Bichrest Rivier a Formal Literature Review of Veteran Acculturation
Volume 51 Number vii, 2014
Pages 1035 — 1046
Low, posttraumatic stress disorder, and grade point average among educatee servicemembers and veterans
Craig J. Bryan, PsyD, ABPP;1* AnnaBelle O. Bryan, BSPH;1–2 Kent Hinkson Jr;3 Michael Bichrest;4 D. Aaron Ahern, PhD5
1National Heart for Veterans Studies, The University of Utah, Salt Lake City, UT; 2Salt Lake Customs Higher, Salt Lake City, UT; iiiDepartment of Psychology, Utah Valley University, Provo, UT; 4Section of Education, Rivier University, Nashua, NH; fiveVeterans Integration To Academic Leadership Program, Cincinnati Department of Veterans Affairs (VA) Medical Center, Cincinnati, OH; and VA Common salt Lake City Wellness Care System, Salt Lake City, UT
Abstract —The current study examined relationships among cocky-reported depression severity, posttraumatic stress disorder (PTSD) symptom severity, and form signal average (GPA) among student servicemembers and veterans. Nosotros asked 422 pupil servicemembers and veterans (72% male, 86% Caucasian, mean age = 36.29 yr) to complete an anonymous online survey that assessed self-reported GPA, depression severity, PTSD severity, and frequency of academic issues (belatedly assignments, depression grades, failed exams, and skipped classes). Female person respondents reported a slightly higher GPA than males (3.56 vs 3.41, respectively, p = 0.01). Low symptoms (beta weight = -0.174, p = 0.03), male sexual practice (beta weight = 0.160, p = 0.01), and younger historic period (beta weight = 0.155, p = 0.01) were associated with lower GPA but not PTSD symptoms (beta weight = -0.040, p = 0.62), although the interaction of depression and PTSD symptoms showed a nonsignificant inverse relationship with GPA (beta weight = -0.378, p = 0.08). More than astringent depression was associated with turning in assignments late (beta weight = 0.171, p = 0.03), failed exams (beta weight = 0.188, p = 0.02), and skipped classes (beta weight = 0.254, p = 0.01). The relationship of depression with self-reported GPA was mediated by frequency of failed exams. Results suggest that student servicemembers and veterans with greater emotional distress likewise report worse academic performance.
Key words: academics, college, depression, GPA, grade point average, military, posttraumatic stress disorder, pupil, university, veteran.
Abbreviations:CI = confidence interval, GPA = grade point boilerplate, PCL = Posttraumatic Stress Disorder Checklist, PCL-SF = Posttraumatic Stress Disorder Checklist-Short Form, PHQ-9 = Patient Wellness Questionnaire-9, PTSD = posttraumatic stress disorder, SD = standard difference, VA = Department of Veterans Affairs.
*Accost all correspondence to Craig J. Bryan, PsyD, ABPP; National Center for Veterans Studies, The University of Utah, 260 S. Central Campus Dr, Room 205, Salt Lake Urban center, UT 84112; 801-587-7978.
Email: craig.bryan@utah.edu
http://dx.doi.org/ten.1682/JRRD.2014.01.0012
In 2012, just under i million U.S. military personnel and veterans received fiscal assistance from the Department of Veterans Affairs' (VA's) various educational programs, which marks an increase of approximately 75 percent since 2008 [1]. This dramatic increase in the utilize of educational benefits by military personnel and veterans is due in big part to the Post-9/11 Veterans Educational Aid Act of 2008, commonly referred to as "the new GI Beak." An additional 121,000 veterans enrolled in higher courses through the vocational rehabilitation and employment program, which is intended to assist veterans with certain service-continued disabilities to obtain stable and suitable employment [i]. It is currently unknown how many war machine personnel and veterans pay for college expenses on their ain without accessing VA educational benefits.
