Military-related PTSD and intimate relationships: from description to theory-driven research and intervention development

Associations of past-year overall trauma, sexual assault and PTSD with social support for young adult sexual minority women

Background: Young adult sexual minority women (SMW) are at elevated risk for sexual assault (SA), posttraumatic stress disorder (PTSD), and inadequate social support. While SA and PTSD can lead to reductions in social support from close significant others, the impact of SA and PTSD on SMWs' social support has not previously been assessed.Objective: This study examined the associations of past year SA and PTSD with SMW's social support from intimate partners, family, and friends. It was hypothesized that SA and PTSD would be negatively associated with support from partners, family and friends, and that PTSD would moderate the effect of SA on support in early adulthood.Method: Young adult SMW in the United States (N = 235) who were M = 23.93 (SD = 2.15) years old, primarily lesbian or bisexual (n = 186, 79.1%) and White (n = 176, 74.9%) completed measures on past year exposure to SA and non-SA trauma, PTSD, and social support from intimate partners, family and friends.Results: PTSD was associated with less social support from partners, (b  = -0.06, SE = 0.02, p = .010, R2change = .02), family, (b  = -0.06, SE = 0.03, p = .025, R2change = .02), and friends, (b  = -0.07, SE = 0.02, p = .008, R2change = .02). There was a significant interaction between PTSD and SA on social support from partners (b  = -0.01, SE = 0.01, p = .047, R2change = .01). Neither non-SA nor SA trauma was associated with support from family or friends.Conclusions: Results underscore the potential impact of recent SA on intimate partnerships for young adult SMW with more severe PTSD. Future work should explore how addressing PTSD and improving social support quality may help SMW recover from traumatic experiences and ameliorate the effects of SA on intimate partnerships.

The role of veterans' PTSD symptoms in veteran couples' insomnia

Insomnia contributes to individual mental and physical health and relationship well-being. Veterans' PTSD symptoms are associated with their own insomnia. However, research has not explored whether and how veterans' PTSD symptoms are associated with their partners' insomnia. The present study examined the association between veterans' PTSD symptom severity and veterans' and partners' insomnia. Veterans (n = 192) and their partners (n = 192; total N = 384) completed baseline assessments in a PTSD treatment study for veterans with PTSD and their partners. Path analysis was used to examine the relation between veterans' PTSD symptom severity, as measured by the PTSD symptom checklist-5 (PCL-5) and veterans' and partners' insomnia, as measured by the Insomnia Severity Index (ISI). Veterans' full-scale PCL-5 was positively related to veterans' and partners' insomnia. For veterans, intrusion and arousal symptoms were positively related to their own insomnia severity, while veterans' negative alterations in cognition and mood were associated with partners' insomnia severity. In exploratory analyses, partners' depressive symptoms fully mediated the relation between veterans' negative cognitions and mood and partners' insomnia. PTSD symptoms impact both veterans' and partners' insomnia. However, different PTSD symptom clusters were related to insomnia for each partner, and the link for partners was explained by their own depression symptoms. PTSD, insomnia, and integrated treatments should consider strategies for including partners in treatment to address these interconnected problems.

Relationship Between Post-Traumatic Stress Symptoms and Caregiver Burden In Breast Cancer Patients: The Mediating Role of Anxiety and Depression

Breast cancer impacts not only the physical and mental health of patients but also the people around them-especially their caregivers. This study examined the relationship between post-traumatic stress symptoms (PTSS) and caregiver burden in breast cancer patients through the mediating pathway of anxiety and depression.

METHODS

A total of 236 breast cancer patients from China completed the Chinese Version of the Posttraumatic Stress Disorder Symptom Scale (PSS), the Chinese version of the Patient Health Questionnaire (PHQ-9), the Chinese version of the General Anxiety Symptoms Scale (GAD-7). In addition, caregivers of these breast cancer patients were surveyed by the Caregiver Self-Assessment Questionnaire (CSAQ).

RESULTS

Structural equation model showed that our model fitted well [χ2 /df = 1.966, TLI = 0.959, CFI = 0.994, RMSEA (90% CI) = 0.065 (0-0.12)] and revealed that anxiety, but not depression, mediated the relationship between PTSS in breast cancer patients and caregiver burden.

CONCLUSION

The level of PTSS was positively correlated with anxiety and depression in breast cancer patients, and the level of anxiety and depression was positively related to caregiver burden. The PTSS of patients positively predicted caregiver burden and this relationship appears to be mediated by the patient's anxiety.

Replication and extension of the military family stress model: The after deployment adaptive parenting tools ADAPT4U study

The military family stress (MFS) model conceptualizes that wartime deployments and post-traumatic stress disorder (PTSD) symptoms are associated with couple, parenting, and child adjustment difficulties. The aim of this study was to replicate and extend the military family stress model by examining the associations among deployment length, PTSD symptoms, marital functioning, parenting practices, and child adjustment in a replication sample of both National Guard and Reserve (NG/R) as well as active-duty service member families. The MFS model is extended to test whether these relationships vary between mothers and fathers. The sample included 208 families enrolled in a randomized controlled trial of a parenting program for military families (94.4% of fathers and 21.6% of mothers were deployed). Replicating the MFS model, we specified parenting, marital quality, and child adjustment as latent variables and conducted multi-group structural equation models. Parenting practices were positively associated with marital quality and child adjustment. PTSD symptoms were negatively associated with marital quality. The indirect effect from PTSD symptoms to parenting practices through marital quality was marginally significant. The indirect effect from marital quality to child adjustment through parenting practices was significant. There were no significant gender differences between the two structural models. This study provides empirical support for the MFS model. Results demonstrate that deployment-related stressors are significantly associated with parent and family functioning. Parenting programs for military families might effectively target similar risk processes among both mothers and fathers.

A longitudinal study examining the associations between interpersonal trauma and romantic relationships among college students

We examined the associations between the developmental timing of interpersonal trauma exposure (IPT) and three indicators of involvement in and quality of romantic relationships in emerging adulthood: relationship status, relationship satisfaction, and partner alcohol use. We further examined whether these associations varied in a sex-specific manner. In a sample of emerging adult college students (N = 12,358; 61.5% female) assessed longitudinally across the college years, we found precollege IPT increased the likelihood of being in a relationship, while college-onset IPT decreased the likelihood. Precollege and college-onset IPT predicted lower relationship satisfaction, and college-onset IPT predicted higher partner alcohol use. There was no evidence that associations between IPT and relationship characteristics varied in a sex-specific manner. Findings indicate that IPT exposure, and the developmental timing of IPT, may affect college students' relationship status. Findings also suggest that IPT affects their ability to form satisfying relationships with prosocial partners.

A preliminary evaluation of the supportive other experiences questionnaire: Integrating the perspectives of SS providers after traumatic injury

BACKGROUND

Social support is a protective factor against the development of Posttraumatic Stress Disorder (PTSD). However, examinations of the social support after trauma have relied primarily on the self-reports of trauma survivors to the exclusion of their support providers. A new measure, the Supportive Other Experiences Questionnaire (SOEQ) was adapted from a well-established behavioral coding schema of support behaviors to capture social support experiences from the support provider perspective.

METHOD

513 Concerned Significant Others (CSOs) recruited on MTurk who had served as support providers to a traumatically injured romantic partner were recruited to respond to SOEQ candidate items and other relevant measures of psychopathology and relational factors. Factor analytic, correlational and regression analyses were conducted.

RESULTS

Confirmatory factor analytic results of SOEQ candidate items provide evidence for three support types (i.e., informational, tangible, and emotional) and two support processes (i.e., frequency, difficulty), producing a final 11-item version of the SOEQ. Evidence of convergent and discriminant validity provide good psychometric support for the measure. Evidence of construct validity was derived from support for two hypotheses: (1) difficulty providing social support is negatively associated with CSO perceptions of trauma survivor recovery, (2) social support provision frequency is positively associated with relationship satisfaction.

LIMITATIONS

Though factor loadings for support types were significant, several were small, limiting interpretability. Cross-validation in a separate sample is needed.

CONCLUSIONS

The final version of the SOEQ demonstrated promising psychometric properties, and can provide key information one the experiences of CSOs as social support providers for trauma survivors.

