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Rattray NA, Flanagan M, Mann A, Danson L, Do AN, Natividad D, Spontak K, True G. Conceptualizing care partners' burden, stress, and support for reintegrating Veterans: a mixed methods study. Front Public Health 2024; 11:1295627. [PMID: 38440161 PMCID: PMC10910616 DOI: 10.3389/fpubh.2023.1295627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 12/07/2023] [Indexed: 03/06/2024] Open
Abstract
Background People who support Veterans as they transition from their military service into civilian life may be at an increased risk of psychological distress. Existing studies focus primarily on paid family caregivers, but few studies include spouses and informal non-family "care partners." We sought to identify key challenges faced by care partners of Veterans with invisible injuries. Methods Semi-structured interviews were conducted with 36 individuals involved in supporting a recently separated US military Veteran enrolled in a 2-year longitudinal study. CPs completed validated measures on perceived stress, caregiving burden, quality of their relationship, life satisfaction, and flourishing. Independent t-tests were used to compare cases in these groups on caregiving burden, quality of their relationship, life satisfaction, and flourishing. Care partners were categorized as reporting high and low levels of stress. Exemplar cases were used to demonstrate divergences in the experiences of CPs with different levels of stress over time. Results Care partners reported shifts in self-perception that occurred from supporting a Veteran, emphasizing how they helped Veterans navigate health systems and the processes of disclosing health and personal information in civilian contexts. Exemplar cases with high and low burdens demonstrated divergent experiences in self-perception, managing multi-faceted strain, and coping with stress over time. Case studies of specific care partners illustrate how multi-faceted strain shifted over time and is affected by additional burdens from childcare, financial responsibilities, or lack of education on mental health issues. Conclusions Findings suggest the unique needs of individuals who support military Veterans with invisible injuries, highlighting variations and diachronic elements of caregiving. This sample is younger than the typical caregiver sample with implications for how best to support unpaid care partners caring for Veterans in the early to mid-period of their use of VA and civilian health services.
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Affiliation(s)
- Nicholas A. Rattray
- VA Health Services Research and Development Center for Health Information and Communication, Roudebush Veteran Affairs Medical Center, Indianapolis, IN, United States
- Regenstrief Institute, Inc., Indianapolis, IN, United States
- Department of General Internal Medicine and Geriatrics, Indiana School of Medicine, Indianapolis, IN, United States
| | - Mindy Flanagan
- VA Health Services Research and Development Center for Health Information and Communication, Roudebush Veteran Affairs Medical Center, Indianapolis, IN, United States
| | - Allison Mann
- VA Health Services Research and Development Center for Health Information and Communication, Roudebush Veteran Affairs Medical Center, Indianapolis, IN, United States
- Department of Psychological Services, University of Indianapolis, Indianapolis, IN, United States
| | - Leah Danson
- VA Health Services Research and Development Center for Health Information and Communication, Roudebush Veteran Affairs Medical Center, Indianapolis, IN, United States
- Department of Psychological Services, University of Indianapolis, Indianapolis, IN, United States
| | - Ai-Nghia Do
- VA Health Services Research and Development Center for Health Information and Communication, Roudebush Veteran Affairs Medical Center, Indianapolis, IN, United States
| | - Diana Natividad
- VA Health Services Research and Development Center for Health Information and Communication, Roudebush Veteran Affairs Medical Center, Indianapolis, IN, United States
| | - Katrina Spontak
- VA Health Services Research and Development Center for Health Information and Communication, Roudebush Veteran Affairs Medical Center, Indianapolis, IN, United States
- Department of Psychological Services, University of Indianapolis, Indianapolis, IN, United States
| | - Gala True
- South Central Mental Illness Research, Education, and Clinical Center, Southeast Louisiana Veterans Health Care System, New Orleans, LA, United States
- Section of Community and Population Medicine, Louisiana State University School of Medicine, New Orleans, LA, United States
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Frank C, Coulthard J, Lee JEC, Skomorovsky A. A moderated-mediation analysis of pathways in the association between Veterans’ health and their spouse’s relationship satisfaction: The importance of social support. Front Psychol 2022; 13:988814. [PMID: 36405134 PMCID: PMC9666880 DOI: 10.3389/fpsyg.2022.988814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 09/30/2022] [Indexed: 11/07/2022] Open
Abstract
Introduction Military personnel and Veterans are at increased risk of mental and physical health conditions, which can impact their families. Spouses often perform a vital role in caring for service members and Veterans facing illness or injury, which can lead to caregiver burden. In turn, this may contribute to relationship issues. Research suggests that ensuring that spouses are well supported can alleviate some of these negative effects. The current study examined whether social support received by spouses of newly released Veterans buffers the impact of Veterans’ health on caregiver burden, subsequently impacting spouses’ relationship satisfaction. Methods Data were collected as part of the Canadian Armed Forces Transition and Well-being Survey. The sample included N = 595 spouses of Regular Force Veterans who released in 2016 with at least 2 years of service. We examined Veterans’ mental and physical health and spouses’ caregiver burden, social support, and relationship satisfaction. A moderated mediation model was tested using structural equation modeling. Results There was a significant indirect association between Veterans’ health (both physical and mental) and spouses’ relationship satisfaction through caregiver burden. Furthermore, social support moderated the association, as evidenced by a weaker association between Veterans’ health and caregiver burden at low levels (−1SD) of social support compared to high levels (+1SD). Implications Findings suggest additional efforts should be made to ensure sufficient support is provided to spouses, especially when they are caring for a service member or Veteran facing illness or injury, to strengthen their families’ well-being.
