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Powling R, Brown D, Tekin S, Billings J. Partners' experiences of their loved ones' trauma and PTSD: An ongoing journey of loss and gain. PLoS One 2024; 19:e0292315. [PMID: 38354114 PMCID: PMC10866491 DOI: 10.1371/journal.pone.0292315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 09/18/2023] [Indexed: 02/16/2024] Open
Abstract
BACKGROUND Traumatic life events can have a profound impact on the physical and psychological wellbeing of not only those who directly experience them, but others who are indirectly affected, such as victims' partners. AIMS This study aimed to explore the experiences and views of partners of individuals who have a history of trauma and diagnosis of posttraumatic stress disorder (PTSD). METHODS In-depth semi-structured interviews were conducted with six partners of people who had experienced trauma and were diagnosed with PTSD and awaiting or receiving treatment at a specialist Trauma Service. The data was analysed using Interpretative Phenomenological Analysis. RESULTS One overarching theme resulted from the data: partners experienced trauma and PTSD as an ongoing journey of loss and gain. This was supported by three superordinate themes: making sense of the trauma and ensuing consequences, shifting identities, and accessing and experiencing outside resources. Partners' journeys were characterised by striving and struggling to make sense of the trauma and its ensuing consequences, whilst grappling with the identities of themselves, their partners and relationships shifting over time. Participants navigated their journeys in the context of external resources and support from friends, family, colleagues and professionals. CONCLUSIONS The results of this study highlight the need for greater information and support for partners of people with PTSD.
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Affiliation(s)
- Rosie Powling
- School of Psychology, University of Surrey, Guildford, United Kingdom
| | - Dora Brown
- School of Psychology, University of Surrey, Guildford, United Kingdom
| | - Sahra Tekin
- Division of Psychiatry, University College London, London, United Kingdom
| | - Jo Billings
- Division of Psychiatry, University College London, London, United Kingdom
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2
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Wang S, Zhang Q, Goh PH, Hu J, Liu X, Du J, Xu W. Relationship Between Post-Traumatic Stress Symptoms and Caregiver Burden In Breast Cancer Patients: The Mediating Role of Anxiety and Depression. J Clin Psychol Med Settings 2023; 30:645-653. [PMID: 36385422 DOI: 10.1007/s10880-022-09927-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/06/2022] [Indexed: 11/17/2022]
Abstract
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.
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Affiliation(s)
- Shoushi Wang
- Beijing Key Laboratory of Applied Experimental Psychology, National Demonstration Center for Experimental Psychology Education (Beijing Normal University), Faculty of Psychology, Beijing Normal University, Beijing, People's Republic of China
| | - Qian Zhang
- University of Leeds, Leeds, United Kingdom
| | - Pei Hwa Goh
- Department of Psychology, Monash University, Subang Jaya, Malaysia
| | - Jingwen Hu
- School of Psychology, Nanjing Normal University, Nanjing, People's Republic of China
| | - Xiaoyan Liu
- Beijing Key Laboratory of Applied Experimental Psychology, National Demonstration Center for Experimental Psychology Education (Beijing Normal University), Faculty of Psychology, Beijing Normal University, Beijing, People's Republic of China
| | - Jiaxuan Du
- School of Psychology, Nanjing Normal University, Nanjing, People's Republic of China
| | - Wei Xu
- Beijing Key Laboratory of Applied Experimental Psychology, National Demonstration Center for Experimental Psychology Education (Beijing Normal University), Faculty of Psychology, Beijing Normal University, Beijing, People's Republic of China.