Postdeployment mental health concerns and family functioning in veteran men and women

OBJECTIVE

Despite growing numbers of veteran women, it is unclear whether the impact of common postdeployment mental health concerns on key aspects of family functioning varies by gender. We examined whether associations between PTSD, depression, and problematic alcohol use and intimate relationship quality and parenting self-efficacy differed among men and women in a large, gender-balanced sample of post-9/11 veterans.

METHOD

Participants included 2,348 veterans (51.49% women) of the wars in Iraq and Afghanistan who were part of a larger study of gender differences in effects of wartime deployment. Veterans who were married or in a relationship (n = 1,536, 49.09% women) reported overall relationship quality. Veterans with children under age 18 (n = 1,049; 51.57% women) self-reported on their sense of efficacy as parents. All participants reported symptoms of PTSD, depression, and problematic alcohol use. We used a series of hierarchical linear regressions to test gender as a moderator of each postdeployment mental health concern and the family functioning constructs of interest.

RESULTS

Each postdeployment mental health concern was associated with reduced relationship quality and parenting self-efficacy, and these associations were largely consistent across gender. However, links between reduced parenting self-efficacy and increased PTSD and depressive symptoms were stronger in women compared with men.

CONCLUSIONS

Postdeployment mental health concerns are associated with impairment in key family relationships for both veteran men and women. This impact may be particularly profound for parenting self-efficacy among female veterans, highlighting the potential importance of targeted interventions in this domain. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Influence of comorbid social anxiety disorder in PTSD treatment outcomes for Prolonged Exposure in female military sexual trauma survivors with PTSD

OBJECTIVE

Posttraumatic stress disorder (PTSD) is a common psychiatric disorder that frequently presents alongside other comorbid diagnoses. Although several evidence-based psychotherapies have been well-studied for PTSD, limited research has focused on the influence of diagnostic comorbidity on their outcomes. The present study sought to investigate the influence of comorbid social anxiety disorder on treatment outcomes in patients with PTSD.

METHODS

One hundred and twelve treatment-seeking female veteran participants with PTSD completed baseline assessments and received 12-15 sessions of Prolonged Exposure. Symptom measures were completed biweekly as well as at immediate posttreatment, 3-month, and 6-month follow-ups.

RESULTS

Thirty (26.8%) participants seeking PTSD treatment also met diagnostic criteria for social anxiety disorder. Multilevel modeling was used to examine effects of social anxiety disorder diagnosis on post-intervention symptoms and revealed significantly worse outcomes for symptoms of PTSD and depression in participants with comorbid PTSD and social anxiety disorder.

CONCLUSION

Consistent with previous studies of co-occurring PTSD and depression, present findings suggest that comorbid diagnoses may adversely affect disorder-specific treatment outcomes. As such, the presence of diagnostic comorbidity may merit further consideration and potential adaptions to the traditional, disorder-specific assessment and treatment practices for PTSD.

‘Where am I in all of this?’ Impact of a morally injurious mission on the home front of Dutchbat III military Veterans

LAY SUMMARY

Research has shown time and time again that war has an impact on the mental well-being of Veterans and their families. But what does that impact look like when a mission is characterized by severe violations of norms and values (in other words, moral injury)? In this study, family members of Dutch Veterans talked about the impact on their lives of a mission gone bad in the former Yugoslavia, 25 years after it happened. Although most of the families were doing well, all of the families felt left alone in taking care of their Veterans after they returned and in dealing with negative press coverage. For the well-being of all, they expressed the need for more appreciation for and acknowledgement of Veterans and their families.

The PTSD Family Coach App in Veteran Family Members: Pilot Randomized Controlled Trial

BACKGROUND

Posttraumatic stress disorder (PTSD) among US military veterans can adversely impact their concerned significant others (CSOs; eg, family members and romantic partners). Mobile apps can be tailored to support CSO mental health through psychoeducation, coping skills, and stress monitoring.

OBJECTIVE

This study assessed the feasibility, acceptability, and potential efficacy of PTSD Family Coach 1.0, a free, publicly available app that includes psychoeducation, stress management tools, self-assessments, and features for connecting to alternative supports, compared with a psychoeducation-only version of the app for cohabitating CSOs of veterans with PTSD.

METHODS

A total of 200 participants with an average age of 39 (SD 8.44) years, primarily female (193/200, 97%), and White (160/200, 80%) were randomized to self-guided use of either PTSD Family Coach 1.0 (n=104) or a psychoeducation-only app (n=96) for 4 weeks. Caregiver burden, stress, depression, anxiety, beliefs about treatment, CSO self-efficacy, and relationship functioning assessed using measures of dyadic adjustment, social constraints, and communication danger signs were administered via a web survey at baseline and after treatment. User satisfaction and app helpfulness were assessed after treatment. Data were analyzed using linear mixed methods.

RESULTS

Overall, 50.5% (101/200) of randomized participants used their allocated app. Participants found PTSD Family Coach 1.0 somewhat satisfying (mean 4.88, SD 1.11) and moderately helpful (mean 2.99, SD 0.97) to use. Linear mixed effects models revealed no significant differences in outcomes by condition for caregiver burden (P=.45; Cohen d=0.1, 95% CI -0.2 to 0.4), stress (P=.64; Cohen d=0.1, 95% CI -0.4 to 0.6), depression (P=.93; Cohen d= 0.0, 95% CI -0.3 to 0.3), anxiety (P=.55; Cohen d=-0.1, 95% CI -0.4 to 0.2), beliefs about treatment (P=.71; Cohen d=0.1, 95% CI -0.2 to 0.3), partner self-efficacy (P=.59; Cohen d=-0.1, 95% CI -0.4 to 0.2), dyadic adjustment (P=.08; Cohen d=-0.2, 95% CI -0.5 to 0.0), social constraints (P=.05; Cohen d=0.3, 95% CI 0.0-0.6), or communication danger signs (P=.90; Cohen d=-0.0, 95% CI -0.3 to 0.3). Post hoc analyses collapsing across conditions revealed a significant between-group effect on stress for app users versus nonusers (β=-3.62; t₂₈₁=-2.27; P=.02).

CONCLUSIONS

Approximately half of the randomized participants never used their allocated app, and participants in the PTSD Family Coach 1.0 condition only opened the app approximately 4 times over 4 weeks, suggesting limitations to this app version's feasibility. PTSD Family Coach 1.0 users reported moderately favorable impressions of the app, suggesting preliminary acceptability. Regarding efficacy, no significant difference was found between PTSD Family Coach 1.0 users and psychoeducation app users across any outcome of interest. Post hoc analyses suggested that app use regardless of treatment condition was associated with reduced stress. Further research that improves app feasibility and establishes efficacy in targeting the domains most relevant to CSOs is warranted.

TRIAL REGISTRATION

ClinicalTrials.gov NCT02486705; https://clinicaltrials.gov/ct2/show/NCT02486705.

The military spouse experience of living alongside their serving/veteran partner with a mental health issue: A systematic review and narrative synthesis

INTRODUCTION

Military healthcare studies have reported a wide range of mental health issues amongst military personnel. Globally, mental health issues are one of the main causes of ill health. Military personnel have a greater prevalence of mental health issues than that of the general population. The impact of mental health issues can be wide and far reaching for family and carers. This systematic narrative review explores the military spouse experience of living alongside their serving or veteran partner with a mental health issue.

METHODS

The systematic review performed was based on the PRISMA guide for searching, screening, selecting papers for data extraction and evaluation. Studies were identified from CINHAL, ASSIA, Proquest Psychology, Proquest Nursing & Allied Health source, Proquest Dissertations & Theses, ETHOS, PsychArticles, Hospital collection, Medline, Science Direct Freedom Collection and hand searching of citations and reference lists.

RESULTS

Twenty-seven studies were included in the narrative synthesis. Five overarching themes from the experiences of military spouses' living alongside their serving/veteran partners mental health issue were identified: caregiver burden, intimate relationships, psychological/psychosocial effects on the spouse, mental health service provision and spouse's knowledge and management of symptoms.

