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Linkage between Crime and Homelessness among Veterans with PTSD and Co-Morbid Disorders

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Linkage between Crime and Homelessness among Veterans with PTSD and Co-Morbid Disorders

Introduction

Studies show that soldiers undergo fear and violence of war. Warriors with PTSD and comorbid disorders have become noticeably functional impaired and have negative cognition after a traumatic event. PTSD is a mental disorder that leads to symptoms such as avoidance, re-living their trauma and individuals show physiological alterations in sleep and hypervigilance (Brown, Stanulis, & McElroy, 2016).  The study also covers three main comorbid disorders that occur in a person with PTSD.  Comorbid disorders denote two or more disorders that interact with the individual’s illness.  The three main comorbid disorders are MD, Anxiety, and SOD.   The gap in the literature of PTSD and comorbid disorders is crime and homelessness.  Thus, I will use a qualitative thematic analysis with the theoretical framework of the BPS Model to comprehend and explain the person’s mental issues and the connection between crime and homelessness.  The major sections of this chapter open by targeting literature review supported by existing issues.  This study will examine (a) diagnostic features of PTSD, (b) reviews of current of PTSD and comorbid disorder and the impact of crime and homelessness among veterans, (c) Engel’s (2013) BPS model to describe the relations between biological, psychological and social factors of “wellness and disease” (p.266), (d) definitions regarding veteran policy and federal government terms, (e) and other potential indicators that can lead to crime and homelessness.  Veterans benefit creates a negative impact on military benefits, emphasizing the potential dangers such as crime and homeliness.  Other factors such as mental issues, unemployment, stigma, and social exclusion, present the soldiers with highly elevated risk factors for crime and homeliness.  Thus, each section of this research will consist of vital research to direct others to produce preventive strategies to reduce crime, homelessness, mental health and bring positive social change.

Literature Search Strategies

The objective of the research literature is to examine the linkage between crime and homelessness among veterans with PTSD and comorbid disorders.  The literature review will also confirm risk factors and barriers that soldiers experience with veteran health policies issues and their struggles made to secure medical care.   The research literature performed provided specific information on veterans with PTSD and comorbid disorder link to crime and homelessness.  The literature review includes BPS model, legal terms, veteran policies and other potential risk factors.  The scope of the review includes primary databases from the Walden Library, National Center for PTSD, Congressional Research Service, and U.S. National Library of Medicine National Institute of Mental Health.  Other databases used in this research literature search are Legal Information Institute, Mayo Clinic, Sunshine Coast Health Center, Google Scholar, and DSM V. A literature strategy was attaining articles by examining the articles reference lists, similar related articles and cited articles within the article.  The articles obtain are from 2014 to the present.  I read earlier research articles to compare the similarities and the differences between past and present information.  The key words in this search include PTSD, crime, homelessness, biopsychosocial model, veteran policies and benefits, comorbidity, major depression, anxiety, drugs and alcohol, mental health, avoidance, social exclusion, employment and stigma.  Conducting these keywords ensures the recovery of additional articles that address research matter.

Theoretical and Conceptual Framework

Biopsychosocial Model (BPS)

The biopsychosocial (BPS) model is used for the conceptual framework research created on the theories that PTSD is the result of the intricate relations with biological, psychological and social factors.  The BPS model transpires relevant historical individuals and earlier developmental historians such as Rudolf Virchow who practiced his biosocial disease medicine and became known as the “father” of both social medicine and biomedicine (Richert, 2018, p. 167).  Other historical individuals are Paul Weis and Ludwig von Bertalanffy who opposed the General System Theory (GST) because it limited the rationale of closed experiments (Richert, 2018). These developments gave emphasis on infectious diseases and gave rise to the biomedicine findings such as Semmelweis, Lister, Pasteur, Koch, and Klebs (Richert, 2018).  Another important historical individual is Adolf Meyer, a psychiatrist from Johns Hopkins Hospital, which drew his assumptions from Emil Kraepelin and Sigmund Freud.  Meyer believed in the importance of the scientific method in understanding a person’s mental illness approach called psychobiology (Richert, 2018).  As a result, George Engel created the BPS model in 1977 as an addition to the “model of disease” (Gritti, 2017, p. 37).  Ten years later, D.M. Donovan and J. Wallace link “addictive behaviors”, and other theorists expanded the model to include genetics such as “learned behavior,” family impact and the need to self-medicate (“Biopsychosocial (BPS) model,” 2018, expression E; Gritti, 2017).  Thus, Engel’s model is the ideal framework because biological, psychological, and social factors interconnect with PSTD and mental health disorder.