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3
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Mahmood HN, Ibrahim H, Ismail AA, Neuner F. The mental health of forcibly displaced couples. J Trauma Stress 2022; 35:1598-1607. [PMID: 35907258 DOI: 10.1002/jts.22862] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Revised: 05/29/2022] [Accepted: 05/31/2022] [Indexed: 12/24/2022]
Abstract
Most current research investigating traumatic stress is focused on its effects at the individual level, utilizing the implicit assumption that trauma-related disorders are mutually independent within families and communities. However, there is reason to assume that trauma-related symptoms within couples are influenced by each partner's risk factors and symptoms. Using the actor-partner interdependence model, this study aimed to test whether symptoms of posttraumatic stress disorder (PTSD) and depression were predicted by participants' partner's exposure to traumatic events over and above the influence of the participant's own experiences. For this purpose, we interviewed 687 heterosexual, married Iraqi and Syrian couples in Iraq's Kurdistan region who had been forcefully displaced. We assessed symptoms of PTSD and depression using locally validated scales. Nearly all participants (98.8%) reported exposure to at least one traumatic event, with husbands reporting exposure to a higher number of traumatic events than wives, d = 0.48, p < .001. More than half of the participants met the criteria for a probable PTSD (61.1%) or major depressive disorder diagnosis (60.4%). Within couples, significant actor effects of experienced trauma exposure on personal PTSD and depressive symptoms were observed for both husbands and wives. Further, there were significant partner effects of wives' traumatic experiences on husbands' PTSD and depressive symptoms as well as of husbands' traumatic experiences on wives' PTSD and depressive symptoms. The findings argue for the interdependence of trauma-related symptoms within dyads in a dual-trauma context, suggesting the presence of intracouple transmission of trauma-related symptoms.
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Affiliation(s)
- Harem Nareeman Mahmood
- Department of Psychology, Clinical Psychology, and Psychotherapy, Bielefeld University, Bielefeld, Germany.,Department of Clinical Psychology, Faculty of Science and Health, Koya University, Koy Sanjaq, Iraq
| | - Hawkar Ibrahim
- Department of Psychology, Clinical Psychology, and Psychotherapy, Bielefeld University, Bielefeld, Germany.,vivo international, Konstanz, Germany
| | - Azad Ali Ismail
- Department of Clinical Psychology, Faculty of Science and Health, Koya University, Koy Sanjaq, Iraq
| | - Frank Neuner
- Department of Psychology, Clinical Psychology, and Psychotherapy, Bielefeld University, Bielefeld, Germany.,vivo international, Konstanz, Germany
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4
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Cozza SJ, Ogle CM, Fisher JE, Zhou J, Zuleta RF, Fullerton CS, Ursano RJ. The effect of war injury and combat deployment on military wives' mental health symptoms. Depress Anxiety 2022; 39:686-694. [PMID: 35708130 DOI: 10.1002/da.23274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 04/27/2022] [Accepted: 05/18/2022] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Although much has been learned about the physical and psychological impacts of deployment and combat injury on military service members, less is known about the effects of these experiences on military spouses. METHODS The present study examined self-reported mental health symptoms (using the Brief Symptom Inventory [BSI]-18 and the posttraumatic stress disorder [PTSD] Checklist [PCL-C]) in wives of service members who were combat-injured (CI; n = 60); noninjured with cumulative deployment longer than 11 months (NI-High; n = 51); and noninjured with cumulativel deployment less than 11 months (NI-Low; n = 53). RESULTS 36.7% and 11.7% of CI wives endorsed above threshold symptoms on the PCL-C and overall BSI-18, respectively. Multivariate linear regressions revealed that being a CI wife was associated with higher PCL-C, overall BSI-18, and BSI-18 anxiety subscale scores compared to NI-Low wives in models adjusted for individual and family characteristics, as well as prior trauma and childhood adversities. Compared with the NI-High group, the CI group was associated with higher overall BSI-18 scores. CONCLUSIONS While CI wives evidenced fewer mental symptoms than expected, these findings suggest a negative impact of service member's combat injury on wives' mental health above that attributable to deployment, highlighting the need for trauma-informed interventions designed to support the needs of military wives affected by combat injury.
