Melissa Polusny | University of Minnesota - Twin Cities (original) (raw)

Papers by Melissa Polusny

Research paper thumbnail of PTSD symptom clusters associated with physical health and health care utilization in rural primary care patients exposed to natural disaster

Journal of Traumatic Stress, 2008

This study investigated the influence of exposure to a tornado disaster and disaster-related post... more This study investigated the influence of exposure to a tornado disaster and disaster-related posttraumatic stress disorder (PTSD) symptomatology on physical health complaints and primary health care utilization among rural medical patients. One-hundred five patients completed self-report measures assessing disaster exposure, PTSD symptoms, and self-reported physical health complaints. Objective rates of health care utilization were gathered by a review of medical records. Tornado disaster exposure and generalized psychological distress were associated with physical health complaints one year following the disaster. After controlling for age, gender, and levels of predisaster health care utilization, PTSD Cluster C (avoidance) symptoms were associated with increased rates of postdisaster health care utilization. Implications of these findings for interventions within the medical system are discussed.

Research paper thumbnail of Predictors of Behavior and Level of Life Satisfaction of Children and Adolescents After a Major Tornado

Journal of Psychological Trauma, 2008

Data were collected on students in Grades 3 to 12 regarding their reactions to a major F4 tornado... more Data were collected on students in Grades 3 to 12 regarding their reactions to a major F4 tornado, which caused damage to their town in southern Minnesota. The purpose of this study was to examine some of the factors (i.e., level of exposure to the disaster, posttraumatic stress disorder symptoms, and home relocation) that may help predict behavioral problems and life satisfaction after a major tornado. The disruption of relocating to a new home after the tornado was associated with higher levels of internalizing behavior problems for children in Grades 3 to 6 and higher levels of externalizing behavior problems for adolescents in Grades 7 to 12. Increased exposure to the tornado was significantly associated with high levels of life satisfaction. Implications of these findings and directions for future research are discussed.

Research paper thumbnail of Assessment and Treatment of Concurrent Posttraumatic Stress Disorder and Substance Abuse

Research paper thumbnail of The distinctiveness of hardiness, positive emotionality, and negative emotionality in National Guard soldiers

Journal of Research in Personality, 2011

Exploratory and confirmatory factor analyses were used to investigate the distinctiveness of hard... more Exploratory and confirmatory factor analyses were used to investigate the distinctiveness of hardiness (using the Short Hardiness Scale; Bartone, 1995) from the broader personality traits of negative emotionality and positive emotionality (NEM and PEM; assessed with items from the MMPI-2 PSY-5 scales); in a sample of 981 Army National Guard soldiers. Exploratory factor analyses demonstrated that hardiness items loaded on a separate factor from PEM and NEM items, and confirmatory factor analysis suggested that hardiness is not simply a sub-facet of either PEM or NEM. However, subsequent regression analyses found that hardiness did not predict symptoms of PTSD or depression beyond the effects of PEM and NEM among combat exposed soldiers.

Research paper thumbnail of Posttraumatic Stress Symptoms Among National Guard Soldiers Deployed to Iraq: Associations With Parenting Behaviors and Couple Adjustment

Journal of Consulting and Clinical Psychology, 2010

Objective-This article reports findings from a one-year longitudinal study examining the impact o... more Objective-This article reports findings from a one-year longitudinal study examining the impact of change in PTSD symptoms following combat deployment on National Guard soldiers' perceived parenting, and couple adjustment one year following return from Iraq.

Research paper thumbnail of Developing and Applying a Systematic Process for Evaluation of Clinical Outcome Assessment Instruments

Psychological Services, 2004

... Douglas Olson, Mental Health PSL, Minneapolis Veterans Administration Medical Center Departme... more ... Douglas Olson, Mental Health PSL, Minneapolis Veterans Administration Medical Center Department of Psychology, University of Minnesota, Twin Cities Campus. The contents of this article are in the public domain. CITATION. ...