Biological Factor

The biological features of the BPS model represent the physical adaption reactions to anxiety, fear, panic, genetic traits and past traumas (Bevers, Watts, Kishino, & Gatchel, 2016). A biological feature can be an individual adjustment to a historical traumatic incident or a genetic vulnerability that can cause the person susceptible to become pathologically unstable.  With long-term disorders, the person’s homeostatic condition leads to high levels of stress effects on the biopsychosocial factors (Bevers, Watts, Kishino, & Gatchel, 2016).  For example, the body needs cortisol to survive stress, but biologically too much cortisol is dangerous.  Another essential biological fact is the hypothalamic-pituitary-adrenal (HPA) axis.  The continuous high levels of HPA can lead to tissue, bone and muscle collapse; and serotonin and norepinephrine can lead to mood disorders (Bevers, Watts, Kishino, & Gatchel, 2016).

Psychological Factor

The psychological feature analyses emotions and perceptions involving the individual’s environmental experiences.  Psychological factor in individuals include mental decondition such as anxiety, personality disorders, substance abuse, depression, PTSD, and negative skills, thinking, and judgment (Babalola et al., 2017).  An example of the psychological factor is a 2014 study of 36 male veterans and their connection with illicit drug use, trauma, and psychological pain (Bennett, Elliott, Golub, Brett Wolfson-Stofko, & Guarino, 2017).  The results of this research indicate that psychological behavioral was the need to self-medicate with illicit drugs or overdose to elevate the psychological pain of their traumatic experiences (Bennett et al., 2017).

Social Factor

The social factor of BPM model approaches issues that impact the persons “socioeconomic status, culture, and religion” (Anon, 2016).  A social factor can include how the person affects their social factors of medical care and social support.  Unfavorable PTSD elements include factors such as family and community social support, unemployment, other life stressors (Robertson, 2015).  Studies also show that “30% of soldiers believe” that seeking mental health will damage their careers, “40% believe” that their leaders would condemn the solider, and “over 50% believe” that people would see them as “weak” individuals (Robertson, 2015, p. 68).

https://media.springernature.com/full/springer-static/image/art%3A10.1186%2Fs12998-017-0147-x/MediaObjects/12998_2017_147_Fig1_HTML.gif

Figure 1 (Gliedt, Evans Jr, Schneider, & Eubanks, 2017, figure 1)

Consequently, the BPS model can verify the influence and interplay structures and stresses of the significances of biological, psychological and sociological dynamics of a person’s disorders (Babalola, Pia, & White, 2017).  By using the BPS model, one can identify perspectives and episodes of events to PTSD and comorbid disorders linkage to crime and homelessness among veterans.

Literature Review Related to Key Variables and/or Concepts

Definitions

Posttraumatic Disorder Stress (PTSD) 

PTSD is a mental illness that’s caused by experiencing or witnessing a traumatic event. Categorization of these symptoms includes four types:  “intrusive memories, avoidance, adverse changes in thinking and mood, and changes in physical and emotional reactions” (Post-traumatic stress disorder (PTSD), 2018, para. 5).  Symptoms can include anxiety, avoiding people, places, things, nightmares, flashbacks and unmanageable negative thought process of the event.  The symptoms can last for one month, can appear years later, and can cause problems in the person’s day-to-day living (Post-traumatic stress disorder (PTSD), 2018).

