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Background: Against a backdrop of more than four decades of war, conflict and insecurity, Afghanistan is recognised as suffering from endemic violence and children are exposed to multiple forms of violence, including at the family and school levels. This paper presents the results of an evaluation of school-based peace education and a community-based intervention to change harmful social norms and practices related to gender and the use of violence in conflict resolution, implemented in Afghanistan with the aim of reducing violence against and between children. Methods: The evaluation consisted of a cross-sectional, interrupted time series design with three data collection points over 12 months. Data was collected from students in 11 secondary schools (seven girls’ and four boys’ schools) in Jawzjan province of Afghanistan, with a total of 361 boys and 373 girls sampled at endline. All children were interviewed with a questionnaire developed for the study. Key outcomes included children’s experience of peer violence (both perpetration and victimization) at school, corporal punishment both at home and at school, and observation of family violence. Other outcomes included children’s gender equitable attitudes, attitudes towards child punishment, depression and school performance. Results: Between baseline and endline evaluation points, there were significant reductions in various forms of violence at the school level, including both boys’ and girls’ past month experience of peer violence victimization, peer violence perpetration, and corporal punishment by teachers. There were also significant reductions in boys’ and girls’ experience of corporal punishment at home and observation of family violence, with a particularly strong effect observed among girls. Both boys and girls had significantly more equitable gender attitudes and significantly less violence-supportive attitudes in relation to children’s punishment, and significantly fewer symptoms of depression. Girls’ school attendance was also significantly higher at endline. Discussion: To our knowledge this is the first time that a peace education program has been evaluated in Afghanistan, with or without a community intervention to change harmful social norms and practices related to gender and the use of violence for conflict resolution. The evaluation suggests that the intervention may have led to a reduction in various forms of violence, including children’s peer violence, corporal punishment of children both at school and at home, and in children’s reports of domestic violence against women at the household level. [ABSTRACT FROM AUTHOR]

The study of positive outcomes associated with strong psychological sense of community (PSOC) has grown worldwide. Yet most research explores PSOC as a uni-dimensional (positive) variable operating in a single referent community. Theoretical and empirical literature has suggested, however, that PSOC can be positive, neutral or negative (Brodsky in J Commun Psychol 24(4):347–363, ; Brodsky et al. in Psychological sense of community: Research, applications and implications. Kluwer, New York ) and since people live in multiple physical and relational communities, there may be multiple PSOCs (M-PSOC) operating simultaneously and interactively (Brodsky and Marx in J Commun Psychol 29(2):1–18, ). This paper explores the operation of M-PSOC in the lives of Afghan women, and male supporters, who belonged to a resistance organization before, during and after the Taliban regime. Decisions to join and stay in this community can be explained, in part, through the differentiation of positive, organizational-level PSOC from negative, macro-community-level PSOC. In addition, M-PSOC suggests unique cultural meanings of the terms “community” and “choice.” Findings have implications for cross-cultural community work and for fostering resilient sub-communities in the face of macro and societal-level risks and oppression. [ABSTRACT FROM AUTHOR]

Evidence suggests that UK veterans are seen as victims with concern for their perceived mental health needs. This study examined sociodemographic factors that contribute to victimizing conceptualizations of British Army Iraq and Afghanistan veterans. UK participants (N = 234) provided three word associations to "British Army Iraq Veteran" and "British Army Afghanistan Veteran" and answered sociodemographic questions. A multiple linear regression outlines that low national pride, mission opposition and higher levels of education predict elevated victimizing word associations. Narrative accounts from UK interviews (N = 21) suggest that participants who perceived the recent conflicts as illegitimate conceptualize veterans as passive, naïve actors who had to submit to the agency of the anthropomorphic described government. This allowed holding overtly appreciative though belittling attitudes toward veterans, while opposing the missions. To dissociate veterans from victimizing perceptions, better knowledge about service and justifications for deployments need to be provided. Study limitations, including over sampling of young adult females, are discussed. [ABSTRACT FROM AUTHOR]