Research paper thumbnail of Helping Military Families Through the Deployment Process: Strategies To Support Parenting

Professional Psychology-research and Practice, 2011

Recent studies have highlighted the impact of deployment on military families and children and th... more Recent studies have highlighted the impact of deployment on military families and children and the corresponding need for interventions to support them. Historically, however, little emphasis has been placed on family-based interventions in general, and parenting interventions in particular, with returning service members. This paper provides an overview of research on the associations between combat deployment, parental adjustment of service members and spouses, parenting impairments, and children's adjustment problems, and provides a social interaction learning framework for research and practice to support parenting among military families affected by a parent's deployment. We then describe the Parent Management Training-Oregon model (PMTO ™ ), a family of interventions that improves parenting practices and child adjustment in highly stressed families, and briefly present work on an adaptation of PMTO for use in military families (After Deployment: Adaptive Parenting Tools, or ADAPT). The article concludes with PMTO-based recommendations for clinicians providing parenting support to military families.

Research paper thumbnail of Predictors of emotional distress reported by soldiers in the combat zone

Journal of Psychiatric Research, 2010

Objective: Few studies have examined rates of distress of military personnel during deployment to... more Objective: Few studies have examined rates of distress of military personnel during deployment to a war zone. Our study sought to (a) identify rates of self-reported posttraumatic stress disorder (PTSD) and depression symptoms during combat deployment, (b) characterize higher order dimensions of emotional distress experienced by soldiers during deployment, and (c) identify predictors of these dimensions of emotional distress. Method: Participants were 2677 National Guard soldiers deployed as part of Operation Iraqi Freedom in 2006-07. We performed a principal components factor analysis on items of the PTSD Checklist -Military Version and the Beck Depression Inventory to identify dimensions of emotional distress, followed by multiple regression analyses to identify factors that predicted these dimensions of distress. Results: Rates of PTSD and depression in our sample were 7% and 9%, respectively. Five dimensions of emotional distress emerged: negative affect/cognitions, trauma-specific re-experiencing and avoidance, vegetative symptoms, loss of interest/numbing symptoms, and arousal/irritability. Two dimensions, trauma-specific symptoms and arousal/irritability, appeared to be more indicative of trauma sequelae, while the other three dimensions were more indicative of depressive symptoms. Demographic factors, combat exposure (including injury and exposure to explosive blast), and attitudinal variables predicted traumaspecific aspects of distress. Symptoms characteristic of depression or generalized distress were predicted by female gender, recent prior deployment, and attitudinal factors but were not predicted by blast exposure or injury. Conclusions: These findings suggest specific targets for contextual and individual interventions to reduce deployment-related distress and point out the need for longitudinal follow-up to determine long-term implications for post-deployment functioning.

Research paper thumbnail of Does trauma survey research cause more distress than other types of survey research

Journal of Traumatic Stress, 2009

Members of institutional review boards who evaluate trauma research protocols frequently face the... more Members of institutional review boards who evaluate trauma research protocols frequently face the task of balancing potential risk with potential benefit. However, no known study has examined the relative effect of participating in a trauma-related survey compared to participating in a nontrauma survey. The authors randomly assigned participants receiving care in an outpatient PTSD treatment program to complete questionnaires assessing either trauma-related or nontrauma content. Participants completing trauma-related questionnaires reported feeling sadder and more tense than other participants, though they did not report differences in perceived gain from participation or retrospective willingness to participate. Results suggest that level of distress after participating in trauma research was insufficient to reduce willingness for, or perceived benefit from, participation in trauma survey research.

Research paper thumbnail of Prevalence and consequences of adult sexual assault of men: Review of empirical findings and state of the literature

Clinical Psychology Review, 2011

Male victims of adult sexual assault (ASA) are understudied as compared with female victims. Furt... more Male victims of adult sexual assault (ASA) are understudied as compared with female victims. Further, commonly-held myths about sexual assault suggest that men cannot be victims or that, if men are victims, they are relatively physically and emotionally unharmed by sexual assault. The goal of this paper was to systematically review the empirical literature on ASA among men to evaluate the veracity of these myths. This paper also sought to examine the methodological quality of the body of research in this area, identify limitations and gaps in the current literature, and suggest directions for future research. Eighty-seven relevant studies were identified through a systematic review of the literature. The reported prevalence of men's sexual aggression varied widely depending on the methods used and the population studied; some populations (e.g., veterans, prison inmates, and gay and bisexual men) reported higher rates of ASA than men in the general population. Few studies have systematically examined the consequences of male ASA; however, those that have suggest that ASA can have notable adverse physical and psychological consequences for some men.