Veteran Policies

Governmental policies are the governments note to guide protocols and rule how, where and when the procedures can be implemented.  The Veteran Affairs (VA) policy influences the possibility of veterans receiving VA benefits.  Before I describe the five veteran policies for veterans, I must first define the word veteran.  Szymendera (2016) describes a veteran “as a person who served in the active military, naval, or air service, and who was discharged or released therefrom under conditions other than dishonorable” (p. 1).  Szymendera (2016) presents five veteran status principles discharges:  Veteran Policy for Discharge and Benefits, Honorable discharge veteran (HDV), Discharge under Honorable Conditions (UHC) or General Discharge (GD), Discharge under Other Than Honorable (UOTHC) or Under-desirable Discharge (UD), Bad Conduct Discharge (BCD), and Dishonorable Discharge (DD).  The VA grants benefits which may vary to American Veterans, but must also meet specific veteran governmental criteria.  The VA Department uses two ways to prove eligibility; verification of a veteran and entitlement for benefits (Szymendera, 2016).  Thus, for this paper, I will define the difference between veteran discharge statuses as it relates to the veterans need for medical attention.

Honorable discharge veteran (HDV)

HDV solider is eligible for public and private benefits depending on the duration of service and the nature of the discharge.  The veteran’s recorded military records must show positive verification of ethical conduct, time and active military service, legal proof of military status, and discharged on honorable bases (Szymendera, 2016).  If the veteran did not serve up to “24 months” in the military or the criteria not met, then the solider is not eligible unless the veteran enlisted before September 8, 1980 (Szymendera, 2016, p. 2).  Other time exceptions include a veteran’s “disease, hardships or service disability” ((Szymendera, 2016, p. 2).

Discharge under Honorable Conditions (UHC) or General Discharge (GD)

Veterans who are GD or UHC discharge despite the reasons why there was a separation will receive benefits.

Discharge Under Other Than Honorable (UOTHC) or Under-desirable Discharge (UD)

The VA reviews UOTHC, or UD discharge, such as court-martial or other dishonorable claims.  Each case is also reviewed for every enlisted period to determine Character of Service (COS) and eligibility of benefits.

Bad Conduct Discharge (BCD)

BCD such as veteran parolees or veteran prisoners may be given some VA benefits but must contact the VA to determine entitlement; although, if the veteran has a felony warrant, the VA will not provide the veteran or their dependents benefits (Szymendera, 2016).

Dishonorable Discharge (DD)

DD soldiers receive no benefits unless the law discovers the veteran was insane.

Crime

The definition of crime by the Correctional Officer Organization is “an act committed to endanger, harm, or violate the rights of an individual or an entire community” (Definition of crime, 2018, p. 1).   Committing a crime can be made by one person, a group, can be intentionally or unintentionally.  The crime can be executed in a physical, mental, emotional, or financial way.  A crime can also consists of damaging property, the environment, animals, preventing a crime, assisting, helping or organizing the criminal act.  They are three degree classifications of a crime:  “Felony, Misdemeanor, and Infraction” (Definition of crime, 2018, para. 10).  Felony is the extremely serious which entails property and violent crimes.  A misdemeanor crime is not as severe and causes no harm to a person or property and infraction is the least serious.  .

One must note that military rules, rights and duties have different process court penalties than civilian criminal justice. They are six different proceeding: Military individuals are “Governed by the United Code of Military Justice (UCMJ)”, issue to “Summary, Special or General Court-Martial”,  “different kind of jury”,  “unanimous vote is not required”,  and “appeals are heard by your Branch of the Military” and lawyers must receive Specialized Military Training” (Martinez, 2016, para. 5-13).

  • The military is governed by the UCMJ, while the civilians follow “local, state and federal laws” (Martinez, 2016, para. 4).
  • The military has “Summary, Special and General Court-Martials;” if they break a civilian law, the soldier can take part in the civilian law; although, the military holds violent or serious crimes in their court (Martinez, 2016, para. 5).  Civilians follow a similar court, such as investigations and can resume during the court proceedings (Martinez, 2016).
  • The military has a particular type of jury and is made up of military member’s, commissioned officers, except the jury does not have 12 peers (Martinez, 2016).  Civilians peer jury is made up of 12 members.
  • The military does not need a unanimous vote unless they are facing a death penalty; plus, life imprisonment requires a three-fourths vote, other cases two-thirds, and the jury creates the sentence (Martinez, 2016).  The civilian courts are unanimous, and the bases of the sentence depend on the individual court charges.
  • The Branch of the Military hears the soldier’s appeals and the civilian cases are appealed in a circuit or federal courts (Martinez, 2016).
  • Military lawyers receive specialized training, and the civilian lawyers are trained on the state, local and federal laws.