CONCLUSIONS

The systematic review and narrative synthesis identified that the majority of studies focused on spouses of veterans, very few were specific to serving military personnel, but similarities were noted. Findings suggest that care burden and a negative impact on the intimate relationship is evident, therefore highlight a need to support and protect the military spouse and their serving partner. Likewise, there is a need for greater knowledge, access and inclusion of the military spouse, in the care and treatment provision of their serving partner's mental health issue.

The Role of Social Support in Coping with Psychological Trauma: An Integrated Biopsychosocial Model for Posttraumatic Stress Recovery

This theoretical review proposes an integrated biopsychosocial model for stress recovery, highlighting the interconnectedness of intra- and interpersonal coping processes. The proposed model is conceptually derived from prior research examining interpersonal dynamics in the context of stressor-related disorders, and it highlights interconnections between relational partner dynamics, perceived self-efficacy, self-discovery, and biological stress responsivity during posttraumatic recovery. Intra- and interpersonal processes are discussed in the context of pre-, peri-, and post-trauma stress vulnerability as ongoing transactions occurring within the individual and between the individual and their environment. The importance of adopting an integrated model for future traumatic stress research is discussed. Potential applications of the model to behavioral interventions are also reviewed, noting the need for more detailed assessments of relational dynamics and therapeutic change mechanisms to determine how relational partners can most effectively contribute to stress recovery.

Development of an Evidence-Informed Solution to Emotional Distress in Public Safety Personnel and Healthcare Workers: The Social Support, Tracking Distress, Education, and Discussion CommunitY (STEADY) Program

Public safety personnel (PSP) and healthcare workers (HCWs) are frequently exposed to traumatic events and experience an increased rate of adverse mental health outcomes compared to the public. Some organizations have implemented wellness programming to mitigate this issue. To our knowledge, no programs were developed collaboratively by researchers and knowledge users considering knowledge translation and implementation science frameworks to include all evidence-informed elements of posttraumatic stress prevention. The Social Support, Tracking Distress, Education, and Discussion Community (STEADY) Program was developed to fill this gap. It includes (1) peer partnering; (2) distress tracking; (3) psychoeducation; (4) peer support groups and voluntary psychological debriefing following critical incidents; (5) community-building activities. This paper reports on the narrative literature review that framed the development of the STEADY framework and introduces its key elements. If successful, STEADY has the potential to improve the mental well-being of PSP and HCWs across Canada and internationally.

A Systematic Review of Evidence-Based Family Interventions for Trauma-Affected Refugees

Family connections are crucial for trauma-affected refugees from collectivistic cultures. Evidence-based family interventions are consistently promoted to support a host of mental and relational health needs of families exposed to traumatic stressors; however, there is still limited research focused on cultural adaptation and the testing of the effectiveness of these interventions on some of the most disenfranchised populations in the aftermath of forced displacement. This systematic review was conducted to examine the reach of existing evidence-based family interventions implemented with newly resettled refugees globally. Studies included in this review include those testing the effectiveness of a systemic treatment with pre and post intervention evaluation, studies with or without control groups, and studies that include at least one family member in addition to the target participants. Twelve studies met the inclusion criteria. Barriers to conducting randomized control trials with displaced refugee populations are discussed. Recommendations are made for future studies to include a focus on scientifically rigorous multi-method designs, specific cultural adaptation frameworks, and the integration of relational aspects rather than focusing only on individual adjustment. Global displacement continues to rise; therefore, it is imperative that the mental health and wellbeing of displaced populations be treated with a comprehensive, multi-level framework.

Aging together in the aftermath of war: marital adjustment and subjective age of veterans and their spouses

OBJECTIVES

Trauma has long-term effects on those directly exposed to it, but it also impacts those closest to them, particularly one's spouse, as the marital relationship is of central importance for late-life development. Furthermore, traumatic experiences have been shown to be involved in an acceleration of aging, whether through physical health, or via psychological pathways, through an older subjective age. The present work seeks to examine the mutual connections between marital adjustment and the psychological accelerated aging of both spouses among military veterans of the Israeli 1973 Yom Kippur War.

METHOD

Data from two assessments were drawn from a larger longitudinal study. In 2008 (T1) and again in 2015 (T2), 247 veterans and their wives were interviewed on their subjective age, marital adjustment, and PTSD symptoms.

RESULTS

An actor-partner interdependence model combined with an autoregressive cross-lagged model, controlling for T1 PTSD symptoms revealed that men's subjective age at T1 was associated with women's subjective age at T2, and women's subjective age at T1 was associated with men's subjective age at T2. Women's marital adjustment at T1 was associated with men's marital adjustment at T2 but not the other way around.

CONCLUSION

Spousal relationships are an important arena in the lives of older adult veterans. The present study contributes new knowledge regarding the paths that predict subjective age by taking account of the subjective age of one's spouse, as well as levels of marital adjustment. Insights regarding secondary traumatization, as well as gender differences, for the aging process are discussed.

Adverse childhood experiences, mental health, and relationship satisfaction in military couples

Adverse Childhood Experiences (ACEs) have been found to influence one's own mental health and relationship satisfaction in adulthood; however, the association between one's own ACEs and their partner's individual and relationship functioning has not been explored. Veterans (n = 103) and their significant others (S-O; total N = 206) completed assessments on ACEs, depression, relationship satisfaction, and Posttraumatic Stress Disorder (PTSD) symptom severity as part of a baseline assessment in a treatment outcome study for veterans with PTSD and their S-Os. Actor Partner Interdependence Moderation Modeling (APIMoM) was conducted. Higher ACE score was positively related to PTSD for all participants. Female S-O's ACE score was positively related to their own depression, and male S-Os reported higher depression and lower relationship satisfaction when their partners reported a higher ACE score. Surprisingly, female veterans experienced higher relationship satisfaction when their S-Os reported a higher ACE score. ACEs are related differently to one's own and one's partner's mental health and relationship satisfaction and should be assessed when conducting couple's interventions. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Analysis of Discourse Production to Assess Cognitive Communication Deficits Following Mild Traumatic Brain Injury With and Without Posttraumatic Stress

PURPOSE

Cognitive communication deficits can be difficult to assess in individuals with mild traumatic brain injury (mTBI). However, the use of discourse analysis as a direct and sensitive metric of cognitive communication skills has shown promising clinical utility for other TBI severity levels. This exploratory study investigated discourse production in service members and veterans (SMVs) with uncomplicated mTBI with and without posttraumatic stress disorder (PTSD) and SMVs with neither mTBI or PTSD.

METHOD

Fifteen SMVs with mTBI and PTSD, 26 with mTBI, and 25 controls with no brain injury (NBI) and without PTSD were given a wordless picture story to elicit spontaneous discourse. Discourse samples were analyzed for global coherence, word count, the use of negative emotion words, cognitive process words, nonfluencies, and story completeness.

RESULTS

Results revealed a significant difference between the mTBI (Mdn = 3.33) and NBI (Mdn = 3.50) groups, χ²(3) = 6.044, p = .017, ε² = .03, for global coherence. Word count differed significantly between the mTBI + PTSD (Mdn = 135) and NBI (Mdn = 195) groups, χ²(3) = 7.968, p = .006, ε² = .06. No other group differences were observed.

DISCUSSION

Structural features of discourse production may serve as potential markers of cognitive communication deficits in mTBI. Furthermore, PTSD may contribute to verbal fluency deficits in individuals with mTBI. Additional research is needed to develop discourse-related measures that are more sensitive to the effects of mTBI and PTSD.