Research paper thumbnail of The role of cumulative sexual trauma and difficulties identifying feelings in understanding female veterans' physical health outcomes

General Hospital Psychiatry, 2008

Objective: To examine the role of alexithymia (difficulties identifying one's emotions) in unders... more Objective: To examine the role of alexithymia (difficulties identifying one's emotions) in understanding the link between PTSD symptoms and negative health outcomes in sexually victimized female veterans. We hypothesized that having experienced multiple types of sexual trauma across the lifespan, experiencing greater severity of PTSD symptoms, and reporting difficulties in identifying emotions would be associated with increased negative health outcomes. Method: Anonymous cross-sectional survey of a convenience sample of 456 female veterans enrolled in a VA clinic within the prior year. Data collected included demographics, lifetime trauma exposure, psychological and medical symptoms, emotion recognition problems (alexithymia), health-risk behaviors, and health care utilization. Results: A total of 57.5% of participants reported a lifetime history of sexual trauma. After controlling for sexual trauma history, PTSD symptoms, and other well-established predictors of health care utilization in the VA medical system such as pre-disposing, enabling and needbased factors, hierarchical regression analyses showed that alexithymia independently explained unique variance in participants' physical health complaints and in their odds of reporting at least one outpatient urgent care visit in the past year. Conclusions: These data suggest that emotion recognition problems may contribute to poorer health outcomes in sexually traumatized women veterans beyond what is explained by sexual trauma exposure, health risk behaviors and PTSD. Psychological interventions that enhance emotion identification skills for women who have experienced sexual trauma could improve health perceptions and reduce need for acute health care. Published by Elsevier Inc.

Research paper thumbnail of Effects of Parents' Experiential Avoidance and PTSD on Adolescent Disaster-Related Posttraumatic Stress Symptomatology

Journal of Family Psychology, 2011

Despite the importance of family context to adolescents' reactions following disaster, little res... more Despite the importance of family context to adolescents' reactions following disaster, little research has examined the role of parents' functioning on adolescents' disaster-related posttraumatic stress disorder (PTSD) symptoms. Using data from 288 adolescents (ages 12 to 19 years) and 288 parents exposed to a series of severe tornadoes in a rural Midwestern community, this study tested a conceptual model of the interrelationships between individual and parental risk factors on adolescents' disaster-related PTSD symptoms using structural equation modeling. Results showed that the psychological process of experiential avoidance mediated the relationship between family disaster exposure and PTSD for both adolescents and their parents. Parents' PTSD symptoms independently predicted adolescents' PTSD symptoms. Further, parents' postdisaster functioning amplified the effects of adolescent experiential avoidance on adolescents' disaster-related PTSD symptoms. Findings highlight the importance of family context in understanding adolescents' postdisaster reactions. Clinical implications are discussed.

Research paper thumbnail of Psychiatric diagnoses, comorbidity, and functioning in National Guard troops deployed to Iraq

Journal of Psychiatric Research, 2011

Research paper thumbnail of Predictors of alcohol use prior to deployment in National Guard Soldiers

Addictive Behaviors, 2009

a b s t r a c t a r t i c l e i n f o Keywords: Alcohol use Substance use Military PTSD Personality

Research paper thumbnail of The Structure of PTSD Among Two Cohorts of Returning Soldiers: Before, During, and Following Deployment to Iraq

Journal of Abnormal Psychology, 2011

Evidence suggests either a four-factor emotional numbing or dysphoria model likely reflects the u... more Evidence suggests either a four-factor emotional numbing or dysphoria model likely reflects the underlying structure of posttraumatic stress disorder (PTSD). Questions remain as to which of these structures best represents PTSD, how the structure changes with time, the applicability of models to returning veterans, and the validity of the symptom clusters. The present study addresses these questions among two longitudinal samples of National Guard soldiers assessed prior to, during, and following a combat deployment to Iraq. Findings support a four-factor intercorrelated dysphoria model of PTSD that remains stable across samples and time points. Differential associations were observed among PTSD symptom clusters over time and between symptom clusters and both depression and combat exposure, supporting important distinctions between symptom clusters.

