Examining Executive Functioning as a Moderator of Intimate Partner Violence Risk in Veterans
Abstract: This study examined the inter-relationships among posttraumatic stress disorder (PTSD) symptoms, cognitive bias, executive functioning deficits, and intimate partner violence (IPV) outcomes in a sample of 104 military veterans who had served in conflicts in Afghanistan and Iraq. Veteran participants completed questionnaires, a neuropsychological assessment, and a laboratory procedure assessing social information (SIP) processing biases during a single assessment, and collateral reports of IPV from intimate partners were obtained for 69 participants via telephone interviews. Findings indicated that executive functioning deficits in the areas of inhibition and impulsivity were associated with increased risk for all IPV perpetration outcomes, and these risk factors also moderated the association between cognitive bias and psychological IPV. Cognitive inflexibility also appeared to moderate the associations between both PTSD symptoms and cognitive bias with injurious IPV, though the latter moderated relationship was marginally significant. Findings suggest the salience of executive functioning deficits with respect to understanding IPV perpetration risk from a trauma-informed, SIP perspective, and highlight several possible clinical strategies that may enhance intervention.
Abstract: Introduction: Persistent inequities exist in obstetric and neonatal outcomes in military families despite universal health care coverage. Though the exact underlying cause has not been identified, social determinants of health may uniquely impact military families. The purpose of this study was to qualitatively investigate the potential impact of social determinants of health and the lived experiences of military individuals seeking maternity care in the Military Health System. Materials and methods: This was an Institutional Review Board-approved protocol. Nine providers conducted 31 semi-structured interviews with individuals who delivered within the last 5 years in the direct or purchased care market. Participants were recruited through social media blasts and clinic flyers with both maximum variation and homogenous sampling to ensure participation of diverse individuals. Data were coded and themes were identified using inductive qualitative research methods. Results: Three main themes were identified: Requirements of Military Life (with subthemes of pregnancy notification and privacy during care, role of pregnancy instructions and policies, and role of command support), Sociocultural Aspects of the Military Experience (with subthemes of pregnancy as a burden on colleagues and a career detractor, postpartum adjustment, balancing personal and professional requirements, pregnancy timing and parenting challenges, and importance of friendship and camaraderie in pregnancy), and Navigating the Healthcare Experience (including subthemes of transfer between military and civilian care and TRICARE challenges, perception of military care as inferior to civilian, and remote duty stations and international care). Conclusions: The unique stressors of military life act synergistically with the existing health care challenges, presenting opportunities for improvements in care. Such opportunities may include increased consistency of policies across services and commands. Increased access to group prenatal care and support groups, and increased assistance with navigating the health care system to improve care transitions were frequently requested changes by participants.