Suchergebnisse

OBJECTIVES: Unwanted sexual stressors experienced by military men and women are associated with a host of negative physical and mental health problems. Government officials are making it a priority to put a stop to these unwanted sexual experiences. However, the measure typically used measures sexual stressors much better for women than for men. The purpose of the present study was to test the factor structure of an alternative measure, the Sexual Harassment Inventory (SHI), to examine whether sexual stressors experienced by men correspond to women's experiences. METHODS: We used three pre-existing datasets in which the SHI was used to assess active and former military members' sexual stressor experiences. We conducted an exploratory factor analysis to identify women's response patterns and a confirmatory factor analysis to determine whether men's response patterns corresponded to women's. RESULTS: Findings showed that the SHI has evidence of factorial validity in female service members and adequate, but not exceptional, factorial fit for male service members. CONCLUSIONS: It is imperative that more work be done to better understand how men experience and perceive potential military sexual stressors and how those perceptions and experiences compare to women's.

Sexual harassment has long been a problem in educational, employment, and military populations. It is unclear whether existing questionnaires used to measure sexual harassment in the U.S. military—particularly, derivatives of the Sexual Experiences Questionnaire—perform similarly in men and women. Using exploratory factor analyses in a mixed sample of active duty troops and veterans (289 men, 181 women) sex differences were found in one version's factor structure. Implications and suggestions for improving the validity of the questionnaire for men are offered.

It is difficult to apply U.S. Federal Code of Regulation's criterion for "minimal risk," because benchmarks of minimal risk have not been quantified. Our goal was to examine the psychological risks of several day-to-day activities. Using the Self-Assessment Manikin (SAM), we assessed the state valence and arousal of 432 patients and employees at a large Midwestern Department of Veterans Affairs medical facility before and after they had their blood drawn, saw their primary care physician or mental health provider, or took part in an exercise class. Exercise was associated with near-large to large salutary effects (Cohen's d = 0.76-1.17); other effects were small or moderate in positive directions (Cohen's d = 0.02-0.51). Our findings are a promising start toward establishing benchmarks and quantifying the psychological harms of minimal risk activities. Estimates such as these may help researchers determine whether their own research exceeds minimal risk.

BACKGROUND: Non-random non-response bias in surveys requires time-consuming, complicated, post-survey analyses. Our goal was to see if modifying cover letter information would prevent non-random non-response bias altogether. Our secondary goal tested whether larger incentives would reduce non-response bias. METHODS: A mailed, survey of 480 male and 480 female, nationally representative, Operations Enduring Freedom, Iraqi Freedom, or New Dawn (OEF/OIF/OND) Veterans applying for Department of Veterans Affairs (VA) disability benefits for posttraumatic stress disorder (PTSD). Cover letters conveyed different information about the survey's topics (combat, unwanted sexual attention, or lifetime and military experiences), how Veterans' names had been selected (list of OEF/OIF/OND Veterans or list of Veterans applying for disability benefits), and what incentive Veterans would receive ($20 or $40). The main outcome, non-response bias, measured differences between survey respondents' and sampling frame's characteristics on 8 administrative variables, including Veterans' receipt of VA disability benefits and exposure to combat or military sexual trauma. Analysis was intention to treat. We used ANOVA for factorial block-design, logistic, mixed-models to assess bias and multiple imputation and expectation-maximization algorithms to assess potential missing mechanisms (missing completely at random, missing at random, or not random) of two self-reported variables: combat and military sexual assault. RESULTS: Regardless of intervention, men with any VA disability benefits, women with PTSD disability benefits, and women with combat exposure were over-represented among respondents. Interventions explained 0.0 to 31.2% of men's variance and 0.6 to 30.5% of women's variance in combat non-response bias and 10.2 to 43.0% of men's variance and 0.4 to 31.9% of women's variance in military sexual trauma non-response bias. Non-random assumptions showed that men's self-reported combat exposure was overestimated by 19.0 to 28.8 ...