Few studies have focused on homelessness among Operations Iraqi Freedom, Enduring Freedom and New Dawn (OEF/OIF/OND) veterans, especially female veterans. An explanatory model of homelessness was constructed and tested for each gender. Data collected in the United States from 833 OEF/OIF/OND veterans (41.5% female; Mage = 35.22, SD = 8.86) who completed the baseline assessment of the Survey of the Experiences of Returning Veterans between September 2011 and July 2014 were analysed. Path analysis was used to examine associations between risk factors and any lifetime homelessness, stratified by gender. Adverse childhood events (ACEs) and low social support were significantly associated with lifetime homelessness for both genders. Social support mediated associations between ACEs and homelessness, after controlling for sociodemographic factors. While sociodemographic risk factors are often considered in homeless prevention, these findings highlight the importance of social support among male and female OEF/OIF/OND veterans, underscoring the need to target this life domain in preventing homelessness. [ABSTRACT FROM AUTHOR]

Military sexual trauma (MST) has been linked with increased rates of mental health disorders among veterans. Few studies have addressed how MST is related to use of VA and non-VA health care. The purpose of the current study was to (a) examine the association between MST, combat experiences, and mental health outcomes (i.e., posttraumatic stress disorder [PTSD] and depression) and (b) examine the association of MST and use of VA and non-VA health care services among female veterans who served in Iraq and Afghanistan. Female respondents to a survey assessing Operation Enduring Freedom (OEF)/Operation Iraqi Freedom (OIF) veterans' needs and health (N = 185) completed measures of demographic variables, military history, combat exposure, MST, PTSD, and depression symptoms, and use of VA and non-VA health care. Overall, 70% of the sample experienced one or more combat-related experiences and 15.7% endorsed MST during deployment to Iraq or Afghanistan. MST and combat exposure were both positively associated with PTSD and depression symptoms even after controlling for the effects of demographic and military history variables. MST was associated with increased use ofVA mental health services in bivariate results but was not independently related to VA service utilization after accounting for PTSD and depression symptoms. Approximately half of the women who reported MST had not used VA health care. Continued outreach and education initiatives may be needed to ensure veterans understand the resources available to address MST-related mental and physical health problems through the VA. [ABSTRACT FROM AUTHOR]

The association of post-traumatic stress disorder (PTSD) symptom clusters with combat and other operational experiences among United Kingdom Armed Forces (UK AF) personnel who deployed to Afghanistan in 2009 were examined. Previous studies suggest that the risk of developing PTSD rises as combat exposure levels increase. To date, no UK research has investigated how specific classes of combat and operational experiences relate to PTSD symptom clusters. The current study was a secondary analysis of data derived from a two-arm cluster, randomized-controlled trial of a postdeployment operational stress-reduction intervention in deployed UK AF personnel. 2510 UK AF personnel provided combat exposure data and completed the PTSD checklist (civilian version) immediately post-deployment while 1635 of the original cohort completed further followed-up measures four to six months later. A 14-item combat experience scale was explored using principle component analysis, which yielded three main categories of experience: (1) violent combat, (2) proximity to wounding or death and (3) encountering explosive devices. The association of combat experience classes to PTSD 5-factor “dysphoric arousal” model (re-experiencing, avoidance, numbing, dysphoric-arousal and anxious-arousal symptoms) was assessed. Greater exposure to violent combat was predictive of re-experiencing and numbing symptoms, while proximity to wounding or death experiences were predictive of re-experiencing and anxious-arousal symptoms. Explosive device exposure was predictive of anxious-arousal symptoms. The present study suggests that categories of combat experience differentially impact on PTSD symptom clusters and may have relevance for clinicians treating military personnel following deployment. [ABSTRACT FROM AUTHOR]

