Women Veterans' Experiences of Intimate Partner Violence and Non-Partner Sexual Assault in the Context of Military Service: Implications for Supporting Women's Health and Well-Being.

Women who have served in the military in the United States experience high rates of intimate partner violence (IPV) and non-partner sexual assault (SA). The military setting presents challenges and opportunities not experienced in other employment contexts that may compound the negative impacts of IPV/SA on women's lives. The purpose of this study was to explore the intersection of women's experiences of IPV/SA and military service through analysis of women veterans' narrative accounts. We conducted in-depth face-to-face qualitative interviews with 25 women veterans receiving primary care at a U.S. Veterans Affairs Medical Center. We draw upon Adler and Castro's (2013) Military Occupational Mental Health Model to frame our understanding of the impact of IPV/SA as a stressor in the military cultural context and to inform efforts to prevent, and support women service members who have experienced, these forms of violence. Our findings highlight the impact of IPV/SA on women's military careers, including options for entering and leaving military service, job performance, and opportunities for advancement. Women's narratives also reveal ways in which the military context constrains their options for responding to and coping with experiences of IPV/SA. These findings have implications for prevention of, and response to, intimate partner or sexual violence experienced by women serving in the military and underscore the need for both military and civilian communities to recognize and address the negative impact of such violence on women service members before, during, and after military service.

Intimate partner violence, unhealthy alcohol use, and housing instability among women veterans in the Veterans Health Administration.

Women U.S. military veterans face particularly high rates of homelessness, which may be associated with psychosocial experiences including unhealthy alcohol use and experience of intimate partner violence (IPV). In this study, we examined clinical social health screening data to assess the association between housing instability and (a) experience of past-year IPV victimization, and (b) unhealthy alcohol use among 554 women receiving primary care from the Veterans Health Administration. Approximately 12% of patients screened reported housing instability. Experience of past-year IPV was associated with increased risk of housing instability (OR = 2.10, 95% CI [1.16, 3.81]), with 1 in 5 women screening positive for IPV also reporting housing concern. There was no statistically significant association between current unhealthy alcohol use and housing instability. Findings hold implications for addressing potential housing concerns among women VA patients. (PsycINFO Database Record

Timing of Intimate Partner Violence in Relationship to Military Service Among Women Veterans.

Women U.S. military veterans report higher rates of lifetime intimate partner violence (IPV) compared with women who have never served in the military. However, we know little about the timing of IPV exposure relative to military service. To begin to understand the relationship between military service and IPV experience, we conducted surveys with 249 women military veterans seeking care at a Veterans Affairs medical center about experiences of physical, psychological, and sexual IPV before, during, and after military service. Additionally, we examined the association between deployment and IPV experience during and after military service. Findings indicated that women experienced IPV during each time period (before/during/after military service), with significant overlap of experiencing IPV during more than one time period and one-third (34.6%) experiencing IPV during all three time periods. Compared to those who were not deployed, women who had been deployed reported increased odds of experiencing psychological, but not physical or sexual, IPV during (but not after) military service. Implications of study findings for theory, research, and practice are discussed.

Women Veterans' Pathways to and Perspectives on Veterans Affairs Health Care.

BACKGROUND: We examined Veterans Affairs (VA) health care experiences among contemporary women veteran patients receiving care at a VA medical center. Specifically, we examined women veteran patients' satisfaction with VA care along dimensions in line with patient-centered medical home (patient-aligned care teams [PACT] in VA) priorities, and pathways through which women initially accessed VA care. METHODS: We used a mixed methods research design. First, 249 racially diverse women (ages 22-64) who were past-year users of primary care at a VA medical center completed interviewer-administered surveys in 2012 assessing ratings of satisfaction with care in the past year. We then conducted in-depth qualitative interviews of a subset of women surveyed (n = 25) to gain a deeper understanding of perspectives and experiences that shaped satisfaction with care and to explore women's initial pathways to VA care. RESULTS: Ratings of satisfaction with VA care were generally high, with some variation by demographic characteristics. Qualitative interviews revealed perceptions of care centered on the following themes: 1) barriers to care delay needed medical care, while innovative care models facilitate access, 2) women value communication and coordination of care, and 3) personalized context of VA care, including gender sensitive care shapes women's perceptions. Pathways to VA care were characterized by initial delays, often attributable to lack of knowledge or negative perceptions of VA care. Informal social networks were instrumental in helping women to overcome barriers. CONCLUSIONS: Findings highlight convergence of women's preferences with PACT priorities of timely access to care, provider communication, and coordination of care, and suggest areas for improvement. Outreach is needed to address gaps in knowledge and negative perceptions. Initiatives to enhance women veterans' social networks may provide an information-sharing resource.