INTRODUCTION: Mandatory, age-based re-evaluations for posttraumatic stress disorder (PTSD) service connection contribute substantially to the Veterans Benefits Administration's work load, accounting for almost 43% of the 168,013 assessments for PTSD disability done in Fiscal Year 2017 alone. The impact of these re-evaluations on Veterans' disability benefits has not been described. MATERIALS AND METHODS: The study is an 18-year, ecological, ambispective cohort of 620 men and 970 women receiving Department of Veterans Affairs PTSD disability benefits. Veterans were representatively sampled within gender; all were eligible for PTSD disability re-evaluations at least once because of age. Outcomes included the percentage whose PTSD service connection was discontinued, reduced, re-instated, or restored. We also examined total disability ratings among those with discontinued or reduced PTSD service connection. Subgroup analyses examined potential predictors of discontinued PTSD service connection, including service era, race/ethnicity, trauma exposure type, and chart diagnoses of PTSD or serious mental illness. Our institution's Internal Review Board reviewed and approved the study. RESULTS: Over the 18 years, 32 (5.2%) men and 180 (18.6%) women had their PTSD service connection discontinued; among them, the reinstatement rate was 50% for men and 34.3% for women. Six men (1%) and 23 (2.4%) women had their PTSD disability ratings reduced; ratings were restored for 50.0% of men and 57.1% of women. Overall, Veterans who lost their PTSD service connection tended to maintain or increase their total disability rating. Predictors of discontinued PTSD service connection for men were service after the Vietnam Conflict and not having a Veterans Health Administration chart diagnosis of PTSD; for women, predictors were African American or black race, Hispanic ethnicity, no combat or military sexual assault history, no chart diagnosis of PTSD, and persistent serious mental illness. However, compared to other women who lost their ...

BACKGROUND: In 2011, the Department of Veterans Affairs (VA) strengthened its disability claims processes for military sexual trauma, hoping to reduce gender differences in initial posttraumatic stress disorder (PTSD) disability awards. These process improvements should also have helped women reverse previously denied claims and, potentially, diminished gender discrepancies in appealed claims' outcomes. Our objectives were to examine gender differences in reversals of denied PTSD claims' outcomes after 2011, determine whether disability awards (also known as "service connection") for other disorders offset any PTSD gender discrepancy, and identify mediating confounders that could explain any persisting discrepancy. METHODS: From a nationally representative cohort created in 1998, we examined service connection outcomes in 253 men and 663 women whose initial PTSD claims were denied. The primary outcome was PTSD service connection as of August 24, 2016. Secondary outcomes were service connection for any disorder and total disability rating. The total disability rating determines the generosity of Veterans' benefits. RESULTS: 51.4% of men and 31.3% of women were service connected for PTSD by study's end (p < 0.001). At inception, 54.2% of men and 63.2% of women had any service connection—i.e., service connection for disorders other than PTSD (p = 0.01) and similar total disability ratings (p = 0.50). However, by study's end, more men than women had any service connection (88.5% versus 83.5%, p = 0.05), and men's mean total disability rating was substantially greater than women's (77.1 ± 26.2 versus 66.8 ± 30.7, p < 0.001). History of military sexual assault had the largest effect modification on men's versus women's odds of PTSD service connection. CONCLUSION: Even after 2011, cohort men were more likely than the women to reverse initially denied PTSD claims, and military sexual assault history accounted for much of this difference. Service connection for other disorders initially offset women's lower rate of ...

OBJECTIVE: To examine the relative importance of harassment-tolerant norms emanating from troops' senior officers, immediate supervisors, and units on troops' sexual stressor experiences and to see if associations differed by sex. METHOD: Cross-sectional survey of all 681 willing and confirmed active duty troops enrolled in the VA National Enrollment Database between 1998 and 2002. Findings extended an earlier analysis. RESULTS: After adjusting for other significant correlates, senior officers' perceived tolerance of sexual harassment was not associated with the severity of sexual harassment troops reported (p = 0.64) or with the numbers of sexual identity challenges they reported (p = 0.11). Harassment-tolerant norms emanating from troops' units and immediate supervisors were associated with reporting severer sexual harassment and more sexual identity challenges (all p's < 0.003). Findings generalized across sex. CONCLUSIONS: Senior officers' norms did not appear to affect troops' reports of military sexual stressors, but unit norms and immediate supervisors' norms did.