Military personnel and veterans who nourish college and university courses (i.e., student servicemembers and veterans) may differ from traditional higher students in several means [ii–iii]. First, student servicemembers and veterans are more likely than traditional college students to be male, older in historic period, married, and have children [two]. Student servicemembers and veterans too comport differently than traditional students because of the unpredictability of the military machine system (eastward.g., deployments, training requirements, reassignments). For case, student servicemembers and veterans are much more probable to stop attending college completely for a temporary catamenia of fourth dimension and so resume at a later engagement [three]. In addition, military personnel and veterans accept elevated rates of medical and psychiatric weather condition relative to the general population [4]. Up to 75 pct of student servicemembers and veterans have service-connected disabilities, of which the most common is a psychological or emotional condition such as posttraumatic stress disorder (PTSD) or depression [v].
Research among college students suggests that emotional distress is inversely related to bookish performance and grades [6]. To engagement, all the same, these associations take not been examined among student servicemembers and veterans, a group that may be at elevated risk for anxiety and mood disorders. In a recent sample of student servicemembers and veterans, for example, 25 percentage screened positive for depression and 45 percentage screened positive for PTSD [seven], rates that are over twice the reported rates among veterans of the conflicts in Republic of iraq and Afghanistan, of whom an estimated five to 17 percent meet criteria for PTSD and up to 25 percent report a mental wellness problem of some kind [8–10]. Research supports a human relationship between gainsay exposure and mental wellness problems amid military personnel [10–11] and pupil servicemembers and veterans [12]. Given that approximately two-thirds of educatee servicemembers and veterans written report having been in combat while in the military, the relatively loftier rates of emotional distress among them may be due to military-related stressors. It is also possible that the college rates of depression and PTSD reported by student servicemembers and veterans relative to armed services personnel are influenced past contextual demands such as mental wellness stigma. Specifically, student servicemembers and veterans may exist more than willing to study emotional distress on surveys conducted external to the military. Although the exact reasons for the higher rates of depression and PTSD amidst student servicemembers and veterans are not yet clear, information technology is clear that many pupil servicemembers and veterans are reporting elevated levels of emotional distress.
Of the anxiety and stressor-related disorders, PTSD has an particularly potent relationship with lower academic accomplishment in general higher student populations [13], particularly during the first year of higher. Students with PTSD are also more than likely to earn a lower grade point boilerplate (GPA) during their first year in college, which may partially account for increased attrition among first-year students who study a history of trauma [14–xv]. Depression is as well inversely related to bookish functioning among college students [sixteen–18], possibly because depressed students experience classroom difficulties such as skipped classes, missed assignments, and failed exams more than often than nondepressed students [xviii]. When low and anxiety are considered together, depression may have a relatively stronger relationship with academic operation [sixteen], although the combination of low and anxiety is associated with worse academic performance than each condition solitary [19].
Given that PTSD and low are associated with lower GPA and increased likelihood of early on drop out from schoolhouse, student servicemembers and veterans may be a subgroup of higher students at increased risk for experiencing academic difficulties. However, nosotros are unaware of any studies that have examined academic operation amongst student servicemembers and veterans. In light of this research gap, the principal aim of the current study was to conduct a preliminary test of the relationships among self-reported PTSD, depression, academic performance, and bookish bug in a sample of student servicemembers and veterans who completed an anonymous survey online. We specifically hypothesized that self-reported PTSD and depression symptoms would be associated with lower GPA and more frequent academic issues and that the interaction of PTSD and depression (i.due east., greater severity of each) would exist associated with significantly lower GPA.
Participants included 422 college student servicemembers and veterans (71.9% male) ranging in age from 19 to 78 yr (mean ± standard difference [SD] = 36.29 ± 10.25 yr) attending universities and colleges beyond the Usa. Racial distribution was 85.5 per centum Caucasian, 5.7 percentage African American, 3.three percent Asian, 3.3 percent Native American, and 1.2 percent Pacific Islander. Hispanic and Latino ethnicity was assessed separately from racial identity and endorsed by 11.6 percent of participants. The majority of participants (64.9%) were veterans no longer in military service (e.g., retired, honorably discharged); the remaining participants (35.1%) reported that they were notwithstanding serving in one of the war machine's components. Students represented all branches of service: 32.5 percent Air Force, 37.8 per centum Army, 7.7 percent Marine Corps, 20.1 pct Navy, and one.two percent Declension Guard. About three-quarters (74.ii%) reported having been deployed at to the lowest degree one time while in the war machine.
