Sleep problems and physical pain as moderators of the relationship between PTSD symptoms and aggression in returning veterans.

OBJECTIVE: This study investigated sleep problems and physical pain as moderators of the relationship between PTSD symptoms and aggression among returning veterans. Prior research has demonstrated associations between PTSD symptoms and aggression, but little work has sought to identify moderators of this relationship. Sleep problems and physical pain are both common clinical problems among veterans and have theoretical links to aggression. METHOD: Participants were 103 returning service members and veterans recruited from the greater Boston area and enrolled in the VA Translational Research Center for Traumatic Brain Injury (TBI) and Stress Disorders (TRACTS). Aggression outcomes included physical and psychological intimate partner aggression (IPA), as well as physical and psychological general aggression (GA). Variables were measured via self-report questionnaires, with the exception of PTSD symptoms, which were assessed via clinician interview. RESULTS: Bivariate correlations revealed significant associations between PTSD symptoms, sleep problems, physical pain, and aggression outcomes. Both sleep problems and physical pain significantly moderated the relationship between PTSD symptoms and physical GA, such that this relationship became stronger at higher levels of these moderator variables. However, moderation was not found for the other aggression outcomes. CONCLUSIONS: Findings suggest that sleep problems and physical pain strengthen the relationship between veterans' PTSD symptoms and physical aggression toward others. Although further replication and elucidation is needed, these factors may disinhibit aggression among those at higher risk due to their PTSD symptoms. (PsycINFO Database Record

Social skills deficits as a mediator between PTSD symptoms and intimate partner aggression in returning veterans.

This study examined social skills deficits as a mediator of the relationship between posttraumatic stress disorder (PTSD) symptoms and use of intimate partner aggression (IPA) among returning veterans. Prior research with veterans has focused on PTSD-related deficits at the decoding stage of McFall's (1982) social information processing model, and the current study adds to this literature by examining social skills deficits at the decision stage. Participants were 92 male veterans recruited from the greater Boston area. PTSD symptoms were assessed through clinician interview, IPA use was assessed through self- and partner report, and social skills deficits were assessed in a laboratory task in which veterans listened to a series of problematic marital situations and responded with what they would say or do in the situation. Responses were coded for social competency. Bivariate correlations revealed several significant associations among PTSD symptoms, social skills deficits, and use of IPA. When all PTSD symptom clusters were entered into a regression predicting social skills deficits, only emotional numbing emerged as a unique predictor. Finally, social skills deficits significantly mediated the relationship between veterans' PTSD symptoms and use of psychological (but not physical) IPA. Findings extend prior research on McFall's (1982) social information processing model as it relates to veterans' PTSD symptoms and use of IPA. More research is needed to understand the associations between PTSD symptoms and deficits at each individual step of this model. (PsycINFO Database Record

Mistrust of others as a mediator of the relationship between trauma exposure and use of partner aggression.

OBJECTIVE: Prior research indicates a connection between the experience of trauma and use of intimate partner aggression (IPA), but little work has focused on core cognitive schemas that can be influenced by trauma. In the current study, we examine the cognitive schema of mistrust in others as a mediator of the relationship between trauma exposure and IPA use. This schema may lead to IPA through distorted social information processing that can escalate relationship conflict. METHOD: The sample consisted of 83 heterosexual community couples. All variables were assessed via written questionnaires, and IPA frequency was calculated by incorporating both partners' reports on each member of the couple. RESULTS: For males, mistrust significantly mediated the relationships between trauma exposure and both physical and psychological IPA use. For females, mistrust did not mediate the significant relationship between trauma exposure and IPA use. In analyses using the actor-partner interdependence model, both actor and partner mistrust uniquely predicted physical and psychological IPA use. CONCLUSIONS: The findings of the study suggest the importance of examining core schemas that may underlie trauma reactions and use of IPA. (PsycINFO Database Record

Social Information Processing in Anger Expression and Partner Violence in Returning U.S. Veterans.

We examined social information processing factors that could represent pathways through which posttraumatic stress disorder (PTSD) symptoms relate to anger expression and intimate partner violence (IPV) perpetration in returning U.S. veterans. The sample included 92 male Operation Enduring Freedom/Operation Iraqi Freedom veterans, primarily Caucasian (77.4%), with smaller numbers of African American, Asian, Hispanic or Latino, American Indian or Alaskan Native, and other minority participants (9.7%, 2.2%, 2.2%, 3.2%, and 5.3% respectively). The average age was 40.37 (SD = 9.63) years. Data were collected through self-report questionnaires (PTSD Checklist, State-Trait Anger Expression Scale, Revised Conflict Tactics Scales) and the Articulated Thoughts in Simulated Situations experimental protocol. Laboratory-based assessment of cognitive biases and hostile attributions were tested as mediators of associations between PTSD symptoms and anger expression and IPV. Among the PTSD symptom clusters, hyperarousal symptoms were most strongly associated with anger expression (r = .50) and IPV perpetration (r = .27). Cognitive biases mediated associations between PTSD total scores and 3 of 4 PTSD cluster scores as well as anger expression. Hostile attribution biases were also associated with IPV perpetration (r = .23). We discuss the implications of these findings for understanding social information processing mechanisms for the relationship between PTSD symptoms and aggression.