Impacts of Internet-Based Interventions for Veterans With PTSD: A Systematic Review and Meta-Analysis

Background: Veterans who did not seek and complete treatment as intended have been shown to have an elevated risk of experiencing and being exposed to post-traumatic stress disorder (PTSD). Internet-based interventions (IBIs) provide more confidentiality and fewer treatment barriers, and they are regarded as potential treatments to reduce PTSD in veterans. However, the effects of IBI for veterans with PTSD are inconclusive. Objectives: IBI is defined as any internet-based series of psychosocial interventions, of which the internet works as a way of delivery. Psychosocial content and reduction of PTSD symptoms in veterans have been recognized as two core elements of this intervention. This study aimed to (1) examine the effects of IBI on veterans' PTSD outcomes and (2) distinguish between the elements of IBI that play an important role for veterans with PTSD. Methods: Web of Science, PubMed, EMBASE, PsycINFO, Cochrane, Wanfang Data, CNKI, and CQVIP databases were searched for randomized controlled trials (RCT) in IBI programs for veterans with PTSD, covering all studies in English and Chinese published from January 1990 to November 2020. Also, related studies tracking citations were identified. Studies met the following inclusion criteria of (1) being RCTs; (2) containing IBI in the full text; (3) having IBI conducted on veterans as participants; and (4) being on PTSD. All processes followed PRISMA. The risk of bias of the studies was assessed by the Cochrane Systematic Review Handbook. The confidence of outcomes of this review was valued according to the GRADE (Grading of Recommendations Assessment, Development, and Evaluation). The meta-analysis was done by RevMan 5.13. Two teams of reviewers independently searched the literature, made the assessment, and extracted the data. Results: A total of 1,493 citations were identified after initial searching, of which the full texts of 66 studies were screened. Eventually, six RCT studies met the inclusion criteria. Beneficial effects of IBI were found on the overall PTSD outcome (-0.29; 95% CI-0.48 to -0.11, p<0.01). Particularly, IBI based on cognitive behavioral therapy (CBT) with peer support was found to be effective for PTSD outcomes (-0.36; 95% CI-0.61 to -0.11, p<0.01). The subgroup analysis demonstrated that scores of PTSD outcome measured by a PCL (PTSD Checklist) decreased to an average score of 0.38 (95% CI -0.60 to -0.15, p=0.001). The intervention had a positive effect on the PTSD outcome on veterans with comorbid psychological disorders (-0.30; 95% CI -0.61 to -0.11, p<0.01). Overall, the six studies included were evaluated with a low risk of bias, and the outcomes of the meta-analysis were proven with high confidence. Conclusion: On the whole, IBIs have a positive effect on the overall PTSD outcome of veterans. The results encouraged us to focus on IBI with CBT with peer support for veterans, on specific instruments for veterans with PTSD, and on veterans with comorbid psychological disorders. This study, however, has limits. Only six studies with a Western population were included, which might result in cultural bias on IBI effects. In future, more high-qualified research and diverse cultural background of RCTs is needed to prove the effectiveness of IBI on veterans with PTSD.

Interpersonal Psychotherapy of Posttraumatic Stress Disorder for Veterans and Family Members: An Open Trial

OBJECTIVE

Military service members and veterans have high rates of posttraumatic stress disorder (PTSD), as do military family members. Exposure-based, cognitive-behavioral approaches have received ample research, but other PTSD therapies require further empirical attention. Interpersonal psychotherapy (IPT) targets affective awareness, life circumstances, and social support. IPT has shown efficacy for civilians with PTSD but awaits rigorous testing among military personnel; only two small military pilot studies and two case reports have been published. Military family members have received minimal attention from clinical outcomes research. Addressing these gaps, this open trial examined IPT for PTSD among veterans, service members, and family members, including a patient subset with comorbid PTSD and depression.

METHODS

Fifty U.S. military service members, veterans, and family members (age ≥18 years) were offered 14 sessions of IPT for PTSD. Individuals with psychosis, bipolar disorder, moderate or severe substance use disorders, or high suicide risk were excluded. PTSD and depressive symptoms were assessed at baseline, midtreatment, posttreatment, and 3-month follow-up.

RESULTS

Clinician-assessed PTSD (Clinician-Administered PTSD Scale) and depression (Hamilton Depression Rating Scale) symptoms decreased over time in the full sample and the comorbid PTSD/depression subset (p<0.05). Service members, veterans, and family members had similar treatment responses.

CONCLUSIONS

Patients receiving IPT showed reductions in PTSD and depressive symptoms. These open trial findings provide preliminary support for the utility of IPT in reducing PTSD symptoms among veterans and family members. This largest IPT trial to date for PTSD in military patients also bolsters the literature on treating military family members.

The interpersonal implications of PTSD and complex PTSD: The role of disturbances in self-organization

BACKGROUND

In the aftermath of trauma not only the primary traumatized survivors' mental health is affected but often also their significant others. The current study explores the specific associations of ICD-11 symptoms of posttraumatic stress disorder (PTSD) and disturbances in self organization (DSO) for secondary traumatic stress and dyadic adjustment among both spouses.

METHODS

Male Israeli veterans and their wives (N = 216) were assessed 30 years after the war. Primary PTSD/DSO symptoms of the veterans and secondary posttraumatic stress symptoms (secondary PTSS)/DSO of the wives were assessed. Actor Partner Independence Modelling (APIM) evaluated the differential effects of PTSD and DSO for trauma transmission and dyadic adjustment.

RESULTS

While veterans' primary PTSD only related to secondary PTSS of the wives, the veterans' DSO predicted the wives' secondary PTSS as well as DSO. Moreover, the APIM revealed that the primary and secondary DSO of both partners were associated with dyadic adjustment while their PTSD symptoms were not.

LIMITATIONS

The cross-sectional data did not allow to identify directional or causal effects and DSO symptoms were not assessed with an ICD-specific instrument as such scales did not exist at the time of data collection.

CONCLUSIONS

ICD-11 DSO symptoms seem to drive the transmission of posttraumatic stress among spouses to a more significant extent than PTSD symptoms. As DSO are also strongly implicated in decreased dyadic adjustment, they are valuable targets for couple therapy after one spouse experienced severe trauma, both in order to prevent interpersonal trauma transfer as well as to enhance dyadic adjustment.

The deadly gap: Understanding suicide among veterans transitioning out of the military

In the period following separation from the military, service members face the challenge of transitioning to a post-military civilian life. Some evidence suggests these transitioning Veterans are at higher risk for suicide compared with both the broader Veteran population and the United States public, yet they often do not receive adequate support and resources. In this review, we use the Three-Step Theory of suicide to outline characteristics of transitioning Veterans and the transition process that may affect suicide risk. We then highlight relevant services available to this specific subgroup of Veterans and make recommendations that address barriers to care. Cumulatively, this literature suggests transitioning Veterans fall within a "deadly gap" between the end of their military service and transition into civilian life. This "deadly gap" consists of limited psychiatric services and increased suicide risk factors which together may explain the increase in suicide during this transition period.

Interactive Motion-Assisted Exposure Therapy for Veterans with Treatment-Resistant Posttraumatic Stress Disorder: A Randomized Controlled Trial

BACKGROUND

Veterans with posttraumatic stress disorder (PTSD) tend to benefit less from evidence-based treatments than other PTSD populations. A novel virtual reality and motion-assisted exposure therapy, called 3MDR, provides treatment in an immersive, personalized and activating context.

OBJECTIVE

To study the efficacy of 3MDR for veterans with treatment-resistant PTSD.

METHOD

In a randomized controlled trial (n = 43) 3MDR was compared to a non-specific treatment component control group. Primary outcome was clinician-rated PTSD symptoms at baseline, after 3MDR, and at the 12-week and 16-week follow-up (primary end point). Intention-to-treat analyses of covariance and mixed models were applied to study differences between groups at the end point and over the course of intervention, controlling for baseline scores.

RESULTS

The decrease in PTSD symptom severity from baseline to end point was significantly greater for 3MDR as compared to the control group, with a large effect size (F[1, 37] = 6.43, p = 0.016, d = 0.83). No significant between-group difference was detected in the course of PTSD symptoms during treatment when including all time points. The dropout rate was low (7%), and 45% of the patients in the 3MDR group improved clinically. The number needed to treat was 2.86.

CONCLUSIONS

In this trial, 3MDR significantly decreased PTSD symptoms in veterans with, on average, a history of 4 unsuccessful treatments. The low dropout rate may be indicative of high engagement. However, a lack of significant differences on secondary outcomes limits conclusions that can be drawn on its efficacy and underlines the need for larger phase III trials. These data show emerging evidence for 3MDR and its potential to progress PTSD treatment for veterans (Dutch Trial Register Identifier: NL5126).