Intimate Partner Violence Detection and Care in the Veterans Health Administration: Patient and Provider Perspectives.

BACKGROUND: Women veterans experience high rates of intimate partner violence (IPV), with associated negative health impacts. The Veterans Health Administration (VHA) has recently developed plans to implement routine IPV screening and provide IPV-related follow-up services for VHA patients. Previous research has examined barriers and facilitators to health care provider screening for IPV. The next step is to examine patients' disclosure of IPV experiences to health care providers and effective response to such disclosures. We sought to identify VHA patients' and providers' perspectives on how to facilitate effective IPV detection and care in VHA. METHODS: We conducted semistructured, qualitative interviews with 25 female veteran patients and 15 VHA health care providers. We used an inductive approach to analyzing interview transcripts and identifying themes that constituted study findings. RESULTS: Themes fell in to two broad categories: 1) barriers to disclosure and 2) barriers to an adequate response to disclosure and providing follow-up care. Barriers to disclosure of IPV to health care providers included lack of provider inquiry, lack of comfort, and concerns about the consequences of disclosure and lack of privacy. Patients and providers both indicated a need for expanded resources to respond to IPV in VHA. CONCLUSIONS: Findings support current plans for IPV program implementation in VHA and point to recommendations for practice and implications for further research.

Brief report: Executive functions in adolescent offspring of mothers with a history of depression.

Deficits in executive functions (EFs) have been documented among individuals with unipolar depression, but controversy exists as to whether such deficits are state-dependent or are trait markers that precede disorder onset. The present study examined whether maternal history of unipolar depression was associated with deficits in EFs in early adolescent offspring, a finding that would support a trait marker conceptualization of EF deficits. Participants were a diverse sample (N = 493) of adolescents and their mothers recruited through local schools. Measures included semi-structured diagnostic interviews of mother and adolescent, mother-report forms assessing demographic information, and tests of executive function. Hierarchical linear regression analyses were conducted to examine the association between maternal depression diagnosis and adolescent offspring performance on tests of EF. Maternal lifetime history of depression was not associated with offspring EF task performance. Findings are not consistent with the conceptualization of impaired executive functions as trait markers of unipolar depression.

Trait rumination, depression, and executive functions in early adolescence.

Although deficits in executive functions have been linked with both depression and rumination in adulthood, the nature of the relationship between these constructs is not well understood and remains understudied in adolescence. The present study examined the relationship of rumination and depression to deficits in executive functions in early adolescence, a critical developmental period for the emergence of depression and rumination and the development of executive functions. Participants were 486 early adolescents (52.7% female; 47.1% African American, 48.8% Caucasian; 4.2% Biracial/Multiracial/Other; M age = 12.88 years; SD = .62) and their mothers, recruited through local schools. Measures included (a) a semi-structured diagnostic interview of the mother and adolescent, (b) youth self-report forms assessing depressive symptoms and trait rumination, (c) mother-report forms assessing demographic information, and (d) behavioral tests of executive function (sustained, selective and divided attention, attentional set shifting, and working memory). Gender moderated rumination-set shifting associations, such that rumination predicted better set shifting in boys only. The current level of depressive symptoms moderated rumination-sustained attention associations, such that rumination predicted better sustained attention in those with low levels of depressive symptoms and worse sustained attention in those with high levels of depressive symptoms. Rumination did not predict performance on other measures of executive functions. Likewise, depressive symptoms and diagnosis were not associated with executive functions. Implications for future research are discussed.

Rumination prospectively predicts executive functioning impairments in adolescents.

BACKGROUND AND OBJECTIVES: The current study tested the resource allocation hypothesis, examining whether baseline rumination or depressive symptom levels prospectively predicted deficits in executive functioning in an adolescent sample. The alternative to this hypothesis was also evaluated by testing whether lower initial levels of executive functioning predicted increases in rumination or depressive symptoms at follow-up. METHODS: A community sample of 200 adolescents (ages 12-13) completed measures of depressive symptoms, rumination, and executive functioning at baseline and at a follow-up session approximately 15 months later. RESULTS: Adolescents with higher levels of baseline rumination displayed decreases in selective attention and attentional switching at follow-up. Rumination did not predict changes in working memory or sustained and divided attention. Depressive symptoms were not found to predict significant changes in executive functioning scores at follow-up. Baseline executive functioning was not associated with change in rumination or depression over time. CONCLUSIONS: Findings partially support the resource allocation hypothesis that engaging in ruminative thoughts consumes cognitive resources that would otherwise be allocated towards difficult tests of executive functioning. Support was not found for the alternative hypothesis that lower levels of initial executive functioning would predict increased rumination or depressive symptoms at follow-up. Our study is the first to find support for the resource allocation hypothesis using a longitudinal design and an adolescent sample. Findings highlight the potentially detrimental effects of rumination on executive functioning during early adolescence.

