Women veterans are more likely to receive cervical cancer screening than their civilian peers. Among veterans, those with mental health conditions are less likely to receive timely screening as compared to veterans without mental health conditions. The current study aimed to investigate whether a history of military sexual trauma, with or without concurrent PTSD disorder, and care from a provider with advanced training in women’s health (WH-PCP) altered the likelihood of cervical cancer screening among veterans. We conducted crosssectional analysis using a cohort of 89,249 women veterans, aged 21 through 64 years, who received outpatient care at any VHA medical center between FY13 and FY16. We used multivariable logistic regressions to examine variation in screening rates. The current study found that cervical cancer screening rate was higher among women assigned to WH-PCP (69.5% vs 61.2%). In the multivariable model with adjustment for patient characteristics and provider assignment, women veterans were more likely to receive cervical cancer screenings if they had a history of MST (OR = 1.14, p < 0.001), did not have a diagnosis of PTSD (OR = 1.06, p < 0.05), and were assigned to WH-PCP (OR = 1.48, p < 0.001). A statistically significant interaction effect was detected between MST and WH-PCP (p < 0.05). Veterans with a history of MST assigned to a WH-PCP were more likely to receive a screening than veterans with a history of MST not assigned to a WH-PCP. There is a complex relationship between MST and provider status, indicating a need to understand barriers and facilitators to cancer screenings.

Moral injury is a condition that can occur after incidents in which individuals perform an action that violates their own deeply held moral beliefs, or fail to prevent such actions from occurring. In the wake of these incidents, negative self-evaluations can lead to intense feelings of shame and self-loathing; hallmarks of the condition of moral injury. Unfortunately, potentially morally injurious circumstances are plentiful for the modern-day service member and veterans of recent conflicts. Existing treatment options for moral injury are currently insufficient, and there is a lack of attention paid to the condition in psychology research due in part to moral injury’s absence in the DSM 5. Moral injury has been erroneously conceptualized as an element of PTSD, and is commonly treated by trauma-processing modalities that, while effective in trauma-focused treatment, are ineffective in reducing symptoms of moral injury. The present article details how Positive Psychology interventions may be effective in the treatment of moral injury (heretofore untested and unexplored), and is a call for such research to be conducted.

Examine characteristics associated with increased odds of nonfatal suicidal behaviors among former active-duty servicemembers (F-ADSM) using data from the 2013–2019 National Survey on Drug Use and Health (NSDUH). F-ADSM were respondents who reported being separated/retired from the military and previously serving on active-duty. For each outcome of interest (suicidal ideation, made a suicide plan, made a suicide attempt), we used multivariable logistic regression with backwards elimination to identify characteristics with statistically significant associations. In the 12 months preceding the survey, 3.6% of F-ADSM reported suicidal ideation, 1.0% reported making a plan, and 0.3% reported making a suicide attempt. There were increased odds of self-reported suicide attempts among F-ADSM who were female; aged 18–49 years; non-Hispanic black; gay or bisexual; divorced/separated or widowed; not employed; in poverty; binged alcohol in the past month; or ever had a major depressive episode. Suicide can be prevented through a comprehensive, upstream approach addressing veteran’s holistic needs to prevent them from becoming suicidal in the first place, and support veterans at increased risk.

Pain education programming is considered one avenue of treatment for comorbid chronic pain and mental health disorders. The purpose of the current single group, longitudinal ex post facto study was to determine whether participation in a pain education program would decrease symptoms on psychiatric and functional disability domains using emerging screening measures. A sample of 90 Veterans participated in a pain education program at a Midwestern VA Medical Center between November 1, 2013 and October 31, 2014. The Pain Education School program is a comprehensive program that is open to all Veterans and introduces them to different modalities that deal with chronic pain available in the VA hospital. All participants completed pre- and post-education screening measures. Paired-samples t-tests were conducted to evaluate the impact of the pain education program on Veterans’ scores on these measures. The current study found a significant difference in depression (p=.005; d=.18), mobility (p=.000; d=.47), social participation (p=.001; d=.30), and total functional disability scores (p=.001; d=.30) upon completion of the program. The current study serves as a model of how to use emerging screening measures and education programming to enhance clinical practice and decision-making to better address Veterans’ needs.

Parents influence their child’s positive development, and this is especially true during early childhood. In military families, the largest percentage of children are between 0 and 5 years old, and there is growing interest in developing and disseminating parent-focused interventions that target this age range for military parents. The present study examines the feasibility and proof-of-concept of the universal, web-based, Take Root parenting program, which was designed to empower military and civilian parents with a 0- to 3-year-old child in their parenting role and support positive child development. Seventy-nine participants were recruited from two Armed Services YMCA locations in fall 2019 and summer 2020. Results indicate that executing the research protocol and implementing the program among military families with young children were feasible. Further, significant pre- to post-changes in self-reports of parenting efficacy, mindful relaxation, and family functioning were found; however, when a Bonferroni-Holm correction was applied to account for multiple testing, only parenting efficacy remained significant. Collectively, the favorable results indicate the potential usefulness of Take Root for military families with young children and support the need for further, more rigorous evaluations of the program.