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Higgins Neyland MK, Shank LM, Lavender JM, Burke NL, Rice A, Gallagher-Teske J, Markos B, Faulkner LM, Djan KG, Kwarteng EA, LeMay-Russell S, Parker MN, Schvey NA, Sbrocco T, Wilfley DE, Ford B, Ford C, Haigney M, Klein DA, Olsen CH, Quinlan J, Jorgensen S, Brady S, Shomaker LB, Yanovski JA, Tanofsky-Kraff M. Examination of the Interaction between Parental Military-Status and Race among Non-Hispanic Black and Non-Hispanic White Adolescents with Overweight/Obesity. J Pediatr Psychol 2022; 47:743-753. [PMID: 35238941 PMCID: PMC9297095 DOI: 10.1093/jpepsy/jsac008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 01/27/2022] [Accepted: 01/31/2022] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES Adolescent military-dependents experience distinct risk and protective factors, which may necessitate additional clinical considerations. In civilian youth, overweight/obesity is associated with eating, internalizing, and externalizing difficulties, with some studies reporting more difficulties among non-Hispanic White (vs. non-Hispanic Black) youth. It is unknown if these disparities exist among adolescent military-dependents, or between civilian and military-dependent youth. METHODS Non-Hispanic Black (187 civilian, 38 military-dependent) and non-Hispanic White (205 civilian, 84 military-dependent) adolescents with overweight/obesity (14.7 ± 1.6 years; 73.9% girls; body mass index adjusted for age and sex 1.9 ± 0.5) completed a disordered-eating interview; parents completed a measure assessing their child's internalizing and externalizing difficulties. Multiple linear regressions examined parental military-status as a moderator of the relationship of participant race with eating, internalizing, and externalizing difficulties. RESULTS White civilian youth with overweight/obesity reported significantly greater disordered-eating than their Black peers (p < .001); there were no other significant racial differences. In all regressions, parental military-status significantly moderated the association between race and each dependent variable (ps < .047). Black military-dependents (vs. civilians) reported more disordered-eating and internalizing difficulties (ps = .01). White military-dependents (vs. civilians) reported fewer externalizing difficulties (p = .01). CONCLUSIONS Black adolescent military-dependents with overweight/obesity may experience more eating and internalizing difficulties (vs. civilians), a pattern not observed among White participants. Future work should examine if being a military-dependent and a historically marginalized racial group member accounts for these findings. Such data may inform providers of youth with intersecting minority identities.
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Affiliation(s)
- M K Higgins Neyland
- Military Cardiovascular Outcomes Research (MiCOR), Department of Medicine, Uniformed Services University of the Health Sciences (USU), USA
| | - Lisa M Shank
- Military Cardiovascular Outcomes Research (MiCOR), Department of Medicine, Uniformed Services University of the Health Sciences (USU), USA
- Section on Growth and Obesity, Program in Developmental Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), USA
| | - Jason M Lavender
- Military Cardiovascular Outcomes Research (MiCOR), Department of Medicine, Uniformed Services University of the Health Sciences (USU), USA
| | | | - Alexander Rice
- Military Cardiovascular Outcomes Research (MiCOR), Department of Medicine, Uniformed Services University of the Health Sciences (USU), USA
| | - Julia Gallagher-Teske
- Military Cardiovascular Outcomes Research (MiCOR), Department of Medicine, Uniformed Services University of the Health Sciences (USU), USA
| | - Bethelhem Markos
- Military Cardiovascular Outcomes Research (MiCOR), Department of Medicine, Uniformed Services University of the Health Sciences (USU), USA
| | - Loie M Faulkner
- Section on Growth and Obesity, Program in Developmental Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), USA
| | - Kweku G Djan
- Section on Growth and Obesity, Program in Developmental Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), USA
| | - Esther A Kwarteng
- Section on Growth and Obesity, Program in Developmental Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), USA
| | - Sarah LeMay-Russell
- Section on Growth and Obesity, Program in Developmental Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), USA
- Department of Medical and Clinical Psychology, USU, USA
| | - Megan N Parker
- Section on Growth and Obesity, Program in Developmental Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), USA
- Department of Medical and Clinical Psychology, USU, USA
| | - Natasha A Schvey
- Section on Growth and Obesity, Program in Developmental Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), USA
- Department of Medical and Clinical Psychology, USU, USA
| | - Tracy Sbrocco
- Department of Medical and Clinical Psychology, USU, USA
| | | | | | - Caitlin Ford
- Department of Family Medicine, Fort Belvoir Community Hospital, USA
| | - Mark Haigney
- Military Cardiovascular Outcomes Research (MiCOR), Department of Medicine, Uniformed Services University of the Health Sciences (USU), USA
| | - David A Klein
- Department of Family Medicine, USU, USA
- Department of Pediatrics, USU, USA
| | - Cara H Olsen
- Preventative Medicine and Biometrics Department, USU, USA
| | - Jeffrey Quinlan