Conner states that Iraq and Afghanistan soldiers who have seen disturbing events are “more likely to commit violent crimes” (Connor, 2013, para. 1).  A study of 14,000 military individuals discovered that 20% of soldiers are under 30 years returning home had one violent offense contrast to less than 7% of men in the overall population (Connor, 2013).  Steele (2017) notes that while veteran incarceration for 2001 to 2012 “Bureau of Justice Statistics” rates military soldier’s lower imprisonments from 855 per 10,000 to 968 per 100,000 civilians (para.10).  However, Steele (2017) presents that 64% of veteran’s sentences are due to violent crimes compared to 48% of the civilian population (para. 10).  The “Harvard University Shorenstein Center on Media and FBI statistics” reports that in 2000 to 2006 the average of military crime shootings was 6.4% and more than doubled to 16.4 per year in 2007 to 2013 (Steele, 2017, para. 24).

Homelessness

While history shows that homeless issues have existed for years, history also shows that homelessness was a local issue that did not require federal intervention in information is made public the 80’s (McKinney-Vento Act, 2006). In 1986 the Persons’ Survival Act of 1986 is ratified, but only a few portions tackled long-term homeless solutions (McKinney-Vento Act, 2006).  In 1986 the Homeless Eligibility Clarification Act, the Homeless Housing Act, and the Emergency Shelter Grant program and transitional housing assisted in removing several barriers (McKinney-Vento Act, 2006).  Finally, in 1987, Title 1 of the Homeless Person’s Survival Act was recognized as the Urgent Relief for the Homeless Act and was later named the first and only major federal legislation that response to homelessness is the McKinney-Vento Homeless Assistance Act (McKinney-Vento Act, 2006, p. 1).

A veteran is homeless by the definition of subsection (a) or (b) of the McKinney-Vento Homeless Assistance Act part 103 violence (U.S. Code › Title 42 › Chapter 119 › Subchapter I › § 11302, n.d.; Perl, 2015).  Title 38 United States Code defines section 103 of the McKinney-Vento Homeless Assistance as literally homeless, imminent loss of housing, other federal definitions and domestic violence (U.S. Code › Title 42 › Chapter 119 › Subchapter I › § 11302, n.d.; Perl, 2015).  Title 38 U.S. Code has five descriptions of homelessness; general homeless, expecting loss of housing, and other federal homeless criteria, (U.S. Code › Title 42 › Chapter 119 › Subchapter I › § 11302, n.d.; Perl, 2015).

General Homeless

A general homeless person is an individual that does not have a regular secure nighttime home and meets the general homeless definition of:

  • An individual who does not have a private residence and resides in transportation facilities, vehicle, vacant buildings, or camping sites.
  • Temporary housing, such as hotels, housing or shelters that are financed by organizations, federal, state or local programs.
  • Institutions, such as medical or jail facilities and previously resided in an isolated place.

Expecting Loss of Housing

Expecting loss of housing definition is a homeless individual who:

  • Has verbal or written evidence stating that the person is not allowed to reside for more than 14 days (Perl, 2015).
  • The persons will lose their home which can include, owning, renting, paid or non-paid residencies that are not funded by the government or other charitable organizations.
  • Eviction or written or verbal evidence stating that the person is not allowed to reside for more than 14 days (U.S. Code › Title 42 › Chapter 119 › Subchapter I › § 11302, n.d.).
  • A person where the individual cannot stay more than two weeks or temporary housing where the individual lives temporarily (U.S. Code › Title 42 › Chapter 119 › Subchapter I › § 11302, n.d.).
  • An individual that lacks resources, long periods of finding permanent housing, frequent moves or uncertain residencies or has no residency identification is considered homelessness.

Other Federal Homeless Criteria

Other federal definitions of homeless are families who meet the following criteria:

  • Extended periods (17 to 60 days) in finding permanent housing (Perl, 2015).
  • Two or more frequent moves during a time limit of two months (Perl, 2015).
  • They are uncertain residencies due to physical, mental, social within oneself or to family or employment barriers.