The spouses of military members experience frequent geographic mobility, absences, risk, and other lifestyle dimensions that may cause a greater need for mental health services and barriers to their use, relative to civilians. This was a retrospective, matched cohort study of female spouses of Canadian Armed Forces (CAF) members posted between 04/01/2008 and 03/31/2013 with follow-up to 03/31/2017. 3,358 military-connected spouses were identified and 13,342 civilians matched 4:1 on age, sex, and region of residence. Psychiatric hospitalizations and emergency department (ED) visits, psychiatrist visits, and mental health-related primary care visits were studied. Almost one third of spouses of CAF members visited a family physician for mental health reasons, while a minority visited an ED, a psychiatrist or were hospitalized. Spouses of CAF members were as likely to see a primary care physician, less likely to visit a psychiatrist, visited all measured outpatient sources of mental health services less frequently than the general population and had a longer interval to their first psychiatrist visit than the general population. Information on how mental health services are accessed in the public health system are critical to understanding pathways of care, and the planning and delivery of mental health services to military-connected families.

A growing recognition of the importance of resilience skills for psychological health and optimal performance has led to the development of a wide array of resilience trainings. Across the military, resilience training has been implemented by military personnel and training experts. To date, no direct assessment of the comparative efficacy of instructor type on training outcomes has been conducted. To that end, we conducted a program evaluation that examined differences in the efficacy of a two-hour resilience training course for new recruits in Basic Combat Training on resilience-focused knowledge and skills as a function of instructor specialization. Soldiers (n = 401) received training from either a training specialist or a drill sergeant. Findings revealed that soldiers’ knowledge and perceived resilience skills improved regardless of instructor type. Soldiers preferred training specialists to drill sergeants; however, soldiers who received training from drill sergeants had greater improvements in knowledge as compared to soldiers instructed by training specialists. Soldiers with high levels of pre-training resilience who received training from drill sergeants showed the greatest improvements in knowledge. We conclude that drill sergeants, when provided with train-the-trainer preparation by subject matter experts, can efficaciously provide resilience training to new Army recruits during Basic Combat Training.

Prior to the integration of Intensive Outpatient Programs (IOPs) into the U.S Army Behavioral Health Service Line (BHSL) in 2015, very few military IOPs existed to meet the unique needs of active-duty service members. As a director and clinician of the gold-standard Western region military IOP, it is imperative to share first-hand experiences and expertise with the scientific community so that it can be used as a template for the future establishment of IOPs. Along with these first-hand experiences and expertise, evidentiary support from current research on best practices for operating Military IOPs is offered. It is noteworthy to mention that from the inception of this Western region military IOP in 2010 to the present, treatment outcomes have been maintained and analyzed to substantiate the clinical benefits of this program. These clinical outcome measures were the determining factor used by U.S. Army MEDCOM to substantiate IOPs as a BHSL. This IOP provides fiscally cost-effective treatment and decreases the length of hospitalization time resulting in lowered fiscal expenses. Furthermore, a rationale and analysis for the utilization of dialectical behavior therapy, cognitive processing therapy, and complimentary alternative medicine as treatment modalities in current IOP is justified. Along with the above topics, this article also reviews the relevancy and benefits of group therapy as a viable intervention in the context of military culture and group cohesion.

High rates of alcohol use have been documented within military personnel and spouses. However, scant research has investigated alcohol consumption behaviors in matched couples or nonclinical veteran samples. The manner in which couples influence one another’s drinking remains unclear. The current study examined hazardous drinking scores and drinking behaviors in a sample of post-9/11 separated service members (most of whom were veterans) and active duty reservists and their spouse/partners; 260 military-connected couples participated in the Study for Employment Retention of Veterans (SERVe) and were recruited from 35 workplace organizations in the Pacific Northwest. Participants completed baseline and daily surveys on alcohol consumption over the span of 32 days. Among study highlights, Actor–Partner Interdependence Models (APIM) revealed actor effects for psychological distress predicting alcohol use variables. Significant partner effects were also revealed for hazardous drinking (AUDIT) scores predicting subsequent alcohol use, over and above actor (i.e., within-person) effects of those relationships. Higher levels of subsequent drinking frequency and quantity were evident among partners of veterans with higher hazardous drinking scores. Spouses with higher hazardous drinking scores were associated with veteran partners who drank more frequently. Results shed light on how military-connected couples, particularly those engaging in hazardous drinking, uniquely influence one another’s alcohol consumption behaviors. Ultimately, findings highlight the importance of including spouses of veterans to elucidate the interplay of drinking behaviors within military-connected couples.

The most stressful phase of deployment for military families with young children is pre-deployment; they are often overlooked in family preparation strategies. Failure to prepare young children may put them at risk for disrupted attachment and it can increase parenting stress. Preparing young children for deployment could buffer the potential negative impact by reducing associated parenting stress and empowering parents with attachment-strengthening strategies. Telephone-based interventions are the preferred method of service delivery among military families. The current study randomly assigned (N = 13) mothers of children who were under age five, to either a control group (n = 6) or to a telephone-administered pre-deployment parent coaching program (n = 7). Parent coaching was comprised of two content modules and two follow-up calls. Feasibility analysis of the assessment and implementation procedures are provided. There were large effect sizes for reduced parenting stress and increased parenting competence and emotion regulation. Between subjects comparisons found small and medium effect sizes for the parenting coaching compared to controls on number and intensity or parenting hassles. Preliminary data are promising, suggesting that investigation of the parent coaching program with larger samples is possible.