- Department of Family Medicine, University of Iowa Hospitals & Clinics, USA
| | - Sarah Jorgensen
- Department of Family Medicine, University of Iowa Hospitals & Clinics, USA
| | - Sheila Brady
- Section on Growth and Obesity, Program in Developmental Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), USA
| | - Lauren B Shomaker
- Department of Human Development and Family Studies, Colorado State University, USA
| | - Jack A Yanovski
- Section on Growth and Obesity, Program in Developmental Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), USA
| | - Marian Tanofsky-Kraff
- Section on Growth and Obesity, Program in Developmental Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), USA
- Department of Medical and Clinical Psychology, USU, USA
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Sylvia LG, Chudnofsky R, Winklosky T, Mulzoff A, Francona J, Sampson B, Lynch E, Xu B, McCarthy MD, Gupta C, Denninger JW, Mehta DH, Park ER, Ohye B, Spencer T, Fricchione GL. Resilient Family
: A Pilot Study of a Stress Management Program for Military-Connected Families. Psychiatr Ann 2022. [DOI: 10.3928/00485713-20220506-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Crockett JL, Yu-Lefler HF, Shumate ED, Benson JL, Karray N, Perkins-Parks S, Riley AW. Retention in Outpatient Child Behavioral Health Services Among Military and Civilian Families. J Behav Health Serv Res 2020; 47:126-138. [PMID: 31165416 DOI: 10.1007/s11414-019-09663-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Retention in treatment for children with behavior problems is critical to achieve successful outcomes, and clinical evidence suggests the behavioral health needs and retention of military-connected and civilian families differ meaningfully. Military and civilian children in outpatient behavioral treatment were compared in terms of presenting problems as well as appointment adherence (n = 446 children and their parents). Demographics and rates of externalizing behavior were similar across the two groups. More military than civilian children had internalizing problems. Military parents had more parenting distress and depressive symptoms. Fewer military families dropped out of treatment early. Within-military comparisons demonstrated that children whose parent had recently deployed were more likely to have internalizing problems and poor adaptive skills. Although retention was better among military families, the early treatment drop-out proportions (20-30%) for both groups highlight a barrier to effective behavioral intervention.
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Affiliation(s)
- Jennifer L Crockett
- Kennedy Krieger Institute, 720 Aliceanna St., 2nd Floor, Baltimore, MD, 21202, USA.
| | - Helen F Yu-Lefler
- Kennedy Krieger Institute, 720 Aliceanna St., 2nd Floor, Baltimore, MD, 21202, USA
| | - Emily D Shumate
- Kennedy Krieger Institute, 720 Aliceanna St., 2nd Floor, Baltimore, MD, 21202, USA
| | - Jamie L Benson
- Kennedy Krieger Institute, 720 Aliceanna St., 2nd Floor, Baltimore, MD, 21202, USA
| | - Neha Karray
- Kennedy Krieger Institute, 720 Aliceanna St., 2nd Floor, Baltimore, MD, 21202, USA
| | - Susan Perkins-Parks
- Kennedy Krieger Institute, 720 Aliceanna St., 2nd Floor, Baltimore, MD, 21202, USA
| | - Anne W Riley
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Cobos A. “Shelter from the Storm”: Military Service Member Spousal Caregiver Challenges and Barriers to Resources in the Midst of Enduring Conflicts. JOURNAL OF VETERANS STUDIES 2020. [DOI: 10.21061/jvs.v6i1.171] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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Dreer LE, Cox MK, McBrayer A, Neumeier WH, Herman C, Malone LA. Resilience Among Caregivers of Injured Service Members: Finding the Strengths in Caregiving. Arch Phys Med Rehabil 2019; 100:S76-S84. [PMID: 30684488 DOI: 10.1016/j.apmr.2018.12.027] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2018] [Accepted: 12/07/2018] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To examine the relationships between caregiver resilience and a comprehensive set of sociodemographic and health-related quality of life (HRQOL) predictors among both caregivers and injured service members. DESIGN Cross-sectional analysis of an observational cohort. SETTING Community dwelling. PARTICIPANTS Caregivers (n=87) who provide instrumental or emotional support to injured service members (n=73)(N=160). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURE The Connor-Davidson Resilience Scale 25-item version. RESULTS Higher caregiver resilience scores were related to lower depressive symptom severity, greater health responsibility, physical activity, nutrition, spiritual growth, interpersonal relations, stress management, and problem-solving orientation. A multivariable regression model showed that spiritual growth and aspects of problem-solving orientation were significantly related to resilience. CONCLUSIONS Results highlight the relationships between resilience and spirituality, problem-solving orientation, and aspects of HRQOL among caregivers of injured service members. These findings have important implications for caregiver behavioral health programs designed to promote resilience and draw upon caregiver strengths when taking on a caregiver role. Approaches that include a more integrative medicine or strengths-based emphasis may be particularly beneficial when working with families of injured military.