PTSD and the Top Three Co-Morbid Disorders

There are concerns regarding soldiers returning home with mental issues that is why understanding PTSD and mental health is essential in this research.  The American Psychological Association (APA) reports there is an increase in PTSD and comorbid disorders in active duty veterans and their disability peeks several years later after their military duty (The mental health needs of veterans, service members and their families, n.d.).  In 2013, the Diagnostic and Statistical Manual of Mental Disorders (DSM5) adheres a new classified location for PTSD.  PTSD location changed from Anxiety Disorders to Trauma-& Stressor-Related and now describes psychological stress after exposure to a traumatic event (“PTSD and DSM-5,” 2018).  This change is now well-defined that the individual subjected to trauma exhibits noticeable characteristic or traits of the personal behavior (“PTSD and DSM-5,” 2018).  The study also identifies soldier’s experiences that have contributed to their mental health disorder and link among crime and homelessness.  This research examines the top three comorbid disorders that can accompany PTSD.  The top three comorbid disorders are major depression disorder, anxiety disorder, and substance use abuse.  Thus, the aim in this research is to review if there is a linkage between crime and veterans with mental health disorders.

Diagnosis of PTSD 

PTSD is a condition that develops after an individual witness or experiences a traumatic event that causes intense anxiety and symptoms lasting for over a month.  There are eight criteria measures of PTSD in the DSM-V.  Criterion A, B, C requires at least one measure listed.  Criterion D, E requires at least two measures.  Criterion F, G, H requires all of the measures listed.  Individuals must also meet dissociative and delayed specifications.

Criterion A:  The U.S. Department of Veterans Affair (2018) describes criterion A as the individual is exposed to a life threating events such as death, injury, or sexual violence through:

  • “Direct exposure” (para 3)
  • Indirect exposure such as in “first responders” (para 3)
  • Indirect exposure such as seeing the trauma
  • Indirect exposure to discovering that someone was subjective to a trauma

Criterion B:  The U.S. Department of Veterans Affair (2018) describes criterion B as the individual constantly re-experiencing the traumatic episode by having:

  • Unwelcomed disturbing memories
  • “Nightmares
  • Flashbacks” (“PTSD and DSM-5,” 2018, para. 4)
  • Emotional pain after experiencing memories
  • Physical reaction after experiencing memories

Criterion C:   Avoids “trauma-related stimuli” (“PTSD and DSM-5,” 2018, para. 5) by:

  • Related feelings or thoughts of the traumatic event
  • Remembering traumatic events

Criterion D:  The U.S. Department of Veterans Affair (2018) describes criterion D as the person feeling of negativity which started or exacerbated after the traumatic event by:

  • Unable to remember main highlights of the traumatic event
  • Excessive negative notions and ideas about “oneself or the world” (“PTSD and DSM-5,” 2018, para. 6)
  • Blames others or self
  • “Negative affect” (“PTSD and DSM-5,” 2018, para. 6)
  • Uninterested in activities
  • Feeling lonely
  • Trouble feeling “positive effect” (“PTSD and DSM-5,” 2018, para. 6)

Criterion E:  Provoked feelings and reactions that start or get worse after the traumatic event such as:

  • Aggression
  • “Destructive behavior
  • Hypervigilance” (“PTSD and DSM-5,” 2018, para. 7)
  • Enhanced surprised reaction
  • Trouble sleeping
  • Trouble concentrating

Criterion F:  Symptoms remain for one month or more.

Criterion G:  Symptoms produce difficulty at work or social aspects.

Criterion H:  Symptoms do not occur due to “medication, substance use or other illness” (“PTSD and DSM-5,” 2018, para. 10).

Dissociative specifications:  The U.S. Department of Veterans Affair (2018) describes both depersonalization and derealization criterions of which one must be met to fulfill the criteria.

  • Depersonalization:  Experience of detachment or feeling as if one is an outsider.
  • Derealization:  Experience of distortion or feelings of unreality.

Delayed Specification:  The individual may not meet a “full diagnostic criteria” of PTSD until after “six months”; although, some diagnostic symptoms may occur instantly (“PTSD and DSM-5,” 2018, para. 12).