Participants were recruited from universities across the United States in coordination with academy administrators and personnel working with educatee servicemembers and veterans during the 2013 calendar yr (i.e., bound 2013, summer 2013, and fall 2013 academic terms). An invitation to participate was sent to university veteran services coordinators via a national organizational email listserv. Interested academy administrators responded to the researchers with their contact data. Data regarding the study was and then emailed to the veteran services coordinators with an embedded hyperlink to the online survey. Coordinators forwarded this message to known student servicemembers and veterans enrolled at their respective universities. Upon visiting the written report Spider web site, pupil servicemembers and veterans reviewed the informed consent document and, if agreeing to participate, proceeded to the survey. Upon completion of the survey, participants were invited to forwards the hyperlink to the study Spider web site to friends and other student servicemembers and veterans. The survey was completed anonymously and took an average of 12 to 15 min to complete. A full of 561 individuals accessed the survey Web site, of whom 437 (77.ix%) completed the survey. Of these 437, 15 (3.3%) indicated that they had never served in the armed services and were therefore excluded, leaving 422 student servicemembers and veterans (i.eastward., 75.two% of all individuals accessing the survey). Because of the methods employed, it is unknown what proportion of all educatee servicemembers and veterans who were provided an opportunity to participate (i.east., those who received an e-mail invitation) actually did so. Participants reported being enrolled at the post-obit types of universities and colleges: big (i.eastward., >ten,000 students) 4-year public (north = 207, 49.0%), small (i.e., < iii,000 students) to medium (i.e., iii,000–9,999 students) four-year public (north = twenty, 4.8%), large 4-year individual (n = 16, 3.9%), pocket-sized to medium iv-twelvemonth private (northward = 24, 5.8%), big 2-year public (n = 88, xx.8%), small to medium 2-twelvemonth public (due north = 16, 3.nine%), and for-profit/online (n = 44, 10.iv%); vii participants did not report their university or institution's proper name.
GPA was assessed via self-study using the following item: "What is your current class signal average?" Participants in their offset academic term who did not even so have a GPA were directed to leave this item blank. Prior research has indicated that self-reported GPAs accept very high correlations with GPAs obtained from schoolhouse records (r = 0.xc ± 0.05) [20] and that discrepancies between cocky-reported GPA and school-reported GPA are so modest that they do not affect research outcomes [21].
Low symptoms were assessed with the Patient Health Questionnaire-9 (PHQ-9) [22], which is a 9-item cocky-report measure out designed to assess how oft the respondent has experienced each symptom of major depressive disorder during the past two wk. The calibration is widely used equally a reliable and validated measure of depression. Internal consistency for the electric current sample was 0.91.
PTSD symptoms were assessed with the PTSD Checklist-Short Form (PCL-SF) [23], which is an abbreviated half-dozen-item version of the full 17-item PTSD Checklist (PCL) [24]. The PCL-SF's six items were chosen by selecting the two items from each of the Diagnostic and Statistical Manual of Mental Disorders-4th Edition PTSD symptom clusters that correlated highest with the total scale score and with its respective symptom cluster total score: intrusive memories and images of the trauma and emotional distress when reminded of the trauma (cluster B), avoidance of activities and situations that remind of the trauma and feeling afar or cut off from others (cluster C), and feeling irritable or angry and feeling super alert (cluster D). The PCL-SF correlates very highly with the full PCL (r = 0.97) and is comparable with the full scale in terms of sensitivity and specificity for a diagnosis of PTSD. Internal consistency for the electric current sample was 0.93. Participants were asked to place and consider their well-nigh stressful lifetime experience when completing the PCL-SF.