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Affiliation(s)
- Laura E Dreer
- Department of Ophthalmology and Visual Sciences, University of Alabama at Birmingham, Alabama, the United States.
| | - Molly K Cox
- Department of Ophthalmology and Visual Sciences, University of Alabama at Birmingham, Alabama, the United States
| | - Alexandra McBrayer
- Department of Ophthalmology and Visual Sciences, University of Alabama at Birmingham, Alabama, the United States
| | - William H Neumeier
- School of Health Professions, UAB-Lakeshore Research Collaborative, University of Alabama at Birmingham, Birmingham, Alabama, the United States
| | - Cassandra Herman
- School of Health Professions, UAB-Lakeshore Research Collaborative, University of Alabama at Birmingham, Birmingham, Alabama, the United States; Department of Health Behavior, University of Alabama at Birmingham, Birmingham, Alabama, the United States
| | - Laurie A Malone
- School of Health Professions, UAB-Lakeshore Research Collaborative, University of Alabama at Birmingham, Birmingham, Alabama, the United States
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Mackintosh MA, Schaper KM, Willis EA, Edland S, Liu C, White LR. Effects of Military Service on Marital Stability Among World War II U.S. Veterans of Japanese Descent. Mil Med 2018; 183:e525-e531. [PMID: 29939363 DOI: 10.1093/milmed/usy091] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Revised: 12/14/2017] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION This study had two goals. First, we investigated how World War II (WW II) military service impacted marital stability during men's young and middle adulthood in a large community sample of American men of Japanese descent. Second, within a subgroup of WW II veterans, we assessed how the level of combat exposure affected marital stability. MATERIAL AND METHODS The Honolulu Heart Program and later Honolulu-Asia Aging Project were longitudinal, community-based studies of Japanese-American men living in Hawai'i. This study is a secondary data analysis of 1,249 male WW II veterans and 3,489 men of Japanese descent who were civilians during WW II, born 1910-1919, who completed interviews at the first (1965-1968) and third (1971-1975) exams. Data from a subsample of veterans who completed a military service interview during the sixth exam (1997-1999) also were used. In the first set of analyses, we compared veterans to civilians on three marital outcomes for ages 15-59: (1) likelihood of never marrying, (2) age at first marriage, and (3) likelihood of divorce. Next, we investigated the negative consequences of increasing combat exposure on the same marital outcomes. All analyses controlled for age in 1941 and occupation. RESULTS Overall, 88% of the sample remained in their first marriage with no differences between veterans and civilians. We found no effects of military service on the timing of first marriages on the likelihood of divorce during young and middle adulthood. However, among those who had not married before WW II, veterans were significantly more likely to remain unmarried compared with civilians; odds ratio = 1.52 (1.10, 2.09). The level of combat exposure did not predict any of the three marital outcomes among WW II veterans. In fact, none of the other military service characteristics assessed (i.e., age of military induction, years of service, and service-connected disability) predicted marital outcomes. We found that age at the beginning of WW II impacted the timing and stability of marriage in both veterans and civilians. Finally, we identified cultural effects on the likelihood of marriage between Nisei and Kibei groups with Nisei men being less likely to marry. CONCLUSION Similar to other groups in this era, long-term marriage with one partner was the norm for both veterans and civilians. For a small portion of American men of Japanese descent, military service seemed to impact the transition into marriage. However, we found no differences in the timing of marriage or the likelihood of divorce based on military service or level of combat exposure. While our findings are inconsistent with previous research on the impact of military service and combat exposure, much of that research was conducted with mainland veterans, usually of European descent. There appears to be little long-term disruption of life course events. Results highlight the importance of studying diverse groups of veterans to understand how experiences in the military interact with pre-military factors in defining long-term responses to military service.