To do it or to let an automatic tool do it? The priority of control over effort.

The aim of the present study is to provide experimental data relevant to the issue of what leads humans to use automatic tools. Two answers can be offered. The first is that humans strive to minimize physical and/or cognitive effort (principle of least effort). The second is that humans tend to keep their perceived control over the environment (principle of more control). These two factors certainly play a role, but the question raised here is to what do people give priority in situations wherein both manual and automatic actions take the same time - minimizing effort or keeping perceived control? To answer that question, we built four experiments in which participants were confronted with a recurring choice between performing a task manually (physical effort) or in a semi-automatic way (cognitive effort) versus using an automatic tool that completes the task for them (no effort). In this latter condition, participants were required to follow the progression of the automatic tool step by step. Our results showed that participants favored the manual or semi-automatic condition over the automatic condition. However, when they were offered the opportunity to perform recreational tasks in parallel, the shift toward manual condition disappeared. The findings give support to the idea that people give priority to keeping control over minimizing effort.

Number of childhood abuse perpetrators and the occurrence of depressive episodes in adulthood.

OBJECTIVE: Although past research has documented a link between adverse childhood experiences - particularly childhood emotional (CEA), physical (CPA), and sexual abuse (CSA) - and depression, relatively few studies have examined the unique impact of each of these highly co-occurring abuse types. Moreover, relatively little is known about the specific aspects of abuse experiences that increase risk for depression (e.g., number of perpetrators). The current study provides a conservative test of the association between the number of CEA, CPA, and CSA perpetrators, and depressive episodes in adulthood. METHOD: Two hundred and ninety-nine participants were followed longitudinally for 2.5 years. CEA, CPA, and CSA were measured using the Lifetime Experiences Questionnaire, and depressive episodes were assessed with diagnostic interviews administered every 6 weeks. RESULTS: After statistically controlling for the influence of cognitive risk for depression, baseline depressive symptoms, past history of clinical depression, and total number of different types of CEA, CSA, and CPA events, the number of CEA and CSA, but not CPA, perpetrators were uniquely associated with the number of depressive episodes experienced over the prospective follow-up. CONCLUSIONS: These results indicate that experiencing CEA and CSA from multiple perpetrators increased risk for clinical depression beyond what is accounted for by the total number of types of abuse experiences. This study highlights the need for future research to assess the specific qualities of childhood abuse experiences that uniquely confer risk for clinical depression, as well as possible mechanisms through which they exert their deleterious effect.

High Behavioral Approach System (BAS) sensitivity, reward responsiveness, and goal-striving predict first onset of bipolar spectrum disorders: a prospective behavioral high-risk design.

A prospective, behavioral high-risk design provided a theoretically guided examination of vulnerability to first onset of bipolar spectrum disorder based on the Behavioral Approach System (BAS) model. Adolescents (ages 14-19) at an "age of risk" for bipolar disorder onset were screened on BAS sensitivity by interviewers blind to current symptoms, lifetime history, and family history of psychopathology. Participants were selected with high versus moderate levels of BAS sensitivity and administered a lifetime diagnostic interview. Those with a bipolar spectrum disorder, psychosis, or hypomanic episode with onset prior to the BAS sensitivity assessment were excluded. High BAS (n = 171) and moderate BAS (n = 119) sensitivity participants in the final sample completed baseline measures of symptoms, goal-setting, and reward responsiveness and were followed prospectively with semistructured diagnostic interviews every 6 months. Consistent with the vulnerability hypothesis of the BAS model of bipolar disorder, high BAS participants had a greater likelihood, and shorter time to onset, of bipolar spectrum disorder than moderate BAS participants across an average of 12.8 months of follow-up (12.9% vs. 4.2%), controlling for baseline depressive and hypomanic symptoms, and family history of bipolar disorder. High reward responsiveness on a behavioral task and ambitious goal-striving for popular fame and financial success (but not impulsivity) also predicted first onset of bipolar spectrum disorder controlling for the covariates and BAS risk group, and ambitious goal-striving partially mediated the BAS risk group effect. We discuss implications of the findings for the BAS model of bipolar disorder and early intervention efforts.