To assess academic operation, participants were asked to written report the frequency of several classroom-related problems during the well-nigh recent academic term on a scale ranging from 0 (never) to v (more than ten times): turning in an assignment or paper late, receiving a lower form than expected on (but still passing) an exam or quiz, failing an test or quiz, and skipping or choosing not to attend class.
Of the 422 participants, 146 (34.6%) were in their outset academinc term and therefore did not yet have a GPA to written report, leaving 276 (65.four%) bachelor for analysis. Mean ± SD and intercorrelations of all variables were commencement calculated (Table one). Self-reported GPA ranged from 0.twenty to iv.00, with a mean GPA of 3.45 ± 0.49. Female person students (3.56 ± 0.forty) reported a significantly higher mean GPA than male students (three.41 ± 0.52, t (275) = ii.610, p = 0.01), but there was no departure between Caucasian and non-Caucasian students (t (275) = i.354, p = 0.18). Electric current GPA was negatively correlated with both PTSD (r = -0.13, p = 0.04) and depression symptom severity (r = -0.20, p = 0.01).
Using empirically derived cutoff scores for the PHQ-9 and PCL-SF scores, we estimated rates of depression and PTSD among participants. For the PHQ-9, we used a cutoff score of 10 to determine likely depression based on the results of a meta-analysis that found this score best balanced sensitivity and specificity for major depressive disorder [25]. For the PCL-SF, we used a cutoff score of 14 to make up one's mind probable PTSD based on the results of Lang and Stein, who identified this score every bit optimizing sensitivity, specificity, and diagnostic efficiency for PTSD [23]. Using these cutoff scores, 31.vii percent of participants screened positive for depression and 48.4 percentage screened positive for PTSD. As displayed in Table 2, 46.0 percent screened positive for neither PTSD nor low, 22.four per centum screened positive for PTSD only, 5.7 pct screened positive for depression only, and 26.0 per centum screened positive for both PTSD and depression.
To test the association of PTSD and depression symptom severity with current GPA, generalized linear regression with robust maximum likelihood estimation was used. To aid with interpretation of results, standardized regression coefficients (i.e., beta weights) and construction coefficients were calculated and are reported. Age and sex were entered as covariates due to their meaning correlations with GPA. Both PTSD symptom severity (ß = -0.151, p = 0.01) and depression symptom severity (ß = -0.209, p < 0.001) were independently associated with significantly lower GPA, even when controlling for sex and age. When both PTSD and depression symptoms were entered into the regression equation simultaneously, the resulting model was statistically significant (F (four, 254) = 5.729, p < 0.001) and accounted for viii.3 percentage of the full variance in GPA (Table 3, model 1). Depression symptoms (ß = -0.174, p = 0.03), male person sex (ß = 0.160, p = 0.01), and younger age (ß = 0.155, p = 0.01) were significantly associated with lower GPA. In contrast, PTSD symptoms were not associated with GPA (ß = -0.040, p = 0.62). We next calculated the interaction of PTSD and depression severity and added it to the regression model. The interaction term showed a strong trend toward significance (ß = -0.378, p = 0.08) and explained an additional 1.0 percentage of variance in GPA (Table 3, model 2). The Figure displays the class of this interaction. The Johnson-Neyman test for regions of significance indicated that more severe low was significantly associated with lower GPA among participants scoring college than 18 on the PCL-SF.
Hateful GPAs with standard errors were next calculated and compared across the four student subgroups. Students with both PTSD and depression had the lowest mean GPA, whereas the three remaining groups had comparable GPAs (Tabular array 2). On average, students with both PTSD and depression reported a GPA that was 0.25 lower than students in all other groups.
Figure 1.
Interaction of depression symptom and posttraumatic stress disorder (PTSD) symptom severity on grade point average (GPA) amid educatee servicemembers and veterans, plotted as mean ± standard divergence scores for low and PTSD.