Examining the relations among moral foundations, potentially morally injurious events, and posttraumatic stress disorder symptoms

Military veterans are exposed to unique deployment stressors that can precipitate the onset of various psychological difficulties, including the perception that an important moral standard has been transgressed (i.e., potentially morally injurious events [PMIEs]) and the development of posttraumatic stress disorder (PTSD) symptoms. Vulnerability to these outcomes may be related to individual differences in moral foundations, including those that function to protect the individual (i.e., individualizing) and those that function to protect the group (i.e., binding).

OBJECTIVE

This study examined the direct and indirect associations among moral foundations, PMIEs, and PTSD symptoms.

METHOD

Participants were 203 military veterans (M age = 35.08, 77.30% male) who completed an online survey.

RESULTS

Only the binding moral foundation was found to be significantly and positively associated with both PMIEs and PTSD symptoms. Further, the association between the binding foundation and PTSD symptoms was explained by PMIEs.

CONCLUSIONS

These findings suggest that certain moral foundations, particularly those that serve "binding" functions-loyalty, authority, and purity-may be important considerations in military mental health. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Rationale, design, and methods of a two-site randomized controlled trial: Comparative effectiveness of two treatments for posttraumatic stress disorder in veterans

PTSD is associated with serious problems in interpersonal functioning, including higher rates of marital conflict and divorce, disrupted relationships with family and friends, estrangement from others and social isolation. Cognitive behavioral and trauma focused treatments are effective for treating PTSD symptoms, but a substantial proportion of individuals, particularly veterans, with PTSD, do not engage, complete, or fully respond to these treatments, and the effects of these treatments on interpersonal functioning are unknown. There is a critical need for alternative treatments with established efficacy, and for treatments that directly address problems in relationship functioning. Interpersonal Psychotherapy for PTSD (IPT-PTSD) is a promising candidate for such a treatment. This paper describes the rationale, design, and methods of the first randomized controlled equivalence trial comparing IPT-PTSD with a first-line gold standard treatment for PTSD (Prolonged Exposure; PE) in the treatment of PTSD in veterans. Both treatments include up to 12 weekly individual sessions. Assessments were conducted at baseline, following sessions four and eight, end of treatment, and 3 and 6 months post-treatment. Primary hypotheses are that IPT-PTSD will be statistically equivalent to PE in reducing the severity of PTSD symptoms, and superior to PE in improving interpersonal functioning. Secondary hypotheses propose that IPT will be superior to PE in improving overall social adjustment and quality of life, and in reducing suicidal ideation. Findings from this study have the potential to improve treatment options for veterans struggling with PTSD and interpersonal problems.

Female U.S. Military Veterans' (Non)Disclosure of Mental Health Issues with Family and Friends: Privacy Rules and Boundary Management

Grounded in communication privacy management (CPM) theory, this study explores the criteria female U.S. military veterans rely on when creating privacy rules regarding (non)disclosure of their mental health information with others as well as how female veterans manage privacy boundaries. Interviews with a diverse sample of 78 female veterans recently diagnosed with PTSD revealed examples of all five criteria for privacy rules proposed by CPM theory and illustrate how factors such as military culture, trauma, and risk/benefit assessments are interconnected. Female veterans also altered their boundary linkages, permeability, and control in response to tensions between revealing and concealing mental health information. Findings suggest the potential utility of drawing connections between tensions that motivate concealing/revealing and boundary management operations and highlight the need to further develop and evaluate programs such as peer support counseling within the Department of Veteran Affairs where female veterans can serve as support resources for their peers.

Abusive Relationship and Its Associated Factors Between Deployed and Un-Deployed Veterans in College

This study is to examine the effect of student veteran status on abusive relationships, namely, emotional, physical, and sexual abuse. In addition, this study divided student veterans into two groups, deployed and un-deployed veterans, to see whether two groups demonstrate different results on abusive relationships. Logistic regression models were employed as a statistical strategy using the 2011-2014 American College Health Association National College Health Assessment II (ACHA-NCHA-II) data. The results found that deployed veterans were more likely to experience physical abuse, while un-deployed veterans were more likely to experience emotional abuse. Student veterans did not show any significant relationship with sexual abuse regardless deployment experience. It would be appropriate to consider the results of this study to address abusive relationships among student veterans, which help them to not only adjust college life but also succeed in careers and have healthy family relationships.

Assessing vigilance in caregivers after traumatic brain injury: TBI-CareQOL Caregiver Vigilance

OBJECTIVE

Caregivers of individuals with traumatic brain injury (TBI) frequently experience anxiety related to the caregiver role. Often this is due to a caregiver's perceived need to avoid people and situations that might upset or "trigger" the care recipient. There are currently no self-report measures that capture these feelings; thus, this article describes the development and preliminary validation efforts for the TBI-Caregiver Quality of Life (CareQOL) Caregiver Vigilance item bank.

DESIGN

A sample of 532 caregivers of civilians (n = 218) or service members/veterans (SMVs; n = 314) with TBI completed 32 caregiver vigilance items, other measures of health-related quality of life (RAND-12, Patient-Reported Outcomes Measurement Information System [PROMIS] Depression, PROMIS Social Isolation, Caregiver Appraisal Scale), and the Mayo-Portland Adaptability Inventory-4.

RESULTS

The final item bank contains 18 items, as supported by exploratory and confirmatory factor analysis, item response theory graded response modeling (GRM), and differential item functioning investigations. Expert review and GRM calibration data informed the selection of a 6-item short form and programming of a computer adaptive test. Internal consistency reliability for the different administration formats were excellent (reliability coefficients ≥ .90). Three-week test-retest stability was supported (i.e., r ≥ .78). Correlations between vigilance and other self-report measures supported convergent and discriminant validity (0.01 ≤ r ≤ .69). Known-groups validity was also supported.

CONCLUSIONS

The new TBI-CareQOL Caregiver Vigilance computer adaptive test and corresponding 6-item short form were developed using established rigorous measurement development standards, providing the first self-report measure to evaluate caregiver vigilance. This development work indicates that this measure exhibits strong psychometric properties. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Prolonged Exposure and Sertraline Treatments for Posttraumatic Stress Disorder Also Improve Multiple Indicators of Social Functioning

Trauma survivors with posttraumatic stress disorder (PTSD) frequently also suffer from difficulties in social functioning that range across emotional, cognitive, and environmental domains. A detailed evaluation of the differential impacts of effective PTSD treatments on social functioning is needed. Men and women (N = 200) with chronic PTSD received 10 weeks of prolonged exposure (PE) or sertraline in a randomized clinical trial and were followed for 24 months. A secondary data analysis examined changes in social functioning with regard to fear of intimacy; receipt of social support; and distress, avoidance, and negative cognitions in social situations. Effects were examined between treatments over time, controlling for baseline functioning. There were large, durable improvements across all indices. Compared to sertraline, PE was more efficient at reducing fear of intimacy and distress from negative social cognitions by posttreatment, ds = 0.94-1.14. Patients who received sertraline continued to improve over the course of follow-up, ds = 0.54-1.17. The differential speed of therapeutic effects may argue for more direct mechanisms in cognitive behavioral interventions versus cascade effects in serotonin reuptake inhibitors. Notably, both treatments produced substantial social benefits for trauma survivors with social functioning difficulties, and effect sizes were comparable to typical reductions in PTSD, depression, and anxiety.

Posttraumatic Stress and Sexual Satisfaction in Husbands and Wives: A Dyadic Analysis

Trauma survivors who suffer from posttraumatic stress symptoms (PTSS) are known to experience impairments in sexual satisfaction. However, the negative effects of PTSS are not limited to the primary survivors, as they can lead to secondary PTSS in their spouses as well. The implications of secondary PTSS in the sexuality of couples remain unknown. This study aimed to investigate whether specific symptom clusters of PTSS (i.e., intrusions, hyperarousal, and avoidance) are implicated in the sexual satisfaction of couples. We assessed a sample of primarily exposed Israeli veterans from the Yom Kippur War and their wives who had been secondarily exposed (N = 191). The dyadic data were analyzed in an Actor-Partner Independence Model. When scrutinizing specific PTSS clusters, the husbands' avoidance related to their own sexual satisfaction. The wives' hyperarousal related to their own and their spouses' sexual satisfaction, whereas their intrusions were associated only with their husbands' sexual satisfaction. In conclusion, PTSS in one spouse is related to both spouses' sexual satisfaction; it is therefore recommended that clinicians adopt a dyadic approach when delivering interventions.