OBJECTIVE: Several researchers have identified associations between exposure to occupational sexual stressors (e.g., sexual harassment) and severer psychiatric symptoms in military personnel. However, few controlled for participants' exposures to other high-magnitude stressors, which could have confounded results. We examined the unique association between military sexual stress and severity of participants' psychiatric symptoms after controlling for their other high-magnitude stressor experiences. Organizational- and individual-level predictors of military sexual stress were also assessed. METHOD: We surveyed by mail all active duty troops registered in the Department of Veterans Affairs' Enrollment Database (2001–2003). The questionnaire contained well-validated measures. RESULTS: Eighty-four percent responded (total sample N = 611); of these 56% reported at least one sexual stressor exposure. A highly significant association between military sexual stress and psychiatric symptoms attenuated by two thirds and lost statistical significance once other stressor experiences were controlled. Besides sociodemographics, the strongest correlates of military sexual stress were working in an environment perceived to tolerate sexual harassment, reporting severer childhood maltreatment, and reporting more high-magnitude stressors. A gender-stratified analysis generated similar findings for men and women. CONCLUSIONS: Little unique variance in psychiatric symptom reporting was explained by military sexual stressor exposure after controlling for other stressors. Childhood maltreatment and other high magnitude stressors acted as risk factors for and confounders of military sexual stress. Understanding how and why these stressors inter-relate could lead to better, more effective interventions to reduce them all—and their sequelae. Findings also highlight the need to routinely include men in sexual stress research.

The Department of Defense's "gold standard" sexual harassment measure, the Sexual Harassment Core (SHCore), is based on an earlier measure that was primarily developed in college women. Furthermore, the SHCore requires a reading grade level of 9.1. This may be higher than some troops' reading abilities and could generate unreliable estimates of their sexual harassment experiences. Results from 108 male and 96 female soldiers showed that the SHCore's temporal stability and alternative forms reliability was significantly worse in soldiers without college experience compared to soldiers with college experience and in men compared to women. For men without college experience, almost 80% of the temporal variance in SHCore scores was attributable to error. A plain-language version of the SHCore had mixed effects on temporal stability, depending on education and gender. The SHCore may be particularly ill suited for evaluating population trends of sexual harassment in military men without college experience.

Millions of US veterans have returned from military service with posttraumatic stress disorder (PTSD), for which a substantial number receive Department of Veterans Affairs (VA) disability benefits. Although PTSD is treatable, comorbid serious mental illness could complicate these veterans' recovery. Using VA administrative data, we examined the burden of persistent serious mental illness in a nationally representative cohort of 1,067 men and 1,513 women who applied for VA PTSD disability benefits between 1994 and 1998 and served during or after the Vietnam conflict. Self-reported outcomes were restricted to the 713 men and 1,015 women who returned surveys at each of 3 collection points. More than 10% of men and 20% of women had persistent serious mental illness; of these, more than 80% also had persistent PTSD. On repeated measures modeling, those with persistent serious mental illness consistently reported more severe PTSD symptoms and poorer functioning in comparison to other participants (ps < .001); their employment rate did not exceed 21.0%. Interactions between persistent serious mental illness and PTSD were significant only for employment (p = .002). Persistent serious mental illness in this population was almost 2 to 19 times higher than in the general US population. Implications are discussed.

Abstract. Background: Suicide is estimated to account for 1.4% of deaths worldwide, making it among the leading causes of premature death. Public health approaches to reduce suicide have the potential to reach individuals across the spectrum of suicide risk. Aims: To review the effectiveness of newer community-based or population-level suicide prevention strategies. Methods: We conducted a systematic review of literature published from January 2010 to November 2020 to evaluate the effectiveness of community- and population-level interventions. The US Center for Disease Control framework was used for grouping studies by strategy. Results: We included 56 publications that described 47 unique studies. Interventions that reduce access to lethal means, implement organizational policies and culture in police workplace settings, and involve community screening for depression may reduce suicide deaths. It is unclear if other interventions such as public awareness and education campaigns, crisis lines, and gatekeeper training prevent suicide. Evidence was inconsistent for community-based, multistrategy interventions. The most promising multistrategy intervention was the European Alliance Against Depression. Limitations: Most eligible studies were observational and many lacked concurrent control groups or adjustment for confounding variables. Conclusions: Community-based interventions that may reduce suicide deaths include reducing access to lethal means, implementing organizational policies in workplace settings, screening for depression, and the multistrategy European Alliance Against Depression Program. Evidence was unclear, inconsistent, or lacking regarding the impact of many other single- or multistrategy interventions on suicide deaths.