PTSD, Crime and Homelessness

Next to healthcare, the second most important issue that Americans are concerned about is “crime and violence” (Sipes, 2018, para. 1).  The Preliminary Semiannual Uniform Crime Report, January-June reports they are two-thirds of American gun owners disclose they own a gun for protection (2016). Statistics show that from 2015 to 2016 crime has increased ranking from “murder, rape, robbery and aggravated assault” (Preliminary semiannual uniform crime report, January—June, 2016, para. 1).  Other research reveals that between 305 and 399 felony crimes during 2006-2011 that for every 100,000 U.S. Army soldiers, almost 4% in post-deployment reported gun and knife fights (Rosellini et al., 2016, p. 304).  A study conducted with the Vietnam Veterans concluded that “33.0% of veterans with PTSD” of intimate partner violence (Norman, Elbogen, & Schnurr, 2017, para. 5).  Within the military personnel, research shows that criminal transgressions are more significant in soldiers with PTSD than with veterans without (Sadeh & Mcniel, 2014). Moreover, behavioral genetics indicates that there is a risk factor and the increase in drug use, environmental and emotional stress is also involved (Sadeh & Mcniel, 2014). Exposure to trauma is being accepted as a significant vulnerability to deliberate within the hazards of the criminal justice system and mental health.

In 2009 President Barack Obama goal was to end homeless veterans by the year of 2015.  In 2015, New Orleans managed to meet the goal.  In 2016, the End Homeless Organization identifies 39,471 “demographics of homeless veterans” as the following below:

Demographics of Homeless Veterans 2016
Male 91%
Single 98%
Live in city 76%
Mental / Physical Disabilities 54%
Returning from Iraq and Afghanistan Younger
Vietnam ages 51-61 43%
Race / Black 39% or 11% of total veteran population

Table 1 (Veteran homelessness, 2015, para 2)

Since then, “Connecticut, Delaware, and Virginia” have ended veteran homelessness (Veteran, 2018, para. 6).  The End Homeless Organization proclaims an estimate of “homeless veterans over the age of 55” and “will increase within the next 10 to 15 years” (Veteran homelessness, 2015, para. 3). Compare to civilians, and veterans are more than likely to become homeless because they have mental health disorders or substance abuse, physical health issues, low social and economic status.  Other issues include a hard time returning to civilian living, employment, and lack of economical housing.

Diagnosis of Major Depression Disorder (MDD)

MDD is a mood disorder that produces severe symptoms.  These symptoms can change the way a person thinks, feels and how they will conduct their day to day duties.  These daily duties can include working, sleeping, eating or drink consumption. MDD causes an individual to feel sad that lasts more than two weeks. Symptoms of depression include loss of interest, change of sleep and appetite, fatigue and nonexistence concentration; agitation, low self-esteem, and suicide ideations are present (Depression (major depressive disorder), 2018).

Nearly half of the individuals who have PTSD in the U.S. also have MDD.  “Trauma-related phenotype” overlaps symptoms in both PTSD and MDD (Flory & Yehuda, p. 141).  A person’s phenotype is described as the individual’s sketch of their physical features (What is genotype? What is phenotype? n.d.).  Examples of phenotypes can be visible features such as one’s eye color or one’s height, and can also be a person’s past and present health, behavior, character or how one presents themselves (What is genotype? What is phenotype? n.d.).   An example of a phenotype that is related to a person’s outlook can be the result of the individual’s life events such as the disposition of dogs due to one’s life events (What is genotype? What is phenotype? n.d.).  Consequently, a traumatic-related phenotype can be the overlapping of MDD symptoms that include trouble sleeping, unable to experience pleasure, difficulty concentrating, and guilt (Flory & Yehuda, 2015).  Flory et al. (2015) explains that PTSD and MDD have levels of higher distress levels, injury neurocognitive operative, and suicide is at a higher risk of comorbidity of depression.  Owens, Held, Blackburn, Auerbach, Clark, Herrera, … Stuart (2013) found that war exposure increases in developing “post-deployment mental health problems,” and that it is connected to PTSD and depression among returning veterans (p. 2). Owen et al. (2013) states that veterans that seek help from the VA 31% experience depression and 36% experience both “comorbid PTSD and depression (p. 2).  The study also reveals that comorbidity complicates treatment and that depression is more critical than just PTSD and illicit drug usage (Owens et al., 2013).  The research indicates that PTSD and depression have higher means with aggression and violence (Owens et al., 2013).