An experiential avoidance conceptualization of depressive rumination: three tests of the model.

This study examined an experiential avoidance conceptualization of depressive rumination in 3 ways: 1) associations among questionnaire measures of rumination, experiential avoidance, and fear of emotions; 2) performance on a dichotic listening task that highlights preferences for non-depressive material; and 3) psychophysiological reactivity in an avoidance paradigm modeled after the one used by Borkovec, Lyonfields, Wiser, and Deihl (1993) in their examination of worry. One hundred and thirty-eight undergraduates completed questionnaire measures and participated in a clinical interview to diagnose current and past episodes of depression. Of those, 100 were randomly assigned to a rumination or relaxation induction condition and participated in a dichotic listening task, rumination/relaxation induction, and depression induction. Questionnaire measures confirmed a relationship between rumination status and avoidance; however, no significant effects were found in the dichotic listening task. Psychophysiological measures indicated no difference in physiological response to a depression induction among high ruminators (HR). However, low ruminators (LR) in the relaxation condition exhibited a larger IBI response than LR in the rumination condition. Overall, these results provide partial support for an avoidance conceptualization of depressive rumination. Implications of these findings are discussed.

Bipolar spectrum-substance use co-occurrence: Behavioral approach system (BAS) sensitivity and impulsiveness as shared personality vulnerabilities.

Bipolar disorders and substance use disorders (SUDs) show high co-occurrence. One explanation for this co-occurrence may be common personality vulnerabilities involved in both. The authors tested whether high behavioral approach system (BAS) sensitivity and impulsiveness are shared personality vulnerabilities in bipolar spectrum disorders and substance use problems and their co-occurrence in a longitudinal study of 132 individuals on the bipolar spectrum and 153 control participants. At Time 1, participants completed the Behavioral Inhibition System/BAS Scales and the Impulsive Nonconformity Scale. Substance use problems were assessed via the Michigan Alcoholism Screening Test and the Drug Abuse Screening Test at 4-month intervals for 1 year. Participants with bipolar disorder had higher rates of lifetime SUDs and substance use problems during the follow-up, relative to control participants. In line with hypotheses, higher BAS sensitivity and impulsiveness predicted bipolar status and increased substance use problems prospectively. BAS total, BAS Fun Seeking, and impulsiveness mediated the association between bipolar spectrum status and prospective substance use problems, with impulsiveness as the most important mediator. High BAS sensitivity and impulsiveness may represent shared personality vulnerabilities for both disorders and may partially account for their co-occurrence.

Longitudinal Predictors of Bipolar Spectrum Disorders: A Behavioral Approach System (BAS) Perspective.

We review longitudinal predictors, primarily psychosocial, of the onset, course, and expression of bipolar spectrum disorders. We organize our review along a proximal - distal continuum, discussing the most proximal (i.e., prodromes) predictors of bipolar episodes first, then recent environmental (i.e., life events) predictors of bipolar symptoms and episodes next, followed by more distal psychological (i.e., cognitive styles) predictors, and ending with the most distal temperament (i.e., Behavioral Approach System sensitivity) predictors. We then present a theoretical model, the Behavioral Approach System (BAS) dysregulation model, for understanding and integrating the role of these predictors of bipolar spectrum disorders. Finally, we consider the implications of the reviewed longitudinal predictors for future research and psychosocial treatments of bipolar disorders.

The role of self-criticism, dependency, and hassles in the course of depressive illness: a multiwave longitudinal study.

The current study utilized a multiwave longitudinal design to examine whether dependency and/or self-criticism influence the course of depressive symptoms in a community sample of adults with a history of major depression. In addition, the authors examined whether self-esteem serves as a buffer against the development of depressive symptoms following increases in hassles in individuals possessing such traits. At Time 1, 102 participants completed measures assessing depressive symptoms, self-criticism, dependency, and self-esteem. Every 6 weeks for the next year, participants completed measures assessing depressive symptoms and hassles. High self-criticism was associated with greater elevations in depressive symptoms following elevations in hassles in low but not high-self-esteem individuals. Results with respect to dependency, however, were contrary to hypotheses. High dependency was associated with elevations in depressive symptoms following elevations in hassles in high-self-esteem individuals. In contrast, high dependency was associated with chronically elevated depressive symptoms in low-self-esteem individuals.