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In terms of self-reported academic problems, the majority of participants reported that each trouble was experienced relatively infrequently (Table 4). The about usually occurring problem was receiving a lower than expected grade on a test or examination, which was experienced at to the lowest degree one time by 74 per centum of participants. Just nether half (44%) of participants turned in an assignment late and 56 percent skipped class at least once. Approximately i-third (37.6%) of participants failed an test at least once during the most recent bookish term. Equally would be expected, electric current GPA was also negatively correlated with greater frequency of academic problems: turning in assignments late (r = -0.33, p < 0.001), earning lower grades than expected (r = -0.39, p < 0.001), failing exams (r = -0.39, p < 0.001), and skipping grade (r = -0.22, p < 0.001).
Generalized linear regression was then used to exam the clan of PTSD and depression severity with cocky-reported academic issues. Age and sex were again entered as covariates due to their meaning correlations with GPA. Table v summarizes the results of regression analyses and indicates that more than severe depression was associated with significantly greater frequency of 3 out of the four academic bug assessed: turning in assignments late (ß = 0.171, p = 0.03), failing exams (ß = 0.188, p = 0.02), and skipping classes (ß = 0.254, p = 0.01). Younger age was associated with significantly more than frequent tardily assignments (ß = -0.158, p = 0.01), earning lower grades than expected (ß = -0.148, p = 0.01), and skipping classes (ß = -0.253, p < 0.001). Male person students also reported earning lower grades than expected (ß = -0.204, p < 0.001) and failing more exams (ß = -0.113, p = 0.04) than female students. Inspection of the beta weights and construction coefficients indicated that depression severity was among the strongest factors associated with each academic problem. Past comparison, the minor beta weights and moderately sized structure coefficients for PTSD suggests that although this variable had a moderate association with academic problems, it did not add together much predictive value overall, due primarily to its high correlation with depression. With respect to skipping classes, even so, younger age showed the relative strongest clan. The interaction of PTSD and depression symptom severity was nonsignificant for each of the four academic problems and was therefore excluded from the last models. Comparisons of academic bug across the four subgroups indicated that students with both PTSD and depression reported significantly greater frequency of all four bookish problems than students with neither PTSD nor depression (Tabular array 2).
Given the significant associations of depression with GPA and bookish bug identified in the previous analyses, we next sought to explore the possibility that bookish problems explained the relationship between low and GPA. To accomplish this, we entered all iv academic problems (i.east., frequency of late assignments, earning lower grades than expected, declining exams, and skipping classes as predictors) to the regression model testing the association of PTSD and depression symptom severity with GPA. Tabular array 3 summarizes results (model 3) and suggests that higher GPA was significantly associated with female sex activity (ß = 0.097, p = 0.10), less frequent late assignments (ß = -0.178, p = 0.01), and less frequent failed exams (ß = -0.232, p = 0.01). With the inclusion of these academic problems, depression was no longer significantly associated with overall GPA, although the structure coefficient (-0.406) suggested that depression was yet moderately associated with GPA. To test the arbitration hypothesis, we used the bootstrapping procedures described by Preacher and Hayes [26]. A total of 10,000 samples were drawn with bias-corrected and accelerated conviction intervals (CIs). Results suggested that only the indirect effect of failed exams was a pregnant pathway (ß = -0.003, standard error = 0.002, 95% CI: -0.008 to 0.000), suggesting the relationship of depression with GPA occurs primarily because participants with more severe depression tend to fail exams more ofttimes.
The current written report provides a preliminary overview of academic performance among pupil servicemembers and veterans, also every bit the relationships among academic functioning, bookish problems, depression, and PTSD. Conclusions based on findings should be made with caution, even so, due to the use of self-report methodology, which could exist vulnerable to response bias. Arbisi et al., for instance, has recently noted that cocky-report measures of depression and PTSD symptoms may issue in higher-than-expected faux positive rates when used with Republic of iraq and Afghanistan personnel because they also assess more generalized or diffuse emotional distress [27]. Furthermore, when comparison cocky-reported GPA to actual GPA, individuals tend to inflate rather than underestimate their GPA [20–21,28], with larger magnitude inflation occurring among individuals involved in litigation and legal proceedings, suggesting that adversarial contexts might contribute more to grade aggrandizement than nonadversarial contexts [28]. A more than recent meta-analysis conducted in academic settings indicates that although 34 percent of college students overestimate their GPA when asked to self-report, with larger aggrandizement occurring amongst those students with lower actual GPAs, the overall correlation between self-reported and actual GPA among college students was even so very high (r = 0.90, 90% CI: 0.82–0.98) [20]. Taken together, these findings advise that grade aggrandizement may be a limitation to the current study, especially among those student servicemembers and veterans who take the lowest actual GPAs. Results of the current written report should therefore be considered preliminary until time to come studies using alternative methods to self-study, such as structured clinical interviews and scholastic records, tin can be conducted.