Research paper thumbnail of Predeployment gender differences in stressors and mental health among U.S. National Guard troops poised for Operation Iraqi Freedom deployment

Journal of Traumatic Stress, 2010

Increased exposure of women soldiers to combat in current conflicts heightens interest in the que... more Increased exposure of women soldiers to combat in current conflicts heightens interest in the question of whether risk and resilience factors differ for female and male military personnel prior to deployment. The authors examined this question in a panel of 522 National Guard soldiers (462 men and 60 women) poised for deployment to Iraq. Soldiers completed a battery of self-report measures, including the PTSD Checklist, Beck Depression Inventory-II, and scales from the Deployment Risk and Resilience Inventory. Modest differences were observed between women and men on predeployment risk factors and some risk-related correlations with PTSD and depression measures; however, gender did not moderate the associations between hypothesized risk/resilience factors and baseline mental health. Implications for interventions and future research are discussed.

Research paper thumbnail of Assessment of Psychological Distress and Disability After Sexual Assault in Adults

... The base rate for symptom exaggeration or malingering is higher in foren-sic settings than in... more ... The base rate for symptom exaggeration or malingering is higher in foren-sic settings than in general clinical practice and is estimated to be between 14% and 30% by surveyed forensic experts (Lees-Haley, 1992, 1997; Rogers, 1997; Rogers et al., 1994). ...

Research paper thumbnail of Unreliability and Error in the Military's “Gold Standard” Measure of Sexual Harassment by Education and Gender

Journal of Trauma & Dissociation, 2011

The Department of Defense's “gold standard” sexual harassment measure, the Sexual Harassment Core... more The Department of Defense's “gold standard” sexual harassment measure, the Sexual Harassment Core Measure (SHCore), is based on an earlier measure that was developed primarily 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 alternate-forms reliability was significantly worse (a) in soldiers without college experience compared to soldiers with college experience and (b) 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.

Research paper thumbnail of Early mental health treatment-seeking among U.S. National Guard soldiers deployed to Iraq

Journal of Traumatic Stress, 2010

The authors examined rates of and factors associated with postdeployment treatment-seeking in a p... more The authors examined rates of and factors associated with postdeployment treatment-seeking in a panel of 424 National Guard soldiers who spent 16 months in Iraq. Soldiers completed a self-report, mailed survey 3- to 6-months after returning home. Approximately one third of respondents reported postdeployment mental health treatment. Those who screened positive for mental health problems were more likely to indicate that they had received treatment compared to those who screened negative, but over one half of those who screened positive were not engaged with mental health treatment. Variables related to reported treatment receipt included positive attitudes about mental health therapies, having been injured in-theater, illness-based need, and having received mental health treatment while in-theater. Implications and future research directions are discussed.

Research paper thumbnail of Couple therapy with combat veterans and their partners

Journal of Clinical Psychology, 2008

Service members returning from Iraq and Afghanistan face psychological challenges that can exert ... more Service members returning from Iraq and Afghanistan face psychological challenges that can exert profound effects on families and couples, but can also be treated within a systemic context. Couple therapy offers a means of increasing social support, decreasing interpersonal conflict, and addressing the experiential avoidance that maintains posttraumatic symptoms. For combat veterans and their partners, we present an adaptation of integrative behavioral couple therapy (IBCT) that reduces conflict and encourages intimacy through acceptance and skills strategies. By doing so, IBCT exposes service members in couple therapy to emotions, interpersonal situations, and activities that facilitate recovery from combat-related distress. We illustrate common presenting problems in this population and the utilization of IBCT with a case example. © 2008 Wiley Periodicals, Inc. J Clin Psychol: In Session 64:1-12, 2008.