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Affiliation(s)
- Margaret-Anne Mackintosh
- Pacific Health Research and Education Institute, 3375 Koapaka St, Suite I-540, Honolulu, HI.,National Center for PTSD, Dissemination and Training Division, VA Palo Alto Healthcare System, 795 Willow Road, Menlo Park, CA
| | - Kim M Schaper
- Pacific Health Research and Education Institute, 3375 Koapaka St, Suite I-540, Honolulu, HI
| | - Emy A Willis
- Department of Psychology, University of Central Florida, 4111 Pictor Lane, Orlando, FL
| | - Steven Edland
- Department of Family Medicine and Public Health, University of California, San Diego, 9500 Gilman Drive #0725, La Jolla, CA
| | - Catherine Liu
- Pacific Health Research and Education Institute, 3375 Koapaka St, Suite I-540, Honolulu, HI
| | - Lon R White
- Pacific Health Research and Education Institute, 3375 Koapaka St, Suite I-540, Honolulu, HI
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Hale-Gallardo J, Jia H, Delisle T, Levy CE, Osorio V, Smith JA, Hannold EM. Enhancing health and independent living for veterans with disabilities by leveraging community-based resources. J Multidiscip Healthc 2017; 10:41-47. [PMID: 28182140 PMCID: PMC5279827 DOI: 10.2147/jmdh.s118706] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
The number of US veterans with disabilities has increased in recent years as service members have returned home with extensive injuries and veterans from previous wars acquire functional limitations as a consequence of aging with chronic diseases. Veterans with severe disabilities need assistance and support to maintain independence at home and to avoid institutionalization. The US Department of Veterans Affairs (VA) strives to network with community organizations to achieve the best possible outcomes for veterans. Key community resources in the US for individuals with disabilities are Centers for Independent Living (CILs) that provide a wide range of services, promoting independent living and well-being for people across disabilities. The widespread availability and services of CILs nationwide suggest their potential as a community-based resource for veterans, particularly for those with limited access to VA care. In this article, we discuss long-term needs of veterans with disabilities, efforts to address veterans' rehabilitation needs at the VA and opportunities for leveraging the strengths of community-based organizations for veterans. More research is warranted to investigate CIL services and potential for CIL-VA partnerships.
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Affiliation(s)
- Jennifer Hale-Gallardo
- Center of Innovation on Disability and Rehabilitation Research, North Florida/South Georgia Veterans Health System
| | - Huanguang Jia
- Center of Innovation on Disability and Rehabilitation Research, North Florida/South Georgia Veterans Health System
| | - Tony Delisle
- Center for Independent Living of North Central Florida
| | - Charles E Levy
- Center of Innovation on Disability and Rehabilitation Research, North Florida/South Georgia Veterans Health System; Physical Medicine and Rehabilitation Service, North Florida/South Georgia Veterans Health Service; The Department of Occupational Therapy, College of Public Health and Health Professions; The Center for the Arts in Medicine, College of the Arts, University of Florida, Gainesville, FL, USA
| | - Valentina Osorio
- Center of Innovation on Disability and Rehabilitation Research, North Florida/South Georgia Veterans Health System
| | - Jennifer A Smith
- Center of Innovation on Disability and Rehabilitation Research, North Florida/South Georgia Veterans Health System
| | - Elizabeth M Hannold
- Center of Innovation on Disability and Rehabilitation Research, North Florida/South Georgia Veterans Health System
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MacDonell GV, Bhullar N, Thorsteinsson EB. Depression, anxiety, and stress in partners of Australian combat veterans and military personnel: a comparison with Australian population norms. PeerJ 2016; 4:e2373. [PMID: 27635339 PMCID: PMC5012292 DOI: 10.7717/peerj.2373] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Accepted: 07/26/2016] [Indexed: 11/20/2022] Open
Abstract
Partners of Australian combat veterans are at an increased risk of experiencing mental health problems. The present study provides a comparative analysis of the mental health of partners of veterans with that of the Australian normative data. To compare different types of groups of partners, the study samples comprised: (a) partners of Australian combat veterans (Sample 1:n= 282, ageM= 60.79,SD= 5.05), (b) a sub-sample of partners of Australian combat veterans from the previous sample (Sample 2:n= 50;M= 60.06,SD= 4.80), (c) partners of Special Air Services Regiment (SASR) personnel (Sample 3:n= 40, ageM= 34.39SD= 7.01), and (d) partners of current serving military (non-SASR) personnel (Sample 4:n= 38, ageM= 32.37,SD= 6.20). Respondents completed measures assessing their reported levels of depression, anxiety, and stress. Samples 1 and 2 comprised partners of Australian military veterans who reported significantly greater symptoms of depression, anxiety, and stress than the comparative population norms. The sample of SASR personnel partners (Sample 3) reported significantly lower levels of depression and anxiety, whereas the sample with non-SASR personnel partners (Sample 4) reported a significantly greater stress symptomatology than the comparative norms. Number of deployments was found to be associated with depression, anxiety, and stress in partners of non-SASR veterans (Sample 4). Lessons and protective factors can be learnt from groups within the current military as to what may assist partners and families to maintain a better level of psychosocial health.