Overall, the mean self-reported GPA of student servicemembers and veterans in the current study suggested good academic performance, with female participants reporting a higher GPA on boilerplate than males. Consistent with expectations and prior enquiry among nonmilitary and nonveteran higher students [fourteen,16–xviii], GPA was inversely associated with depression and PTSD symptoms. Results of the current study further propose depression may play a relatively stronger role than PTSD symptoms. The proportions of student servicemembers and veterans screening positive for probable depression (31.7%) and PTSD (48.4%) in the current study were comparable with previously reported rates among college student servicemembers and veterans (23.seven% screening positive for "severe depression" and 45.vi% screening positive for PTSD) [7] and the general college pupil population (28.iv% reporting they "felt so depressed it was difficult to function" and 46.4% reporting "overwhelming feet") [29]. Although at that place is considerable convergence across these studies, these results nonetheless need to be replicated using more rigorous methods (e.chiliad., structured clinical interviews) designed to maximize diagnostic specificity, thereby minimizing false positives that are often characteristic of screening methods.
The interaction of depression and PTSD symptoms observed in the current study, although marginally nonsignificant, aligns with prior inquiry similarly suggesting an augmenting result of low and anxiety on college students' academic performance [19] and suggests that student servicemembers and veterans with co-occurring conditions may exist especially likely to experience academic challenges. Previous research with student servicemembers and veterans has indicated an interactive consequence of depression and PTSD on increased severity of suicidal thoughts and behaviors among pupil servicemembers and veterans every bit well [20]. The current results therefore expand upon previous studies by confirming that pupil servicemembers and veterans with co-occurring depression and PTSD non only have greater clinical needs only are also more likely to feel challenges in daily performance associated with quality of life (e.one thousand., employment). From a clinical perspective, the current results may provide useful information for engaging educatee servicemembers and veterans in mental wellness services. As noted by Bryan and Morrow, conceptualizing mental health treatment from a more functional perspective is more than consistent with the values of the war machine civilization and may therefore be more acceptable to military personnel and veterans who more often than not have negative impressions of the mental healthcare organisation [thirty]. For example, clinicians may describe and "market" empirically supported treatments for comorbid PTSD and depression such as prolonged exposure and cerebral processing therapy equally methods for improving bookish operation [31]. Indeed, results of clinical trials have consistently supported these therapies as highly effective for comorbid PTSD and depression [32], to include military personnel and veterans beyond eras [32–34].
Our results do not just have implications for clinicians, all the same. In the current written report, depression was also associated with more frequent occurrences of turning in assignments late, earning lower grades than expected, declining exams, and skipping classes. In general, each of these issues was reported relatively infrequently, but student servicemembers and veterans with comorbid low and PTSD experienced all four problems significantly more ofttimes than those with neither low nor PTSD. The occurrence of any of these problems more than a few times during an bookish term may therefore role as potential "alert signs" for emotional distress among student servicemembers and veterans. Faculty members, university staff, and family members may be especially aware of these issues, and therefore could play an important role in detecting at-risk student servicemembers and veterans and encouraging them to seek out appropriate supportive services and/or academic accommodations. Frequency of failing exams may be a especially of import indicator, considering it fully mediated the relationship of depression with GPA, suggesting that this particular bookish problem may be especially important for agreement the association of depression with academic performance. Taken together, these results propose that student servicemembers and veterans with more severe low earn a lower overall GPA primarily because they also tend to fail exams more often. Depressed students report turning in assignments late and skipping class more often, simply the nonsignificant indirect effects observed in our regression analyses suggest these detail problems may not exist every bit central to the relationship between depression and GPA.