Research paper thumbnail of PTSD symptom clusters associated with physical health and health care utilization in rural primary care patients exposed to natural disaster

Journal of Traumatic Stress, 2008

This study investigated the influence of exposure to a tornado disaster and disaster-related post... more This study investigated the influence of exposure to a tornado disaster and disaster-related posttraumatic stress disorder (PTSD) symptomatology on physical health complaints and primary health care utilization among rural medical patients. One-hundred five patients completed self-report measures assessing disaster exposure, PTSD symptoms, and self-reported physical health complaints. Objective rates of health care utilization were gathered by a review of medical records. Tornado disaster exposure and generalized psychological distress were associated with physical health complaints one year following the disaster. After controlling for age, gender, and levels of predisaster health care utilization, PTSD Cluster C (avoidance) symptoms were associated with increased rates of postdisaster health care utilization. Implications of these findings for interventions within the medical system are discussed.

Research paper thumbnail of Predictors of Behavior and Level of Life Satisfaction of Children and Adolescents After a Major Tornado

Journal of Psychological Trauma, 2008

Data were collected on students in Grades 3 to 12 regarding their reactions to a major F4 tornado... more Data were collected on students in Grades 3 to 12 regarding their reactions to a major F4 tornado, which caused damage to their town in southern Minnesota. The purpose of this study was to examine some of the factors (i.e., level of exposure to the disaster, posttraumatic stress disorder symptoms, and home relocation) that may help predict behavioral problems and life satisfaction after a major tornado. The disruption of relocating to a new home after the tornado was associated with higher levels of internalizing behavior problems for children in Grades 3 to 6 and higher levels of externalizing behavior problems for adolescents in Grades 7 to 12. Increased exposure to the tornado was significantly associated with high levels of life satisfaction. Implications of these findings and directions for future research are discussed.

Research paper thumbnail of Assessment and Treatment of Concurrent Posttraumatic Stress Disorder and Substance Abuse

Research paper thumbnail of The distinctiveness of hardiness, positive emotionality, and negative emotionality in National Guard soldiers

Journal of Research in Personality, 2011

Exploratory and confirmatory factor analyses were used to investigate the distinctiveness of hard... more Exploratory and confirmatory factor analyses were used to investigate the distinctiveness of hardiness (using the Short Hardiness Scale; Bartone, 1995) from the broader personality traits of negative emotionality and positive emotionality (NEM and PEM; assessed with items from the MMPI-2 PSY-5 scales); in a sample of 981 Army National Guard soldiers. Exploratory factor analyses demonstrated that hardiness items loaded on a separate factor from PEM and NEM items, and confirmatory factor analysis suggested that hardiness is not simply a sub-facet of either PEM or NEM. However, subsequent regression analyses found that hardiness did not predict symptoms of PTSD or depression beyond the effects of PEM and NEM among combat exposed soldiers.

Research paper thumbnail of Posttraumatic Stress Symptoms Among National Guard Soldiers Deployed to Iraq: Associations With Parenting Behaviors and Couple Adjustment

Journal of Consulting and Clinical Psychology, 2010

Objective-This article reports findings from a one-year longitudinal study examining the impact o... more Objective-This article reports findings from a one-year longitudinal study examining the impact of change in PTSD symptoms following combat deployment on National Guard soldiers' perceived parenting, and couple adjustment one year following return from Iraq.

Research paper thumbnail of Developing and Applying a Systematic Process for Evaluation of Clinical Outcome Assessment Instruments

Psychological Services, 2004

... Douglas Olson, Mental Health PSL, Minneapolis Veterans Administration Medical Center Departme... more ... Douglas Olson, Mental Health PSL, Minneapolis Veterans Administration Medical Center Department of Psychology, University of Minnesota, Twin Cities Campus. The contents of this article are in the public domain. CITATION. ...

