The authors examined psychiatric diagnoses in administrative records for 13,201 United States military veterans who were screened for traumatic brain injury (TBI) in Department of Veterans Affairs facilities. Over 80% of the veterans with positive TBI screens had psychiatric diagnoses. Compared to veterans with negative TBI screens, those with positive screens, but without confirmed TBI status, were three times more likely to have a posttraumatic stress disorder (PTSD) diagnosis and were two times more likely to have depression and substance-related diagnoses. Among veterans with positive TBI screens, those with clinically confirmed TBI status were more likely than those without confirmed TBI status to have diagnoses for PTSD, anxiety, and adjustment disorders. These findings have implications for health care delivery and provider education.

The primary objective of this study was to describe the development, reliability, and construct validity of scores on the Military to Civilian Questionnaire (M2C-Q), a 16-item self-report measure of postdeployment community reintegration difficulty. We surveyed a national, stratified sample of 1,226 Iraq and Afghanistan veterans who used U.S. Department of Veterans Affairs (VA) medical care; 745 completed the M2C-Q and validated mental health screening measures. All analyses were based on weighted estimates. The internal consistency of the M2C-Q was .95 in this sample. Factor analyses indicated a single total score was the best-fitting model. Total scores were associated with measures theoretically related to reintegration difficulties including perception of overall difficulty readjusting back into civilian life (R(2) = .49), probable PTSD (d = 1.07), probable problem drug or alcohol use (d = 0.34), and overall mental health (r = -.83). Subgroup analyses revealed a similar pattern of findings in those who screened negative for PTSD. Nonwhite and unemployed veterans reported greater community reintegration difficulty (d = 0.20 and 0.45, respectively). Findings offer preliminary support for the reliability and construct validity of M2C-Q scores.

This study examined the structure of posttraumatic stress disorder (PTSD) as measured by the Impact of Event Scale-Revised (IES-R; Weiss & Marmar, 1997), tested factorial invariance for samples of 235 Israeli emergency room patients and 306 U.S. undergraduate students, and then evaluated factorial invariance over multiple occasions within the emergency room sample. A four-factor structure representing intrusion, avoidance-numbing, hyperarousal, and sleep emerged as the preferred model. Configural invariance over groups was supported for this model. Likewise, configural invariance over occasions was demonstrated, but metric invariance was not fully supported, with variation in the loadings on the intrusion factor over time seemingly the source of misfit. Interpretations and conclusions center on sleep as a separate factor underlying the structure of the IES-R, the distinction between avoidance and numbing as a function of how the IES-R (vs. the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition) operationalizes the numbing feature of PTSD and possible shifts in the meaning of intrusion over time.

Evidence-based psychotherapies for PTSD are often underused. The objective of this mixed-method study was to identify organizational and clinic factors that promote high levels of reach of evidence-based psychotherapies for PTSD 10 years into their dissemination throughout the Veterans Health Administration. We conducted 96 individual interviews with staff from ten outpatient PTSD teams at nine sites that differed in reach of evidence-based psychotherapies for PTSD. Major themes associated with reach included clinic mission, clinic leader and staff engagement, clinic operations, staff perceptions, and the practice environment. Strategies to improve reach of evidence-based psychotherapies should attend to organizational and team-level factors.Electronic supplementary materialThe online version of this article (doi:10.1007/s10488-017-0809-y) contains supplementary material, which is available to authorized users.

Identity adjustment is a critical yet understudied aspect of veteran reintegration into community life following combat deployment. (PsycINFO Database Record