Purpose: Although it is well established that combat-related PTSD can lead to reduced quality of life, less is known about the relative effect of PTSD on different aspects of former service members' post-military readjustment. Moreover, research on female veterans' reintegration experiences is limited. This study aimed to document the work and family quality of life of post-9/11 male and female veterans and evaluate the gender-specific impact of PTSD on veterans' work and family outcomes.Methods: A national sample of 524 post-9/11 veterans completed mailed surveys as part of a longitudinal study. Descriptive and regression-based analyses were gender-stratified and weighted to enhance representativeness to the larger population.Results: With a few notable exceptions, the majority of post-9/11 U.S. veterans reported high work and family quality of life. PTSD was not associated with either employment or relationship status; however, it did predict poorer work and family functioning and satisfaction for both men and women, with the most consistent negative effects on intimate relationships. Several gender differences were found, primarily with respect to work experiences.Conclusions: Although most post-9/11 veterans appear to be doing well in both their work and family lives, results support the need for interventions that can mitigate the negative effect of PTSD and other associated mental health conditions on several aspects of work and family quality of life. Findings contribute to research suggesting both similarities and differences in the post-military readjustment of male and female post-9/11 veterans and underscore the need for additional consideration of the unique work-related challenges women experience following military service. [ABSTRACT FROM AUTHOR]

This study investigated the relationships among combat exposure, intrusive, and deliberate rumination, resilience, and posttraumatic stress disorder (PTSD) among service members who deployed to Iraq or Afghanistan (N = 191). Participants completed an online survey and hierarchical linear regression results indicated that enlisted rank, higher combat exposure, lower resilience, and higher intrusive rumination predicted higher levels of PTSD symptom severity. Resilience moderated the relationship between combat exposure and PTSD symptom severity, such that participants who had higher levels of resilience had lower levels of PTSD symptom severity at all levels of combat exposure. These findings suggest the importance of increasing resilience in combat veterans, specifically those of enlisted rank and veterans exposed to higher levels of combat. Findings also suggest that teaching veterans how to control or minimize intrusive rumination might help lower PTSD severity. [ABSTRACT FROM PUBLISHER]

Background: Vulnerable populations such as people with refugee backgrounds are at increased risk of poor oral health. Given that maternal characteristics play a significant role in the development of dental caries in children, antenatal care offers an opportunity to both provide information to women about the importance of maternal oral health and accessing dental care. Although pregnant women are recognised for 'priority' care under Victorian state-government policy, rarely do they attend. This study aims to describe Afghan and Sri Lankan women's knowledge and beliefs surrounding maternal oral health, barriers to accessing dental care during pregnancy, and to present the perspectives of maternity and dental service providers in relation to dental care for pregnant women.Methods: One agency comprising both dental and maternity services formed the setting for the study. Using participatory methods that included working with bicultural community workers, focus groups were conducted with Afghan and Sri Lankan refugee background participants. Focus groups were also completed with midwives and dental service staff. Thematic analysis was applied to analyse the qualitative data.Results: Four community focus groups were conducted with a total of 14 Afghan women, eight Sri Lankan women, and three Sri Lankan men. Focus groups were also conducted with 19 dental staff including clinicians and administrative staff, and with ten midwives. Four main themes were identified: perceptions of dental care during pregnancy, navigating dental services, maternal oral health literacy and potential solutions. Key findings included women and men's perception that dental treatment is unsafe during pregnancy, the lack of awareness amongst both the midwives and community members of the potential impact of poor maternal oral health and the overall lack of awareness and understanding of the 'priority of access' policy that entitles pregnant women to receive dental care cost-free.Conclusion: This study highlights a significant policy-to-practice gap which if not addressed has the potential to widen oral health inequalities across the life-course. Stakeholders were keen to collaborate and support action to improve the oral health of mothers and their infants with the over-riding priority being to develop inter-service relationships to promote seamless access to oral health care. [ABSTRACT FROM AUTHOR]