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Affiliation(s)
- Gail V. MacDonell
- Psychology-School of Behavioural, Cognitive and Social Sciences, University of New England, Armidale, New South Wales, Australia
| | - Navjot Bhullar
- Psychology-School of Behavioural, Cognitive and Social Sciences, University of New England, Armidale, New South Wales, Australia
| | - Einar B. Thorsteinsson
- Psychology-School of Behavioural, Cognitive and Social Sciences, University of New England, Armidale, New South Wales, Australia
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Kelly PJ, Cheng AL, Berkel LA, Nilsson J. Perceptions of Individual and Family Functioning Among Deployed Female National Guard Members. JOURNAL OF FAMILY NURSING 2016; 22:419-434. [PMID: 27076466 DOI: 10.1177/1074840716642791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Females currently make up 15% of U.S. military service members. Minimal attention has been paid to families of female National Guard members who have been deployed and their subsequent reintegration challenges. This cross-sectional Internet-based survey of female members of four National Guard units compared those who were and were not deployed. Instruments, guided by the variables of the Family Resilience Model, measured individual, family, and deployment-related factors. Bivariate analysis and ordinal logistic regression were done to assess differences between the groups. Of the 239 National Guard members surveyed, deployed women (n = 164) had significantly higher levels of posttraumatic stress disorder (PTSD; p < .001) and lower coping skills (p = .003) than non-deployed women (n = 75). Perceptions of overall family functioning were higher among deployed when compared with never deployed women. Results indicate community interventions that focus on strengthening coping skills of female Guard members would be useful for this population.
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An Investigation Into the Relationship Between Long-term Posttraumatic Stress Disorder Symptoms and Coping in Australian Volunteer Firefighters. J Nerv Ment Dis 2016; 204:530-6. [PMID: 27367600 DOI: 10.1097/nmd.0000000000000525] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
This study examined the relationship between coping style and long-term posttraumatic stress symptoms in an Australian sample of volunteer firefighters 84 months following a bushfire disaster. A total of 277 firefighters completed 4 questionnaires to assess patterns of psychiatric morbidity. A 2-way repeated-measures analysis of variance was conducted to investigate the effect of time and disorder on coping. Firefighters evidencing distress were more likely to use both problem- and emotion-focused methods of coping. Based on previous research, it was hypothesized that problem-focused coping strategies would be used after 84 months. The use of both problem- and emotion-focused coping may be due to the length of time following this disaster or unique characteristics of firefighters. These data suggest that present coping theories are not sufficient to account for the onset and pattern of psychiatric morbidity within a firefighter sample. The authors declare no conflicts of interest including financial, consultant, institutional, and other relationships that might lead to bias.
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Hojjat SK, Hatami SE, Rezaei M, Khalili MN, Talebi MR. The efficacy of training of stress-coping strategies on marital satisfaction of spouses of veterans with post-traumatic stress disorder. Electron Physician 2016; 8:2232-7. [PMID: 27279997 PMCID: PMC4886563 DOI: 10.19082/2232] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Accepted: 03/05/2016] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION Marital satisfaction is an important factor in people's quality of life. It has become increasingly crucial in healthcare and health research and is dependent on coping styles of people exposed to traumatic events. The aim of this study was to assess the effectiveness of coping-style training on increasing the marital satisfaction of wives of veterans with post-traumatic stress disorder (PTSD). METHODS In this experimental study, 60 subjects were selected from the spouses of veterans with PTSD. The veterans were chosen from the Veterans Foundation of Northern Khorasan Province (Iran) in 2014. In this study, we used the Enrich questionnaire to determine the marital satisfaction of the aforementioned spouses. Subjects were assigned randomly to study and control groups. We used the training package of a Practical Guide for Stress Management according to cognitive behavioral approaches. Cognitive-behavioral group therapy was administered in 90-minute sessions over a 12-week period. We used the paired-samples t-test and ANCOVA to determine the effect of Cognitive Behavior Therapy (CBT) between the two groups. RESULTS The mean and the standard deviation of age in the study and control groups were 36.8 ± 4.33 years and 35.3 ± 4.7 years, respectively. According to p < 0.005, a significant difference was observed between the subjects in the two groups. Therefore, treatment with cognitive behavioral group therapy showed evidence of clinical improvements in marital satisfaction of the study group. CONCLUSION The results of our study showed that methods of coping with stress based on CBT are effective in increasing the marital satisfaction of wives of veterans with PTSD.