Psychological distress and communication quality in military couples after deployment to war

Previous research has found elevated levels of psychological distress (i.e., posttraumatic stress, depressive and anxiety symptoms) among veterans. Existing theory and evidence show how psychological distress is associated with marital disruptions. Only a few studies, however, have tested the link between psychological distress and couple communication quality in military couples, most of which were cross-sectional and employed self-report measures. The current study investigated whether psychological distress predicts changes in observed communication quality across 1 year in 228 couples consisting of male service members, who were deployed to Iraq and/or Afghanistan, and their nondeployed female partners. Psychological distress was indicated by self-reported posttraumatic stress disorder, depressive, and anxiety symptoms. Communication quality was assessed using observed couple interactions. The results of an actor-partner interdependence model showed that men's psychological distress predicted men's lower communication quality at one year after accounting for baseline communication quality. Women's psychological distress did not predict their communication quality, and each partner's psychological distress did not predict changes in their partner's communication quality over time. Consistent with previous findings on civilian populations, our findings highlight the long-term effects of psychological distress among service members on their communication behaviors with their intimate partners, and emphasize the importance of targeting psychological symptoms of service members following deployment to war. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Bidirectional Relationships Between Posttraumatic Stress Disorder and Social Functioning During Cognitive Processing Therapy

This study investigated temporal relationships between posttraumatic stress symptoms and two indicators of social functioning during cognitive processing therapy. Participants were 176 patients (51.5% female, M age = 39.46 [SD = 11.51], 89.1% White, 42.6% active duty military/veteran) who participated in at least two assessment time points during a trial of cognitive processing therapy. Posttraumatic stress disorder (PTSD) symptoms (PTSD Checklist for DSM-IV) and interpersonal relationship and social role functioning problems (Outcome Questionnaire-45) were assessed prior to each of 12 sessions. Multivariate multilevel lagged analyses indicated that interpersonal relationship problems predicted subsequent PTSD symptoms (b = .22, SE = 0.09, cr = 2.53, p = .01, pr = .46) and vice versa (b = .05, SE = 0.02, cr = 2.11, p = .04, pr = .16); and social role functioning problems predicted subsequent PTSD symptoms (b = .21, SE = 0.10, cr = 2.18, p = .03, pr = .16) and vice versa (b = .06, SE = 0.02, cr = 3.08, p < .001, pr = .23). Military status moderated the cross-lag from social role functioning problems to PTSD symptoms (b = -.35, t = -2.00, p = .045, pr = .16). Results suggest a robust association between PTSD symptoms and social functioning during cognitive processing therapy with a reciprocal relationship between PTSD symptoms and social functioning over time. Additionally, higher social role functioning problems for patients with military status indicate smaller reductions in PTSD symptoms from session to session.

Higher anhedonia and dysphoric arousal relate to lower relationship satisfaction among trauma-exposed female service members/veterans

OBJECTIVE

Posttraumatic stress disorder (PTSD) symptoms of detachment, anhedonia, and hyperarousal are associated with poorer relationship satisfaction. Such findings are limited to earlier models of PTSD and samples that were almost exclusively male. The association of current PTSD symptom clusters with relationship satisfaction in partnered female service members/veterans (SM/Vs) are understudied.

METHODS

This study examined the association of PTSD (PTSD Checklist-5 [PCL-5]) symptom clusters identified in the anhedonia model and relationship satisfaction (Couples' Satisfaction Index-4) in 477 partnered female SM/Vs.

RESULTS

Higher anhedonia and dysphoric arousal were associated with lower relationship satisfaction. Among those who scored 31+ on the PCL-5 (n = 255, 53.46%), which is a suggested cutoff for a probable PTSD diagnosis, only higher anhedonia was associated with poorer relationship satisfaction.

CONCLUSIONS

The association of PTSD symptom clusters with relationship satisfaction are similar for male and female SM/Vs. Interventions to improve relationship satisfaction may focus on reducing anhedonia and dysphoric arousal.

Sexual Desire among Veterans Receiving Prolonged Exposure Therapy for PTSD: Does Successful PTSD Treatment Also Yield Improvements in Sexual Desire?

Objective: People with posttraumatic stress disorder (PTSD) commonly report difficulties with sexual desire and other aspects of sexual functioning, but it is currently unknown if people who respond to psychotherapy for PTSD also report improvements in sexual desire. Method: One hundred and eighty-seven veterans with PTSD received prolonged exposure (PE) therapy at two outpatient PTSD specialty clinics and completed measures of PTSD symptoms (the PTSD Checklist - Military Version) and sexual desire (item 21 of the Beck Depression Inventory - Second Edition) repeatedly throughout the course of treatment. Results: The results of a conditional generalized mixed ordinal regression model showed a significant interaction between weeks in treatment and PTSD treatment response in predicting change in sexual desire across the course of treatment. Specifically, PTSD treatment responders reported improvement in sexual desire over the course of treatment, whereas nonresponders did not show changes in sexual desire over time. However, the effect of PTSD treatment response was no longer significant when accounting for severity of depression at the start of treatment. Participants reporting more severe depression at the start of treatment reported less improvement in sexual desire, regardless of PTSD symptom response. Conclusions: People with PTSD who respond to PE also report improvements in sexual desire over time, indicating that response to PE is associated with improved sexual desire, but the effect is complicated by the presence of co-occurring depression symptomatology.

Couple and family therapies for post-traumatic stress disorder (PTSD)

BACKGROUND

Post-traumatic stress disorder (PTSD) refers to an anxiety or trauma- and stressor-related disorder that is linked to personal or vicarious exposure to traumatic events. PTSD is associated with a range of adverse individual outcomes (e.g. poor health, suicidality) and significant interpersonal problems which include difficulties in intimate and family relationships. A range of couple- and family-based treatments have been suggested as appropriate interventions for families impacted by PTSD.

OBJECTIVES

The objectives of this review were to: (1) assess the effects of couple and family therapies for adult PTSD, relative to 'no treatment' conditions, 'standard care', and structured or non-specific individual or group psychological therapies; (2) examine the clinical characteristics of studies that influence the relative effects of these therapies; and (3) critically evaluate methodological characteristics of studies that may bias the research findings.

SEARCH METHODS

We searched MEDLINE (1950- ), Embase (1980- ) and PsycINFO (1967- ) via the Cochrane Common Mental Disorders Controlled Trials Register (CCMDCTR) to 2014, then directly via Ovid after this date. We also searched the Cochrane Central Register of Controlled Trials (CENTRAL) via the Cochrane Library. We conducted supplementary searches of PTSDPubs (all available years) (this database is formerly known as PILOTS (Published International Literature on Traumatic Stress)). We manually searched the early editions of key journals and screened the reference lists and bibliographies of included studies to identify other relevant research. We also contacted the authors of included trials for unpublished information. Studies have been incorporated from searches to 3 March 2018.

SELECTION CRITERIA

Eligible studies were randomised controlled trials (RCTs) of couple or family therapies for PTSD in adult samples. The review considered any type of therapy that was intended to treat intact couples or families where at least one adult family member met criteria for PTSD. It was required that participants were diagnosed with PTSD according to recognised classification systems.

DATA COLLECTION AND ANALYSIS

We used the standard methodological procedures prescribed by Cochrane. Three review authors screened all titles and abstracts and two authors independently extracted data from each study deemed eligible and assessed the risk of bias for each study. We used odds ratios (OR) to summarise the effects of interventions for dichotomous outcomes, and standardised mean differences (SMD) to summarise post-treatment between-group differences on continuous measures.