Objectives: Iraq and Afghanistan war veterans suffer from high rates of posttraumatic stress disorder (PTSD). Given the growing number of women in the military, there is a critical need to understand the nature and extent of potential gender differences in PTSD-associated psychosocial functioning and health-related quality of life (HRQOL) in Operation Enduring Freedom (OEF)/Operation Iraqi Freedom (OIF) veterans, which has not been studied to date. Methods: We used data from a gender-balanced national patient registry of warzone-deployed OEF/OIF veterans (Project VALOR: Veterans After-Discharge Longitudinal Registry) to determine the impact of gender on PTSD-related psychosocial functioning and HRQOL in 1,530 United States Iraq and Afghanistan war veterans (50% female) with and without PTSD. Overall psychosocial functioning was assessed with the Inventory of Psychosocial Functioning (IPF) and mental and physical HRQOL with the Veterans RAND 12-item Health Survey (VR-12) Mental and Physical Component Summary scores, respectively. Stratified linear regression models estimated gender-specific associations, controlling for demographic, deployment, and postdeployment factors. Interaction models tested for significant effect moderation by gender. Results: In gender-stratified models, PTSD was strongly associated with higher IPF scores (greater functional impairment), with similar associations by gender. PTSD was also associated with lower Mental Component Summary scores (lower mental HRQOL) in both men and women, with no evidence of effect moderation by gender. PTSD was associated with lower Physical Component Summery scores in women but not men in adjusted models; however, interactions were not significant. Conclusion: PTSD among warzone-deployed OEF/OIF veterans is associated with significant impairments in both overall psychosocial functioning and HRQOL, with associations that are largely similar by gender. Findings support the need for thorough and continuous assessment of functional impairment and HRQOL during treatment of PTSD for both male and female OEF/OIF veterans. [ABSTRACT FROM AUTHOR]

Since the wars in Iraq and Afghanistan began, the U.S. military has sent millions of troops into battlefield operations—some without proper training, some without rigorous preservice mental health checks, and many without experience. Many were given waivers that allowed them to skirt previously rigorous recruiting standards to bolster troop numbers. A significant amount of returning soldiers have been diagnosed with posttraumatic stress disorder (PTSD), and associated benefits and lifelong payouts for these soldiers have and will continue to cost the military hundreds of millions of dollars each year. The military has been accused of purposely changing PTSD diagnoses or instead issuing diagnoses of personality disorders—which the military considers a preexisting condition—for dodging these costs and as a mechanism for forcing soldiers out of service. This article explores how and why these diagnoses, or changes to existing diagnoses, are (allegedly) made, what purpose they serve the military, and the implications of each diagnosis for veterans and active duty soldiers. After reviewing this information, the question of whether or not the military should be ethically responsible for the continued mental health care of those soldiers after service, despite their condition, is addressed. [ABSTRACT FROM PUBLISHER]

Background Studies of war-affected youth have not yet examined how trauma memories relate to prospective changes in mental health and to subjective or social experiences. Methods We interviewed a gender-balanced, randomly selected sample of Afghan child-caregiver dyads ( n = 331, two waves, 1 year apart). We assessed lifetime trauma with a Traumatic Event Checklist, past-year events with a checklist of risk and protective events, and several child mental health outcomes including posttraumatic distress (Child Revised Impact of Events Scale, CRIES) and depression. We examined the consistency of trauma recall over time, identified mental health trajectories with latent transition modeling, and assessed the predictors of posttraumatic distress and depression trajectories with multinomial logistic regressions. Results From baseline to follow-up, reports of lifetime trauma significantly changed ( p ≤ 0.01). A third of the cohort reported no trauma exposure; only 10% identified the same event as their most distressing experience. We identified four CRIES trajectories: low or no distress (52%), rising distress (15%), declining distress (21%), and sustained high distress (12%). Youth with chronic posttraumatic distress were more likely to be girls ( OR = 5.78, p ≤ 0.01), report more trauma exposure at baseline ( OR = 1.55, p ≤ 0.05) and follow-up ( OR = 5.96, p ≤ 0.01), and experience ongoing domestic violence ( OR = 4.84, p ≤ 0.01). The risks of rising distress and sustained distress showed a steady increase for youth recalling up to four traumatic experiences. Depression and CRIES trajectories showed weak comorbidity. Conclusions Memories of violent events are malleable, embedded in social experiences, and present heterogeneous associations with posttraumatic distress. Our study provides insights on resilience and vulnerability to multiple adverse childhood experiences, highlighting research and clinical implications for understanding trauma in conflict-affected youth. [ABSTRACT FROM AUTHOR]

