD among a second cohort of deployed military veterans. Further research is recommended in order to validate this observation and to determine whether synesthesia is a risk factor for PTSD.

Social psychological theory hypothesizes that one's identity, self-definitions, and meanings used for a particular social role fosters individual purpose in life and affects behavior in specific social situations. As such, it can be protective against the onset of psychological disorders. We examined this hypothesis with data collected from 1,730 military veterans recruited to study the health effects of warzone deployments. The sample was primarily male, older, and White. Our key independent variable was a Likert scale rating the prominence of a respondent's veteran identity: how important it is to the person. Outcome variables included posttraumatic stress disorder (PTSD), suicide ideation, depression, alcohol misuse, and use of VA services. Bivariate analysis suggested that veterans with a prominent veteran identity are older, noncollege graduates, have less income, and had their first deployment to Vietnam. In multivariate analyses, study participants with a prominent veteran identity were less likely to exhibit suicide ideation, but more likely to misuse alcohol and use VA services. We found no differences for PTSD, self-rated health, or depression by veteran identity. Veterans who scored higher on the veteran identity scale appeared to be protected from suicidal thoughts, although they had an elevated risk for alcohol misuse.

Our study examines how the fear of violence and family support influence adolescent social, psychological, and physical well-being, after controlling for exposure to violence and a range of demographic factors. We conduct a secondary analysis of the Project on Human Development in Chicago Neighborhoods (PHDCN) data (N = 1337) using mixed-effect, multi-level regression models for the total sample and for males only and females only samples. We find that family support is the most robust, main effects predictor in all three models and across all outcomes. Our analyses show that the fear of violence is associated with increases in social problems (especially for boys) and with decreases in self-rated health. We discuss the results and implications in light of sociological theories on the health and well-being of adolescents.