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Affiliation(s)
- Seyed Kaveh Hojjat
- MD, Psychiatrist, Assistant Professor, Addiction and Behavioral Sciences Research Center, North Khorasan University of Medical Sciences. Bojnurd, Iran
| | - Seyed Esmaeil Hatami
- M.Sc. of Epidemiology, Addiction and Behavioral Sciences Research Center, North Khorasan University of Medical Sciences, Bojnurd, Iran
| | - Mahdi Rezaei
- MA of Clinical Psychology, Addiction and Behavioral Sciences Research Center, North Khorasan University of Medical Sciences, Bojnurd, Iran
| | - Mina Norozi Khalili
- MD, Department of Community Medicine and Ethics, Faculty of Medicine, North Khorasan University of Medical Sciences, Bojnurd, Iran
| | - Moosa Reza Talebi
- MA of General Psychology, Department of Psychology, Tonekabon Branch, Izlamic Azad University, Tonekabon, Iran
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Mogil C, Hajal N, Garcia E, Kiff C, Paley B, Milburn N, Lester P. FOCUS for Early Childhood: A Virtual Home Visiting Program for Military Families with Young Children. CONTEMPORARY FAMILY THERAPY 2015. [PMID: 26543320 DOI: 10.1007/s10651-015-9327-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/22/2023]
Affiliation(s)
- Catherine Mogil
- UCLA Semel Institute for Neuroscience and Human Behavior, Nathanson Family Resilience Center, 760 Westwood Plaza, Room A8-153, Los Angeles, CA 90095
| | - Nastassia Hajal
- UCLA Semel Institute for Neuroscience and Human Behavior, Nathanson Family Resilience Center, 760 Westwood Plaza, Room A8-153, Los Angeles, CA 90095
| | - Ediza Garcia
- UCLA Semel Institute for Neuroscience and Human Behavior, Nathanson Family Resilience Center, 760 Westwood Plaza, Room A8-153, Los Angeles, CA 90095
| | - Cara Kiff
- UCLA Semel Institute for Neuroscience and Human Behavior, Nathanson Family Resilience Center, 760 Westwood Plaza, Room A8-153, Los Angeles, CA 90095
| | - Blair Paley
- UCLA Semel Institute for Neuroscience and Human Behavior, Nathanson Family Resilience Center, 760 Westwood Plaza, Room A8-153, Los Angeles, CA 90095
| | - Norweeta Milburn
- UCLA Semel Institute for Neuroscience and Human Behavior, Nathanson Family Resilience Center, 760 Westwood Plaza, Room A8-153, Los Angeles, CA 90095
| | - Patricia Lester
- UCLA Semel Institute for Neuroscience and Human Behavior, Nathanson Family Resilience Center, 760 Westwood Plaza, Room A8-153, Los Angeles, CA 90095
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Allen E, Stanley S, Rhoades G, Markman H. PREP for Strong Bonds: A review of outcomes from a randomized clinical trial. CONTEMPORARY FAMILY THERAPY 2015; 37:232-246. [PMID: 26366041 DOI: 10.1007/s10591-014-9325-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
To help address the relationship needs of service members, there have been a number of programs offered within active duty and veteran contexts. One program, offered within the Strong Bonds portfolio delivered by Army Chaplains, is PREP for Strong Bonds (PREP = the Prevention and Relationship Education Program). PREP has a number of empirically based and tested variants. This article reviews the disseminated research regarding results from a large randomized clinical trial designed to test the effectiveness of PREP for Strong Bonds. From a sample of 662 Army couples drawn from two sites, outcome papers have focused on different subsamples, marital outcomes, follow up time points, and moderators. Reviewing these disseminated outcomes, we conclude that PREP for Strong Bonds has significant divorce reduction effects at one site; these divorce effects were found at both one and two years post intervention, and were moderated by factors such as minority status, economic strain, and cohabitation history of the couple. In terms of marital quality outcomes, some modest overall effects were found pre to post intervention, but there were no overall marital quality outcome effects two years post intervention. However, marital quality outcomes are significantly moderated by infidelity and cohabitation history, with couples reporting these risk factors showing greater positive marital quality outcomes. These results to date are discussed in terms of clinical and research implications as well as directions for future work, such as examining longer term preventative effects.