Recent evidence suggests that sleep disturbance may play an important role in the development of cardiovascular disease (CVD). Despite the prevalence of sleep complaints among service members of recent military conflicts, few studies have examined associations between sleep and risk factors for CVD in this population. Symptom checklist items regarding distress about 'trouble falling asleep' and 'restless/disturbed sleep' were used as proxies for sleep onset and maintenance difficulties to examine these associations in US military service members of recent conflicts. Veterans having both sleep onset and maintenance difficulties had greater odds of being a current smoker and having psychiatric symptoms and diagnoses. Increased odds of a self-reported hypertension diagnosis and elevated systolic blood pressure were also found in certain subsets of this sample. Findings highlight the need for greater recognition of sleep difficulties as a CVD risk factor in a population known to be at increased risk for this condition. [ABSTRACT FROM AUTHOR]

To document the socioeconomic situation of street children in Iran and to ascertain the part played by this in becoming a street child, we classified and evaluated studies on this issue from the recent decade according to their strengths and weaknesses. The results will be helpful in policy-making and planning for this group. The study employed a systematic review methodology, searching Iranian and international databases, and many universities and related organisations in Iran. After the quality of studies had been evaluated by three researchers, the findings of 40 research studies were classified, described and analysed. The research finds that street children in Iran come from crowded, low-income families; many of them were rural-urban migrants and Afghans with families who immigrated to Iran; most of their parents had a lower than high school education and many of their fathers were unemployed or had low-income jobs; the majority of these children were unskilled workers who would work many hours of the day for negligible incomes. We conclude that low socioeconomic status was prevalent among the street children's families in Iran and seems to be an important factor in the street-connectedness of the children. [ABSTRACT FROM AUTHOR]

Veterans, as military personnel returning from wars in Afghanistan and Iraq, are frequently coping with various mental health problems. These veterans are at high risk for posttraumatic stress disorder (PTSD) and associated behavioral consequences, including self-harm, verbal and physical aggression, and violence. In this article, we highlight the physiological, physical, and emotional consequences of trauma. We focus on the unique experiences that affect veterans' mental health and associated behaviors and advocate for veterans to receive evidenced-based treatment using trauma-informed and recovery-oriented care. [ABSTRACT FROM AUTHOR]

The purpose of the study was to evaluate the effectiveness of an existing "couples" adaptive sport and recreation program called Higher Ground developed by Sun Valley Adaptive Sports to reduce symptoms of PTSD, facilitate posttraumatic growth, and enhance marital satisfaction for veterans with PTSD and their significant others. The sample consisted of two experimental groups (Group A five couples, Group B six couples) and a control group (six couples). ANCOVA analysis indicated significant decreases in PTSD symptoms and increases in marital satisfaction among the experimental groups following participation in the recreation program. Findings support the use of recreation programs to help veterans with PTSD and their significant others, through specific program elements. [ABSTRACT FROM AUTHOR]

Background Few studies have investigated base rate estimates of risky driving behaviours among veterans of the wars in Afghanistan and Iraq despite evidence suggesting such behaviours result in increased death rates. In addition, published estimates of driving behaviours may be subject to a significant response bias via the impact of perceived mental health stigma on honest self-reporting. Aim The present study compared the unmatched count technique, a form of randomised response technique used to mitigate biased responding, with traditional anonymous self-report to gain information about base rates of risky driving behaviours among combat veterans. Methods Cross-sectional data gathered as part of a study of attitudes and behaviours related to military service provided estimates of target activities. Six facets of risky driving (horn honking, carrying firearms in the vehicle, drinking and driving, screaming at other drivers, following other drivers to complain, and tailgating) were assessed. Results In our sample of 1351 combat veterans, the unmatched count technique revealed significantly higher rates relative to traditional anonymous assessment specifically for horn honking in anger (22.1% vs 13.6%), carrying firearms (51.1% vs 32.2%), and drinking and driving (77.8% vs 54.0%). There were no significant differences for the remaining three items. Conclusions The high level of morbidity associated with risky driving and motor vehicle crashes is a significant concern in the combat veteran population. These data suggest the presence of a strong response bias associated with endorsing certain risky driving behaviours, potentially leading to serious underestimation of these problem behaviours in standard anonymous questionnaires. [ABSTRACT FROM AUTHOR]