PTSD, Major Depression Disorder, Crime and Homelessness

Oxford University performed a study that describes people with only depression is “three times” likely to commit a crime, such as “robbery, sexual offenses, and assault” (Tran, para. 1).  Oxford’s study found that “3.7% of men” committed a violent crime after being diagnosed with depression (Tran, para. 4).  Flory, et al. (2015) explains that risk factors such as having “high neuroticism / low extraversion” can develop into comorbidity of MDD and PTSD which fully displays reports of “childhood sexual and physical abuse” (Flor, et al. 2015, p. 147). Neuroticism is considered a personality trait that involves an individual to become negative, worried or uneasy and extraversion as being aggressive.  After four years later, this study shows excessive neuroticism and non-excessive extraversion connection into developing both PTSD and MDD (Flory & Yehuda, 2015).  Flory, et al. (2015) study also shows that individuals with PTSD with impulsive behavioral thoughts will not develop MDD, but will accompany substance abuse and aggression.

PTSD and MDD play a key role in homelessness.  PTSD has several symptoms besides flashbacks or anxiety, but also includes other symptoms such as guilt, irritability, trouble with a social aspect of life, self-destructive social behavior, and problems concentrating (Depression and homelessness struggles among U.S. Veterans, 2014).  Returning warriors do not start homeless, although their mental health problems can lead to the increase of homelessness (Depression and homelessness struggles among U.S. Veterans, 2014).  Olenick et al. (2015) calculates there are “49,933 veterans are homeless” (p. 635).   The National Coalition for Homeless Veterans discloses that soldiers at risk are ethnic individuals and that 40% of homeless veterans are African American or Hispanic (Depression and homelessness struggles among U.S. Veterans, 2014).   This study also calculates that 5% of veterans who are 18 to 30 years of age and 41% within the age of 31 to 50 are homeless (Depression and homelessness struggles among U.S. Veterans, 2014).  PTSD and MDD is severe and affects individuals socially, work, and social, reinforcements and can lead to veterans being homeless.

Diagnosis of Anxiety Disorder (AD)

Olenick, et al. (2015) discloses that veteran’s medical records indicate that “one in three” soldiers are diagnosed with at least mental health disorder” (p. 637).  AD is the next PTSD comorbid disorder in this discussion.  Studies show that childhood traumatic events can trigger both these overlapping or comorbid disorders (Smith, Goldstein, & Grant, 2016).  As the individual develops PTSD, AD increases with the exposure to tragic events.  As AD increases with PTSD, the overlaps of symptoms become present.

AD interferes with the individuals daily living activities with persistent fear and worry.  AD’s includes symptoms of intense nervousness and panic, weakness, sweating, hyperventilation and increased heart rate, gastrointestinal and sleeping issues (Anxiety disorders, 2018).  Other AD’s exist such as agoraphobia, anxiety disorder due to medical conditions, generalized anxiety disorder, panic disorder, social anxiety disorder, specific phobias, substance-induced anxiety disorder, and other specified anxiety disorder and unspecified anxiety disorder (Anxiety disorders, 2018).

  • Agoraphobia is a form of anxiety where individuals avoid situations or places that cause them fear.
  • AD due to medical condition involves extreme panic as a result of a medical condition.
  • Generalized anxiety disorder is a constant worry about everyday issues. Panic disorder recurrent incidents of anxiety and avoidance of situations they fear (Anxiety disorders, 2018).
  • Social anxiety disorder consists of fear, anxiety, and avoidance due to the feelings of being judged.
  • Specific phobias involve anxiety avoidance due to a specific situation or object (Anxiety disorders, 2018).
  • Substance-induced anxiety disorder entails absolute panic and anxiety attributed to drugs or withdrawal from drugs.
  • Other specified anxiety disorder and unspecified anxiety disorder that does not meet the precise criteria for other anxiety disorders.