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Mogil C, Hajal N, Garcia E, Kiff C, Paley B, Milburn N, Lester P. FOCUS for Early Childhood: A Virtual Home Visiting Program for Military Families with Young Children. CONTEMPORARY FAMILY THERAPY 2015; 37:199-208. [PMID: 26543320 DOI: 10.1007/s10591-015-9327-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Affiliation(s)
- Catherine Mogil
- UCLA Semel Institute for Neuroscience and Human Behavior, Nathanson Family Resilience Center, 760 Westwood Plaza, Room A8-153, Los Angeles, CA 90095
| | - Nastassia Hajal
- UCLA Semel Institute for Neuroscience and Human Behavior, Nathanson Family Resilience Center, 760 Westwood Plaza, Room A8-153, Los Angeles, CA 90095
| | - Ediza Garcia
- UCLA Semel Institute for Neuroscience and Human Behavior, Nathanson Family Resilience Center, 760 Westwood Plaza, Room A8-153, Los Angeles, CA 90095
| | - Cara Kiff
- UCLA Semel Institute for Neuroscience and Human Behavior, Nathanson Family Resilience Center, 760 Westwood Plaza, Room A8-153, Los Angeles, CA 90095
| | - Blair Paley
- UCLA Semel Institute for Neuroscience and Human Behavior, Nathanson Family Resilience Center, 760 Westwood Plaza, Room A8-153, Los Angeles, CA 90095
| | - Norweeta Milburn
- UCLA Semel Institute for Neuroscience and Human Behavior, Nathanson Family Resilience Center, 760 Westwood Plaza, Room A8-153, Los Angeles, CA 90095
| | - Patricia Lester
- UCLA Semel Institute for Neuroscience and Human Behavior, Nathanson Family Resilience Center, 760 Westwood Plaza, Room A8-153, Los Angeles, CA 90095
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Patel BR. Caregivers of veterans with "invisible" injuries: what we know and implications for social work practice. SOCIAL WORK 2015; 60:9-17. [PMID: 25643571 DOI: 10.1093/sw/swu043] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Today, as a result of the longest volunteer-fought conflict in U.S. history, there are many wounded coming home not only with posttraumatic stress disorder (PTSD), but also with traumatic brain injury (TBI), which together have been called the "signature" or "invisible" injuries of the Iraq and Afghanistan wars. Caregivers are an important part of their recovery, yet little is known about them, as previous research on caregivers mostly focused on geriatric populations. According to one estimate 275,000 to 1 million people are currently caring or have cared for loved ones who have returned from Iraq and Afghanistan. These caregivers are unique in that they are younger, some with children, and they are caring for a unique under-studied population for longer periods of time. This article summarizes literature on caregivers of veterans who suffer from PTSD, TBI, or both; provides a theoretical framework; and discusses implications for social workers in assisting caregivers and their families.
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Rodriguez AJ, Margolin G. Parental incarceration, transnational migration, and military deployment: family process mechanisms of youth adjustment to temporary parent absence. Clin Child Fam Psychol Rev 2014; 18:24-49. [PMID: 25304163 DOI: 10.1007/s10567-014-0176-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The temporary absence of a parent (e.g., due to incarceration, migration, or military deployment) is experienced by many youth and can have profound effects. Available research within these disparate literatures primarily has catalogued contextual and individual variables that influence youth adaptation, which are integrated and summarized here. In addition, we present a systematic review of proximal family process mechanisms by which youth and their family members adapt to periods of temporary parent absence. This systematic review across the different types of parent absence produced four themes: communication among family members, parenting characteristics during absence, negotiation of decision-making power and authority, and shifts in family roles. By juxtaposing the three types of temporary parent absence, we aim to bridge the separate research silos of parent absence due to incarceration, deployment, and migration, and to bring wide-ranging characteristics and processes of temporary parent-absent families into sharper focus. The review highlights possibilities for fuller integration of these literatures, and emphasizes the clinical value of considering these types of experiences from a family and relational perspective, rather than an individual coping perspective.
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Affiliation(s)
- Aubrey J Rodriguez
- Department of Psychology, University of Southern California, 3620 S McClintock Ave, SGM 501, Los Angeles, CA, 90089-1061, USA,
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Military service, war, and families: considerations for child development, prevention and intervention, and public health policy--Part 2. Clin Child Fam Psychol Rev 2013; 16:345-7. [PMID: 24166541 DOI: 10.1007/s10567-013-0157-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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20
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Understanding and Supporting the Resilience of a New Generation of Combat-Exposed Military Families and Their Children. Clin Child Fam Psychol Rev 2013; 16:415-20. [DOI: 10.1007/s10567-013-0155-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Glynn SM. Family-Centered Care to Promote Successful Community Reintegration After War: It Takes a Nation. Clin Child Fam Psychol Rev 2013; 16:410-4. [DOI: 10.1007/s10567-013-0153-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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