Crises in personal meaning may be a critical aspect of psychological maladjustment following combat. Using the newly developed Integration of Stressful Life Events Scale (ISLES), this study examined the role of meaning made of a salient stressor following a combat deployment in Iraq or Afghanistan. In a sample of 169 returning service members, findings supported the distinctiveness of meaning made of a stressor (as assessed by the ISLES), factor analytically and as a correlate of several relevant clinical outcomes. In particular, when the model contained potential confounds and psychiatric symptoms, meaning made in the months and years following combat was uniquely associated with the severity of posttraumatic stress symptoms, β = −.39, and referrals for mental health care, β = −.69, in the sample. The present findings highlight the importance of the subjective meaning made of traumatic life events and also suggest that posttraumatic stress and other psychiatric symptomatology may not account for the full clinical picture among many service men and women. [ABSTRACT FROM AUTHOR]

Post-traumatic stress disorder (PTSD) is increasingly recognized as a serious and potentially debilitating condition in combat veterans returning from Iraq and Afghanistan. Exposure to a potentially life-threatening event such as military combat may be followed by PTSD. Despite recent advances in pharmacotherapy for PTSD, monotherapy with the currently available medications is only partially effective, as demonstrated in large clinical trials of combat veterans with PTSD. This underscores the need to investigate novel combination strategies to enhance treatment response in PTSD. The α-1 adrenergic receptor (AR) antagonist, prazosin, appears promising in recent studies for its capacity to reduce trauma-related nightmares (a group B night-time intrusion symptom) and insomnia (a group D night-time arousal symptom), while recent evidence supports using the β-AR antagonist, propranolol, to dampen the emotional content of traumatic memories (daytime intrusion symptoms including flashbacks, intrusive recollections of traumatic event, and heightened physiological reactivity/responsivity to trauma reminders). In this review, we present data supporting the potential utility of combined drug regimen (prazosin and propranolol) acting through different noradrenergic mechanisms, with the potential to target more than one set of PTSD symptoms to optimize PTSD treatment. Copyright © 2011 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Background: Physical injury and psychological trauma associated with combat in the wars in Iraq and Afghanistan frequently lead to a constellation of symptoms including pain, post traumatic stress disorder (PTSD), and depression. Method: This single case study describes the application of a behaviorally-based psychotherapy known as behavioral activation for the treatment of post traumatic stress disorder (PTSD) and depressive symptoms in a recent combat veteran with multiple physical injuries sustained from a blast injury. Treatment was provided concurrently with other rehabilitation services and consisted of weekly individual sessions for 4 months, followed by monthly sessions for 4 months. Results: Clinically significant reductions in PTSD and depressive symptoms were noted between baseline and 1 year followup. Conclusion: Preliminary evidence from this case suggests that behavioral activation may be a promising treatment for PTSD and depression, and can be readily tailored to individuals with physical limitations such as pain and mobility restriction. Treatment can be provided in the context of concurrent interdisciplinary medical and rehabilitation care. [ABSTRACT FROM AUTHOR]

Examines the psychological effects of the Afghanistan war on Pashtun and Tajik groups of young Afghan refugees residing in the United States. Differences between the Pashtun and Tajik refugees in identifying and background variables; Description of the study participants; Differences on their past psychopathology.

In this article the author discusses the article "When a Soldier Commits Suicide in Iraq: Impact on Unit and Caregivers," by Dr. Russell Carr and the lessons it offer to avoid suicide cases. He says that the suicide case provided Carr shows that such acts provide guilt feelings, sense of shock, and distresses the confidence in the combat stress team. He notes that memorials of someone who dies by suicide can be used to honor soldier's memory and stress the needs of seeking help with stress.