Results of the electric current study must be considered within the context of its limitations, which extend beyond the cocky-report methodology already discussed. For case, our report's sample is not necessarily representative of all student servicemembers and veterans enrolled in higher or university courses. Furthermore, a cocky-selection bias may exist due to our recruitment strategy, which could limit the generalizability of our conclusions. The current results should therefore be considered preliminary until additional research tin replicate these findings. Hereafter efforts should exist characterized by the following: (1) use of structured diagnostic interviews in addition to self-report surveys to provide more reliable assessments of depression and PTSD, (ii) use of GPA and other indicators of academic performance based on scholastic records rather than self-report, and (3) sampling methods that are more representative of the population and practise not rely solely on cocky-selection. Finally, our cantankerous-sectional design limits our ability to place the management of effect among emotional distress and academic functioning in educatee servicemembers and veterans. Specifically, nosotros are unable to determine whether emotional distress serves as a forerunner to declines in academic performance or whether poor bookish performance precedes emotional distress. Future studies that incorporate longitudinal designs are needed to better understand the temporal relationships amid psychological and academic variables in this population.
Despite these limitations, the current study provides important information about the academic operation of student servicemembers and veterans and is the first to examine the relationships among low, PTSD, and academic performance in this population, with overall results suggesting that low and PTSD may have negative implications for academic success in this group.
Study concept and blueprint: C. J. Bryan, A. O. Bryan, D. A. Ahern.
Acquisition of data: C. J. Bryan, A. O. Bryan, Thousand. Hinkson Jr,
M. Bichrest, D. A. Ahern.
Analysis and interpretation of data: C. J. Bryan.
Drafting of manuscript: C. J. Bryan, A. O. Bryan, K. Hinkson Jr, Thou. Bichrest, D. A. Ahern.
Financial Disclosures: The authors have alleged that no competing interests exist.
Funding/Back up: This material was unfunded at the time of manuscript preparation.
Institutional Review: Approval for the current written report was provided by the Academy of Utah Institutional Review Board.
Participant Follow-Up: The authors take no plans to notify the study subjects of the publication of this article because of a lack of contact information.
| 4. | Kessler RC, Heeringa SG, Stein MB, Colpe LJ, Fullerton CS, Hwang I, Naifeh JA, Nock MK, Petukhova M, Sampson NA, Schoenbaum G, Zaslavsky AM, Ursano RJ; Army STARRS Collaborators. Thirty-day prevalence of DSM-IV mental disorders among nondeployed soldiers in the US Army: Results from the Regular army Written report to Assess Gamble and Resilience in Servicemembers (Army STARRS). JAMA Psychiatry. 2014;71(5):504–thirteen. [PMID:24590120] |
| 31. | Institute of Medicine; Committee on the Cess of Ongoing Efforts in the Handling of Posttraumatic Stress Disorder. Treatment for posttraumatic stress disorder in military machine and veteran populations: Initial assessment. Washington (DC): The National Academies Press; 2012. |
| 32. | Resick PA, Schuster-Wachen J, Mintz J, Wilkinson C, Dondanville K, Pruiksma 1000, Borah A, Peterson AL; STRONG STAR Consortium. CPT vs. PCT: Final results of a randomized controlled trial. Proceedings of the Annual Meeting of the International Society for Traumatic Stress Studies; 2013 Nov; Philadelphia, PA. |
Submitted for publication January nineteen, 2014. Accustomed in revised form April 29, 2014.
This article and any supplementary material should exist cited as follows:
Bryan CJ, Bryan AO, Hinkson K Jr, Bichrest M, Ahern DA. Depression, posttraumatic stress disorder, and form signal average among student servicemembers and veterans. J Rehabil Res Dev. 2014;51(7):1035–46.
http://dx.doi.org/10.1682/JRRD.2014.01.0012
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