Research paper thumbnail of Helping Military Families Through the Deployment Process: Strategies To Support Parenting

Professional Psychology-research and Practice, 2011

Recent studies have highlighted the impact of deployment on military families and children and th... more Recent studies have highlighted the impact of deployment on military families and children and the corresponding need for interventions to support them. Historically, however, little emphasis has been placed on family-based interventions in general, and parenting interventions in particular, with returning service members. This paper provides an overview of research on the associations between combat deployment, parental adjustment of service members and spouses, parenting impairments, and children's adjustment problems, and provides a social interaction learning framework for research and practice to support parenting among military families affected by a parent's deployment. We then describe the Parent Management Training-Oregon model (PMTO ™ ), a family of interventions that improves parenting practices and child adjustment in highly stressed families, and briefly present work on an adaptation of PMTO for use in military families (After Deployment: Adaptive Parenting Tools, or ADAPT). The article concludes with PMTO-based recommendations for clinicians providing parenting support to military families.

Research paper thumbnail of Predictors of emotional distress reported by soldiers in the combat zone

Journal of Psychiatric Research, 2010

Objective: Few studies have examined rates of distress of military personnel during deployment to... more Objective: Few studies have examined rates of distress of military personnel during deployment to a war zone. Our study sought to (a) identify rates of self-reported posttraumatic stress disorder (PTSD) and depression symptoms during combat deployment, (b) characterize higher order dimensions of emotional distress experienced by soldiers during deployment, and (c) identify predictors of these dimensions of emotional distress. Method: Participants were 2677 National Guard soldiers deployed as part of Operation Iraqi Freedom in 2006-07. We performed a principal components factor analysis on items of the PTSD Checklist -Military Version and the Beck Depression Inventory to identify dimensions of emotional distress, followed by multiple regression analyses to identify factors that predicted these dimensions of distress. Results: Rates of PTSD and depression in our sample were 7% and 9%, respectively. Five dimensions of emotional distress emerged: negative affect/cognitions, trauma-specific re-experiencing and avoidance, vegetative symptoms, loss of interest/numbing symptoms, and arousal/irritability. Two dimensions, trauma-specific symptoms and arousal/irritability, appeared to be more indicative of trauma sequelae, while the other three dimensions were more indicative of depressive symptoms. Demographic factors, combat exposure (including injury and exposure to explosive blast), and attitudinal variables predicted traumaspecific aspects of distress. Symptoms characteristic of depression or generalized distress were predicted by female gender, recent prior deployment, and attitudinal factors but were not predicted by blast exposure or injury. Conclusions: These findings suggest specific targets for contextual and individual interventions to reduce deployment-related distress and point out the need for longitudinal follow-up to determine long-term implications for post-deployment functioning.

Research paper thumbnail of Does trauma survey research cause more distress than other types of survey research

Journal of Traumatic Stress, 2009

Members of institutional review boards who evaluate trauma research protocols frequently face the... more Members of institutional review boards who evaluate trauma research protocols frequently face the task of balancing potential risk with potential benefit. However, no known study has examined the relative effect of participating in a trauma-related survey compared to participating in a nontrauma survey. The authors randomly assigned participants receiving care in an outpatient PTSD treatment program to complete questionnaires assessing either trauma-related or nontrauma content. Participants completing trauma-related questionnaires reported feeling sadder and more tense than other participants, though they did not report differences in perceived gain from participation or retrospective willingness to participate. Results suggest that level of distress after participating in trauma research was insufficient to reduce willingness for, or perceived benefit from, participation in trauma survey research.

Research paper thumbnail of Prevalence and consequences of adult sexual assault of men: Review of empirical findings and state of the literature

Clinical Psychology Review, 2011

Male victims of adult sexual assault (ASA) are understudied as compared with female victims. Furt... more Male victims of adult sexual assault (ASA) are understudied as compared with female victims. Further, commonly-held myths about sexual assault suggest that men cannot be victims or that, if men are victims, they are relatively physically and emotionally unharmed by sexual assault. The goal of this paper was to systematically review the empirical literature on ASA among men to evaluate the veracity of these myths. This paper also sought to examine the methodological quality of the body of research in this area, identify limitations and gaps in the current literature, and suggest directions for future research. Eighty-seven relevant studies were identified through a systematic review of the literature. The reported prevalence of men's sexual aggression varied widely depending on the methods used and the population studied; some populations (e.g., veterans, prison inmates, and gay and bisexual men) reported higher rates of ASA than men in the general population. Few studies have systematically examined the consequences of male ASA; however, those that have suggest that ASA can have notable adverse physical and psychological consequences for some men.