MAIN RESULTS

We included four trials in the review. Two studies examined the effects of cognitive behavioural conjoint/couple's therapy (CBCT) relative to a wait list control condition, although one of these studies only reported outcomes in relation to relationship satisfaction. One study examined the effects of structural approach therapy (SAT) relative to a PTSD family education (PFE) programme; and one examined the effects of adjunct behavioural family therapy (BFT) but failed to report any outcome variables in sufficient detail - we did not include it in the meta-analysis. One trial with 40 couples (80 participants) showed that CBCT was more effective than wait list control in reducing PTSD severity (SMD -1.12, 95% CI -1.79 to -0.45; low-quality evidence), anxiety (SMD -0.93, 95% CI -1.58 to -0.27; very low-quality evidence) and depression (SMD -0.66, 95% CI -1.30 to -0.02; very low-quality evidence) at post-treatment for the primary patient with PTSD. Data from two studies indicated that treatment and control groups did not differ significantly according to relationship satisfaction (SMD 1.07, 95% CI -0.17 to 2.31; very low-quality evidence); and one study showed no significant differences regarding depression (SMD 0.28, 95% CI -0.35 to 0.90; very low-quality evidence) or anxiety symptoms (SMD 0.15, 95% CI -0.47 to 0.77; very low-quality evidence) for the partner of the patient with PTSD. One trial with 57 couples (114 participants) showed that SAT was more effective than PFE in reducing PTSD severity for the primary patient (SMD -1.32, 95% CI -1.90 to -0.74; low-quality evidence) at post-treatment. There was no evidence of differences on the other outcomes, including relationship satisfaction (SMD 0.01, 95% CI -0.51 to 0.53; very low-quality evidence), depression (SMD 0.21, 95% CI -0.31 to 0.73; very low-quality evidence) and anxiety (SMD -0.16, 95% CI -0.68 to 0.36; very low-quality evidence) for intimate partners; and depression (SMD -0.28, 95% CI -0.81 to 0.24; very low-quality evidence) or anxiety (SMD -0.34, 95% CI -0.87 to 0.18; very low-quality evidence) for the primary patient. Two studies reported on adverse events and dropout rates, and no significant differences between groups were observed. Two studies were classified as having a 'low' or 'unclear' risk of bias in most domains, except for performance bias that was rated 'high'. Two studies had significant amounts of missing information resulting in 'unclear' risk of bias. There were too few studies available to conduct subgroup analyses.

AUTHORS' CONCLUSIONS

There are few trials of couple-based therapies for PTSD and evidence is insufficient to determine whether these offer substantive benefits when delivered alone or in addition to psychological interventions. Preliminary RCTs suggest, however, that couple-based therapies for PTSD may be potentially beneficial for reducing PTSD symptoms, and there is a need for additional trials of both adjunctive and stand-alone interventions with couples or families which target reduced PTSD symptoms, mental health problems of family members and dyadic measures of relationship quality.

Effects of the After Deployment: Adaptive Parenting Tools (ADAPT) intervention on fathers and their children: A moderated mediation model

Deployment to war is associated with disruptions to emotion regulation and parenting. Using data from a randomized controlled trial, we examined whether fathers with poorer emotion regulation would differentially benefit from the After Deployment, Adaptive Parenting Tools program, a 14-session group-based parenting intervention. Prior analyses of the intervention demonstrated benefits to observed couple parenting and children's adjustment, but not to fathers’ observed parenting. In this study we examined whether intervention effects on fathers’ observed distress avoidance were moderated by baseline emotion regulation, and whether reduced distress avoidance was associated with improved observed parenting and reduced children's internalizing symptoms. A subset of the full randomized controlled trial sample (181 families with a father who had returned from deployment to war in Iraq or Afghanistan, a nondeployed mother, and a target child aged 4–13) completed measures at baseline, 12-months, and 24-months postbaseline. Results indicated that fathers high in baseline emotion regulation difficulties assigned to the intervention group showed reductions in observed distress avoidance at 12 months compared to controls, which were subsequently associated with improvements in observed parenting practices and reductions in children's internalizing symptoms at 24 months. The results suggest a role for personalizing parenting programs for fathers high in emotion dysregulation.

Design of a randomized superiority trial of a brief couple treatment for PTSD

Interpersonal difficulties are common among veterans with posttraumatic stress disorder (PTSD) and are associated with poorer treatment response. Treatment outcomes for PTSD, including relationship functioning, improve when partners are included and engaged in the therapy process. Cognitive-behavioral conjoint therapy for PTSD (CBCT) is a manualized 15-session intervention designed for couples in which one partner has PTSD. CBCT was developed specifically to treat PTSD, engage a partner in treatment, and improve interpersonal functioning. However, recent research suggests that an abbreviated CBCT protocol may lead to sufficient gains in PTSD and relationship functioning, and yield lower dropout rates. Likewise, many veterans report a preference for receiving psychological treatments through clinical videoteleconferencing (CVT) rather than traditional face-to-face modalities that require travel to VA clinics. This manuscript describes the development and implementation of a novel randomized controlled trial (RCT) that examines the efficacy of an abbreviated 8-session version of CBCT ("brief CBCT," or B-CBCT), and compares the efficacy of this intervention delivered via CVT to traditional in-person platforms. Veterans and their partners were randomized to receive B-CBCT in a traditional Veterans Affairs office-based setting (B-CBCT-Office), CBCT through CVT with the veteran and partner at home (B-CBCT-Home), or an in office-delivered, couple-based psychoeducation control condition (PTSD Family Education). This study is the first RCT designed to investigate the delivery of B-CBCT specifically to veterans with PTSD and their partners, as well as to examine the delivery of B-CBCT over a CVT modality; findings could increase access to care to veterans with PTSD and their partners.

Social Ties and Suicidal Ideation Among Veterans Referred to a Primary Care-Mental Health Integration Program

OBJECTIVE

This study examined associations between three indices of social ties (perceived social support, frequency of negative social exchanges, and degree of social integration) and suicidal ideation among veterans referred by their primary care provider for a behavioral health assessment.

METHODS

The sample included 15,277 veterans who completed a mental health and substance use assessment on referral to a Primary Care-Mental Health Integration (PCMHI) program. Data on sociodemographic factors, mental health and substance use conditions (e.g., depression, anxiety, and substance use), perceived general health, the three indices of social ties, and suicidal ideation were extracted from clinical interviews.

RESULTS

The mean±SD age of the sample was 51.3±15.9, most (89%) were men, and about half (48%) were white. Most met criteria for at least one mental health or substance use condition on PCMHI assessment, and 39% reported either low- or high-severity suicidal ideation, as measured by the Paykel Suicide Scale. Logistic regression analyses indicated that after adjustment for sociodemographic factors, perceived health, and comorbid mental health and substance use conditions, each of the three social tie indices was uniquely associated with higher odds of reporting suicidal ideation, compared with no ideation.

CONCLUSIONS

Findings underscore the value of assessing multiple indices of social ties when examining suicidal ideation among high-risk veterans in primary care experiencing behavioral health issues. Incorporating an assessment of the quality of patients' social interactions and level of social integration into routine PCMHI practice has the potential to enhance screening and intervention efforts aimed at reducing suicidal ideation.

"I'm Still Fighting for the Two of Us": How Partners of UK Veterans Construct Their Experience of Living with Combat-Related Trauma

There has been little qualitative research into the experiences of UK partners of veterans with PTSD. This study therefore aimed to explore how partners constructed their experiences of living with the condition. Fifteen female partners of male UK veterans were recruited and interviewed. Using a social constructionist thematic analysis, five themes were constructed: the women's need to subdue own emotional and behavioral responses; dilemmas about whether the veteran was unwell or 'bad'; attempts at negotiating multiple roles; challenging the narrative of veterans as heroes; and the relational struggle with the transition to nonmilitary life. This study highlighted the importance of considering the veteran as existing within a relational and cultural context, and the need to include partners in therapeutic interventions.