Examining intimate partner aggression assessment among returning veterans and their partners.

There is a growing research base focusing on intimate partner aggression (IPA) in combat veterans, although little work has focused on IPA assessment. In the current study, the authors investigated IPA assessment among 65 male Operation Iraqi Freedom (OIF) and Operation Enduring Freedom (OEF) combat veterans and their female partners. Specifically, we compared overall levels of veteran- and partner-perpetrated IPA, conducted concordance analyses to examine the degree of interpartner agreement on IPA occurrence and frequency, and investigated both veterans' and partners' relationship satisfaction and posttraumatic stress disorder (PTSD) symptoms as correlates of concordance. Results indicated that female partners perpetrated higher levels of physical IPA than did the male veterans, according to both veteran and combined reports. Concordance analyses revealed low to moderate levels of agreement between veterans and their partners on the perpetration of physical and psychological IPA, with particularly low agreement on the veterans' physical IPA. Female partners' relationship satisfaction was associated with reporting less of the veterans' and their own IPA relative to the veterans' reports, and their PTSD symptoms were associated with reporting more of the veterans' and their own IPA. In contrast, the veterans' PTSD symptoms were associated with reporting less of their own IPA relative to their partners' reports. The findings emphasize the need for those researching and treating IPA among military couples to assess IPA perpetrated by both members of the relationship and to consider possible factors that might impact the accuracy of IPA reporting.

Examining gender differences in the relationship between dating violence victimization and anger in college students.

It has been well established that dating violence victimization is associated with various mental health problems. Relatively, little is known about similarities and differences between mental health correlates of dating violence victimization for males and females. We examined the associations between physical and psychological victimization experiences and measures of anger in a sample of 200 male and female undergraduates. Results suggest that men's victimization was more strongly associated with different forms of anger than women's victimization.

Physical abuse of older adults in nursing homes: a random sample survey of adults with an elderly family member in a nursing home.

Few empirical studies have focused on elder abuse in nursing home settings. The present study investigated the prevalence and risk factors of staff physical abuse among elderly individuals receiving nursing home care in Michigan. A random sample of 452 adults with elderly relatives, older than 65 years, and in nursing home care completed a telephone survey regarding elder abuse and neglect experienced by this elder family member in the care setting. Some 24.3% of respondents reported at least one incident of physical abuse by nursing home staff. A logistic regression model was used to estimate the importance of various risk factors in nursing home abuse. Limitations in activities of daily living (ADLs), older adult behavioral difficulties, and previous victimization by nonstaff perpetrators were associated with a greater likelihood of physical abuse. Interventions that address these risk factors may be effective in reducing older adult physical abuse in nursing homes. Attention to the contextual or ecological character of nursing home abuse is essential, particularly in light of the findings of this study.

Elder abuse in nursing homes: an ecological perspective.

Population trends suggest that the next 20 years will witness a dramatic increase in the adult population aged 65 and older. Projected increases in the elderly population are expected to significantly increase the stress on family and professional caretakers. Stress, in the context of caregiving relationships, is a risk factor associated with increased prevalence of elder abuse in familial and institutional settings. As increasing numbers of older adults are moved from family caregiving to nursing home care settings, it becomes important to identify the pattern of elder abuse risk factors in nursing home facilities. An ecological model is proposed for better understanding the risk factors associated with elder abuse in nursing homes and the complex interaction of individual/person characteristics and contextual factors in institutional elder abuse. An ecological perspective to institutional elder abuse provides a framework for guiding and informing future research on the risk factors of nursing home abuse and, in turn, for the development of effective interventions and relevant social policies.

Neglect of older adults in Michigan nursing homes.

Although research on domestic elder abuse and neglect has grown over the past 20 years, there is limited research on elder neglect in nursing homes. The purpose of this study is to estimate the incidence of elder neglect in nursing homes and identify the individual and contextual risks associated with elder neglect. Data came from a 2005 random digit dial survey of individuals in Michigan who had relatives in long term care. Our analytic sample included 414 family members who had a relative aged 65 or older in nursing homes. Results showed that about 21% of nursing home residents were neglected on one or more occasion in the last 12 months. Two nursing home residents' characteristics reported by family members appear to significantly increase the odds of neglect: functional impairments in activities of daily living and previous resident-to-resident victimization. Behavior problems also are associated with higher odds of neglect (p = 0.078). Policy implications of these results are discussed.

Intimate partner and general aggression perpetration among combat veterans presenting to a posttraumatic stress disorder clinic.

This study examined rates and correlates of intimate partner and general aggression perpetration among 236 male combat veterans seeking services in a Veteran's Affairs posttraumatic stress disorder (PTSD) clinic. Approximately 33% of those in an intimate relationship reported perpetrating partner physical aggression in the previous year, and 91% reported partner psychological aggression. Comparable rates were found for general aggression perpetration among partnered and nonpartnered veterans. PTSD symptoms as well as symptoms of depression were associated with aggression across subgroups and forms of aggression, and PTSD symptoms reflecting arousal and lack of control were generally the strongest predictor of aggression. Findings indicate a need for additional aggression screening and intervention development for this population, and highlight the targeting of heightened arousal and lack of behavioral control in aggression interventions.