Research paper thumbnail of The role of cumulative sexual trauma and difficulties identifying feelings in understanding female veterans' physical health outcomes

General Hospital Psychiatry, 2008

Objective: To examine the role of alexithymia (difficulties identifying one's emotions) in unders... more Objective: To examine the role of alexithymia (difficulties identifying one's emotions) in understanding the link between PTSD symptoms and negative health outcomes in sexually victimized female veterans. We hypothesized that having experienced multiple types of sexual trauma across the lifespan, experiencing greater severity of PTSD symptoms, and reporting difficulties in identifying emotions would be associated with increased negative health outcomes. Method: Anonymous cross-sectional survey of a convenience sample of 456 female veterans enrolled in a VA clinic within the prior year. Data collected included demographics, lifetime trauma exposure, psychological and medical symptoms, emotion recognition problems (alexithymia), health-risk behaviors, and health care utilization. Results: A total of 57.5% of participants reported a lifetime history of sexual trauma. After controlling for sexual trauma history, PTSD symptoms, and other well-established predictors of health care utilization in the VA medical system such as pre-disposing, enabling and needbased factors, hierarchical regression analyses showed that alexithymia independently explained unique variance in participants' physical health complaints and in their odds of reporting at least one outpatient urgent care visit in the past year. Conclusions: These data suggest that emotion recognition problems may contribute to poorer health outcomes in sexually traumatized women veterans beyond what is explained by sexual trauma exposure, health risk behaviors and PTSD. Psychological interventions that enhance emotion identification skills for women who have experienced sexual trauma could improve health perceptions and reduce need for acute health care. Published by Elsevier Inc.

Research paper thumbnail of Effects of Parents' Experiential Avoidance and PTSD on Adolescent Disaster-Related Posttraumatic Stress Symptomatology

Journal of Family Psychology, 2011

Despite the importance of family context to adolescents' reactions following disaster, little res... more Despite the importance of family context to adolescents' reactions following disaster, little research has examined the role of parents' functioning on adolescents' disaster-related posttraumatic stress disorder (PTSD) symptoms. Using data from 288 adolescents (ages 12 to 19 years) and 288 parents exposed to a series of severe tornadoes in a rural Midwestern community, this study tested a conceptual model of the interrelationships between individual and parental risk factors on adolescents' disaster-related PTSD symptoms using structural equation modeling. Results showed that the psychological process of experiential avoidance mediated the relationship between family disaster exposure and PTSD for both adolescents and their parents. Parents' PTSD symptoms independently predicted adolescents' PTSD symptoms. Further, parents' postdisaster functioning amplified the effects of adolescent experiential avoidance on adolescents' disaster-related PTSD symptoms. Findings highlight the importance of family context in understanding adolescents' postdisaster reactions. Clinical implications are discussed.

Research paper thumbnail of Psychiatric diagnoses, comorbidity, and functioning in National Guard troops deployed to Iraq

Journal of Psychiatric Research, 2011

Research paper thumbnail of Predictors of alcohol use prior to deployment in National Guard Soldiers

Addictive Behaviors, 2009

a b s t r a c t a r t i c l e i n f o Keywords: Alcohol use Substance use Military PTSD Personality

Research paper thumbnail of The Structure of PTSD Among Two Cohorts of Returning Soldiers: Before, During, and Following Deployment to Iraq

Journal of Abnormal Psychology, 2011

Evidence suggests either a four-factor emotional numbing or dysphoria model likely reflects the u... more Evidence suggests either a four-factor emotional numbing or dysphoria model likely reflects the underlying structure of posttraumatic stress disorder (PTSD). Questions remain as to which of these structures best represents PTSD, how the structure changes with time, the applicability of models to returning veterans, and the validity of the symptom clusters. The present study addresses these questions among two longitudinal samples of National Guard soldiers assessed prior to, during, and following a combat deployment to Iraq. Findings support a four-factor intercorrelated dysphoria model of PTSD that remains stable across samples and time points. Differential associations were observed among PTSD symptom clusters over time and between symptom clusters and both depression and combat exposure, supporting important distinctions between symptom clusters.