Supporting a Spouse With Military Posttraumatic Stress: Daily Associations With Partners' Affect

Service members and veterans (SM/Vs) with posttraumatic stress disorder (PTSD) can receive significant benefits from social support by a spouse or romantic partner. However, little is known about how providing support impacts partners. This study sought to identify (a) how provision of support is associated with partners' daily negative and positive affect and (b) how SM/Vs' PTSD symptom severity might moderate such associations. In a 14-day daily-diary study that assessed 64 couples in which one member was an SM/V with PTSD symptoms, partners reported nightly on whether or not they provided instrumental support and/or emotional support that day as well as their current negative and positive affect. Multilevel modeling showed that the provision of emotional and instrumental support were both significantly related to partners' lower levels of negative affect, f ² = 0.09, and higher levels of positive affect, f ² = 0.03, on that same day but not the next day. The positive same-day effects were seen if any support was given, with no additive effects when both types of support were provided. Severity of SM/V PTSD moderated the association between provision of emotional support and lower same-day negative affect such that the association was significant only when PTSD symptoms were more severe. Overall, these findings indicate that support provision to a partner with PTSD is associated with improved affect for the romantic partner providing support. However, given that only same-day affect was associated with support, the findings may also suggest that positive affect increases the provision of support.

Posttraumatic Stress Disorder Symptoms and Criminal Behavior in U.S. Army Populations: The Mediating Role of Psychopathy and Suicidal Ideation

Whereas past research has demonstrated the relationship between posttraumatic stress disorder (PTSD) and criminal behavior, the present study examines the underlying mechanisms driving this association. The primary objective was to determine the role of psychopathy and suicidal ideation as mediating factors in the relationship between military PTSD symptoms and criminal behavior (defined as incarceration status). A correlational study using archival data from the U.S. Disciplinary Barracks (USDB) and a control population of U.S. Army soldiers was conducted. The USDB provided data from 310 incarcerated male U.S. Army soldiers. Data were also collected from 310 nonincarcerated, male U.S. Army soldiers in the greater Fort Rucker, Alabama area. Data validity checks eliminated some cases, thus yielding a final dataset of 246 USDB and 252 control participants. The results suggested partial mediation, in that PTSD symptoms had a direct effect on incarceration status, and significant indirect effects through suicidal ideation and psychopathy while controlling for intelligence and warmth. In furnishing evidence of how psychopathy and suicidal ideation mediate the relationship between PTSD and incarceration status in military personnel, this research highlights specific internalization and externalization mechanisms that may increase the tendencies of people with greater PTSD symptoms to engage in criminal behaviors. By adding to the small amount of prior research on why PTSD sometimes leads people to engage in criminal behaviors, our research provides specific, observable symptoms that clinicians may use to identify, treat, and possibly ameliorate facets of PTSD that can lead affected people to engage in criminal behaviors.

What doesn't kill you makes you feel older: lifespan adversity and its association with subjective age among former prisoners of war

Background: Subjective age (SA) is an indicator of aging that has been empirically associated with health impediments and hindered longevity. Studies show that adverse life events may result in relatively older SA, but have not addressed the differential contribution of life events across the lifespan and the course of posttraumatic psychopathology on the SA of aging survivors of extreme trauma. Objective: Filling this gap, the current study explored the differential contribution of (1) adverse experiences in various life-stages and (2) trajectories of posttraumatic stress disorder (PTSD) to the prediction of SA in a sample of former prisoners-of-war as they enter old age. Method: A cohort of Israeli former prisoners-of-war of the 1973 Yom Kippur War (N = 103) was assessed at four points throughout four decades after the war. A linear hierarchical regression was utilized to assess the contribution of negative life events during childhood, participation in other wars, combat exposure, suffering in captivity, life events since the war and the trajectories of PTSD for predicting SA 42-years post-repatriation. Results: Lifespan adversity explained 50% of the variance in SA, with trajectories of PTSD making the largest contribution, followed by life events since the war. Negative life events in childhood added to the explained variance only when PTSD trajectories were accounted for. Exposure to combat, participation in additional wars and the severity of specific experiences during captivity did not reach significance, though the latter marginally contributed to the explained variance (p = .069). Conclusions: This study demonstrates the importance of considering the prolongation of posttraumatic psychopathology together with life adversities and their differential implications when addressing SA after extreme trauma. The findings suggest that early life adversity may be a latent factor that increases vulnerability to posttraumatic premature aging processes.

OEF/OIF/OND Veterans Seeking PTSD Treatment: Perceptions of Partner Involvement in Trauma-Focused Treatment

INTRODUCTION

Post-traumatic stress disorder (PTSD) has been linked to a variety of adverse mental and physical health outcomes including distressed relationships. Involving romantic partners in PTSD treatment appears to be a promising new avenue for PTSD treatment; however, additional research is necessary to clarify veteran preferences for inclusion of significant others in treatment and relationship characteristics that may influence such preferences. Accordingly, the present study was designed to evaluate Operation Enduring Freedom/Operation Iraqi Freedom/Operation New Dawn (OEF/OIF/OND) veterans' desire to include romantic partners in trauma-focused care (n = 74) and to explore psychological and relationship variables associated with preference for partner inclusion in PTSD treatment.

MATERIALS AND METHODS

This study surveyed male (N = 74) OEF/OIF/OND combat veterans seeking mental health services at a Veterans Health Administration PTSD treatment program. Relationships between PTSD symptoms, romantic relationship functioning, and interest in including their romantic partner in PTSD treatment were examined.

RESULTS

Consistent with previous research, OEF/OIF/OND veterans seeking treatment at a specialty PTSD program report low relationship satisfaction. The majority of participants reported that PTSD symptoms interfere with relationship functioning; specifically, numbing symptoms were a significant predictor of PTSD-related relationship impairment. A minority (26%) of participants reported a desire to include their romantic partner in PTSD treatment. Greater behavioral avoidance and communication difficulties were associated with increased interest in including a romantic partner in PTSD treatment.

CONCLUSION

We confirmed that OEF/OIF/OND veterans seeking PTSD treatment experience PTSD-related problems in romantic relationships, low-relationship satisfaction, and relationship satisfaction was positively associated with perceived communication and problem-solving skills. A minority of veterans were interested in involving significant others in their PTSD treatment; however, in the present study, veterans were not given information about the various ways that a romantic partner might be involved in treatment, and they were not presented with specific conjoint therapies (e.g., Cognitive-Behavioral Conjoint Therapy for PTSD, Strategic Approach Therapy). For veterans with PTSD, relationship distress, and communication difficulties, conjoint psychotherapies may offer a way of increasing engagement in PTSD treatment by parsimoniously addressing multiple treatment targets at once (PTSD symptoms, relationship distress, communication problems) and providing veteran-centered care.

Sticking it out in trauma-focused treatment for PTSD: It takes a village

OBJECTIVE

One in 3 veterans will dropout from trauma-focused treatments for posttraumatic stress disorder (PTSD). Social environments may be particularly important to influencing treatment retention. We examined the role of 2 support system factors in predicting treatment dropout: social control (direct efforts by loved ones to encourage veterans to participate in treatment and face distress) and symptom accommodation (changes in loved ones' behavior to reduce veterans' PTSD-related distress).

METHOD

Veterans and a loved one were surveyed across 4 VA hospitals. All veterans were initiating prolonged exposure therapy or cognitive processing therapy (n = 272 dyads). Dropout was coded through review of VA hospital records.

RESULTS

Regression analyses controlled for traditional, individual-focused factors likely to influence treatment dropout. We found that, even after accounting for these factors, veterans who reported their loved ones encouraged them to face distress were twice as likely to remain in PTSD treatment than veterans who denied such encouragement.

CONCLUSIONS

Clinicians initiating trauma-focused treatments with veterans should routinely assess how open veterans' support systems are to encouraging veterans to face their distress. Outreach to support networks is warranted to ensure loved ones back the underlying philosophy of trauma-focused treatments. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Male psychosexual therapy in the UK military

Military personnel can experience psychosexual difficulties for a variety of reasons. Problems can arise because of psychological trauma, physical injury, consequences arising from pharmacological and surgical complications and social or emotional concerns relating to intrapersonal and interpersonal relationship dynamics. Such individuals might seek to minimise or avoid resolving their pertinent difficulties, while others can experience cultural, personal or organisational barriers to accessing professional help. This paper offers an overview of the development of a national specialist psychosexual therapy service (PST), commenting specifically on the service delivery for male military personnel. It will also consider factors which may support progress in treatment and reflect upon the importance of considering psychosexual functioning in relationships as part of the broader service-life context, which is especially relevant to military personnel.