PTSD, Anxiety Disorder, Crime and Homelessness

PTSD and anxiety often occur simultaneously.  Anxiety is a vital emotion and is essential to prepare a person for survival and danger.  A subsample of 3119 veterans research presented by Smith, Goldstein, and Grant discloses that one-third of adults have “experienced an anxiety disorder” and 45% of veterans have experienced an AD (para 3, 17).   Robinson and Gadd (2016) discuss Hurvich’s work of annihilation anxiety which is defined as “fears of being overwhelmed, merged, penetrated, fragmented, and destroyed” (p. 185).  Hurvich’s concludes that there is a connection between crime, fears, and anxiety (Robinson & Gadd, 2015).  Huskey reports that exposure to combat events can lead to PTSD and anxiety and in turn “linked to misconduct” (Huskey, 2015, p. 81).  The VA adds that symptoms of PTSD can lead to criminal activity (Huskey, 2015).

The VA indicates that 80% of veterans are homeless due to mental health and is a complicated issue when treating these disorders (Homeless veterans, 2017).   The study shows that even after veterans obtain a home, mental disorders can isolate the soldiers that result in higher medical visits and there is a need for a model center of care for veterans within the housing community (Homeless veterans, 2017).  In Montgomery et al. (2014) study, a three month risk period of 1,582,125, from the Health Administration, veterans are screened for homelessness.  Results indicate that veterans who screen for homelessness and behavioral health issues are two or more times predisposed to homelessness and instability (Montgomery et al., 2014).

Diagnosis of Substance Use Disorder (SUD)

The third PTSD comorbid disorder is SUD.  SUD is a significant issue in the U.S. Military duties raises the risk of soldiers having issues with illicit drug use and that tobacco and alcohol is more significant than in the civilian population (Olenick et al., 2015).   They are several reasons why veterans use drugs to self-medicate.  Several veterans use alcohol and drugs to escape their stress, past trauma, relieve physical or emotional pain.  Self-medication is short term and makes the persons issues worse by intensifying health issues, ruining relationships, and making it difficult to make right choices.  The updated version of the DSM-V no longer utilizes the words “substance abuse and substance dependence,” but uses the terms “substance use disorders” and classifies them as “mild, moderate, or severe” to specify the severity level (Substance use disorders, 2015, para. 2). SUD emerges when the individual meets criteria, causes social impairment, unsafe usage, unimpaired and unable to meet their responsibility.

PTSD, Substance Use Disorder, Crime and Homelessness

The most common drug usage is alcohol, cocaine, heroin, marijuana, and opioids.  Medical records reveal that diagnosed veterans have 41% diagnosis of comorbid disorders, and many veterans develop substance use disorders (SUDs) (Olenic, Flowers, & Diaz, 2015).  Research study confirms that alcohol and cigarette smoking is higher with veterans than with non-military workers (Olenic et al., 2015). Combat experience and deployments are responsible for alcohol intake.  Alcohol is used to self-medicate or as a coping mechanism. An increase of one in five veterans binge drink and the measures go higher if the soldier experiences war (“Veterans and addiction,” 2018).  Studies also show that 68% of Vietnam Veterans who sought PTSD treatment have alcohol issues and tend to be “binge drinkers” (PTSD and problems with alcohol use, 2015, para. 5).  Statistically, in 2008, 47% of active veterans binge drank and in 2006, 1.2% billion expenses lost in medical expenses due to excessive drinking (“Veterans and addiction,” 2018).  While 43% the Vietnam War veterans most popular illicit drugs that led to dependency were “heroin and opium,” today’s most three most illicit drugs are “cocaine, heroin, and marijuana” (“Veterans and addiction,” 2018, para. 12).  Opioid Use Disorder (OUD) presents a huge problem in the U.S. military.  In 1995 to 2013 there was a 56% treated in the increase of outpatient soldiers for SUD and 2006 and 2009, 45% out of 397 of noncombat deaths as a result of overdose (“Veterans and addiction,” 2018).  While one in four veteran deaths are due to substance abuse and illicit drug use is at an all-time low, alcohol consumption and prescription opioid abuse are significant areas of concern (“Veterans and addiction,” 2018). Research shows that pain afflicts 60% returning Middle East veterans and 50% of previous soldiers (“Veterans and addiction,” 2018).

Other Potential Indicators

No Post Deployment Health Assessment

No Medical Care

Rural Communities

Stigma, Avoidance and Social Exclusion

Employment Issues

Summary and Conclusion

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