Research paper thumbnail of Predeployment gender differences in stressors and mental health among U.S. National Guard troops poised for Operation Iraqi Freedom deployment

Journal of Traumatic Stress, 2010

Increased exposure of women soldiers to combat in current conflicts heightens interest in the que... more Increased exposure of women soldiers to combat in current conflicts heightens interest in the question of whether risk and resilience factors differ for female and male military personnel prior to deployment. The authors examined this question in a panel of 522 National Guard soldiers (462 men and 60 women) poised for deployment to Iraq. Soldiers completed a battery of self-report measures, including the PTSD Checklist, Beck Depression Inventory-II, and scales from the Deployment Risk and Resilience Inventory. Modest differences were observed between women and men on predeployment risk factors and some risk-related correlations with PTSD and depression measures; however, gender did not moderate the associations between hypothesized risk/resilience factors and baseline mental health. Implications for interventions and future research are discussed.

Research paper thumbnail of Assessment of Psychological Distress and Disability After Sexual Assault in Adults

... The base rate for symptom exaggeration or malingering is higher in foren-sic settings than in... more ... The base rate for symptom exaggeration or malingering is higher in foren-sic settings than in general clinical practice and is estimated to be between 14% and 30% by surveyed forensic experts (Lees-Haley, 1992, 1997; Rogers, 1997; Rogers et al., 1994). ...

Research paper thumbnail of Unreliability and Error in the Military's “Gold Standard” Measure of Sexual Harassment by Education and Gender

Journal of Trauma & Dissociation, 2011

The Department of Defense's “gold standard” sexual harassment measure, the Sexual Harassment Core... more The Department of Defense's “gold standard” sexual harassment measure, the Sexual Harassment Core Measure (SHCore), is based on an earlier measure that was developed primarily 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 alternate-forms reliability was significantly worse (a) in soldiers without college experience compared to soldiers with college experience and (b) 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.

Research paper thumbnail of Early mental health treatment-seeking among U.S. National Guard soldiers deployed to Iraq

Journal of Traumatic Stress, 2010

The authors examined rates of and factors associated with postdeployment treatment-seeking in a p... more The authors examined rates of and factors associated with postdeployment treatment-seeking in a panel of 424 National Guard soldiers who spent 16 months in Iraq. Soldiers completed a self-report, mailed survey 3- to 6-months after returning home. Approximately one third of respondents reported postdeployment mental health treatment. Those who screened positive for mental health problems were more likely to indicate that they had received treatment compared to those who screened negative, but over one half of those who screened positive were not engaged with mental health treatment. Variables related to reported treatment receipt included positive attitudes about mental health therapies, having been injured in-theater, illness-based need, and having received mental health treatment while in-theater. Implications and future research directions are discussed.

Research paper thumbnail of Couple therapy with combat veterans and their partners

Journal of Clinical Psychology, 2008

Service members returning from Iraq and Afghanistan face psychological challenges that can exert ... more Service members returning from Iraq and Afghanistan face psychological challenges that can exert profound effects on families and couples, but can also be treated within a systemic context. Couple therapy offers a means of increasing social support, decreasing interpersonal conflict, and addressing the experiential avoidance that maintains posttraumatic symptoms. For combat veterans and their partners, we present an adaptation of integrative behavioral couple therapy (IBCT) that reduces conflict and encourages intimacy through acceptance and skills strategies. By doing so, IBCT exposes service members in couple therapy to emotions, interpersonal situations, and activities that facilitate recovery from combat-related distress. We illustrate common presenting problems in this population and the utilization of IBCT with a case example. © 2008 Wiley Periodicals, Inc. J Clin Psychol: In Session 64:1-12, 2008.