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Affiliation(s)
- Stephen J Cozza
- Department of Psychiatry, Center for the Study of Traumatic Stress, Uniformed Services University, Bethesda, Maryland, USA
| | - Christin M Ogle
- Department of Psychiatry, Center for the Study of Traumatic Stress, Uniformed Services University, Bethesda, Maryland, USA.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc, Bethesda, Maryland, USA
| | - Joscelyn E Fisher
- Department of Psychiatry, Center for the Study of Traumatic Stress, Uniformed Services University, Bethesda, Maryland, USA.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc, Bethesda, Maryland, USA
| | - Jing Zhou
- Department of Psychiatry, Center for the Study of Traumatic Stress, Uniformed Services University, Bethesda, Maryland, USA.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc, Bethesda, Maryland, USA
| | - Rafael F Zuleta
- Department of Psychiatry, Center for the Study of Traumatic Stress, Uniformed Services University, Bethesda, Maryland, USA.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc, Bethesda, Maryland, USA
| | - Carol S Fullerton
- Department of Psychiatry, Center for the Study of Traumatic Stress, Uniformed Services University, Bethesda, Maryland, USA
| | - Robert J Ursano
- Department of Psychiatry, Center for the Study of Traumatic Stress, Uniformed Services University, Bethesda, Maryland, USA
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5
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Russin SE, Stein CH. The Aftermath of Trauma and Abuse and the Impact on Family: A Narrative Literature Review. TRAUMA, VIOLENCE & ABUSE 2022; 23:1288-1301. [PMID: 33653179 DOI: 10.1177/1524838021995990] [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: 06/12/2023]
Abstract
The present narrative review examined quantitative and qualitative research on family members who support survivors of trauma or abuse. Studies included in the present review were found in peer-reviewed journal articles, available in English, published between 1980 and 2019, and focused specifically on the experiences of adult familial supporters of adult trauma and abuse survivors. A search of PsychInfo and Google Scholar identified 136 relevant articles, and analysis of their content generated the following categories: individual-level impacts (i.e., quality of psychological health, burden, secondary traumatic stress, quality of physical health, and positive impacts), interpersonal and environmental level impacts (i.e., quality of relationships with survivors, navigating environment, maltreatment and safety, and social impacts), and other experiences (i.e., social roles, needs, coping strategies, and sociocultural context). Findings indicate that the majority of existing studies examined the experiences of family members of adult survivors of military trauma. Results of the review suggest that family supporters of adult trauma and abuse survivors generally experience physical, emotional, cognitive, behavioral, social, safety, and relational impacts. Implications of review findings and directions for future research are discussed.
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Affiliation(s)
- Sarah E Russin
- Department of Psychology, 1888Bowling Green State University, OH, USA
| | - Catherine H Stein
- Department of Psychology, 1888Bowling Green State University, OH, USA
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Mangold A, King AR, Herting NA. The Role of Children's PTSD Symptomatology in Non-Offending Caregivers' Secondary Traumatic Stress Symptomatology Following Disclosures of Sexual or Physical Abuse. JOURNAL OF CHILD & ADOLESCENT TRAUMA 2022; 15:553-565. [PMID: 35958711 PMCID: PMC9360266 DOI: 10.1007/s40653-021-00408-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/16/2021] [Indexed: 06/15/2023]
Abstract
This research examined factors influencing levels of secondary traumatic stress (STS) in non-offending caregivers (NOCs) of children with histories of sexual or physical abuse. These factors included the nature of the abuse, NOCs' relationships with the initiators of the abuse, children's ages and genders, NOCs' trauma histories, and the elapsed time between children's disclosures of abuse and their trauma assessments. As a secondary objective, this research examined the interactions between children's self-reports of their own posttraumatic stress disorder (PTSD) symptomatology, NOCs' estimates of their children's PTSD symptomatology, and NOCs' self-reports of their own STS symptomatology. Participants from a clinical sample (N = 300, children = 150, NOCs = 150; child age M = 9.89, SD = 4.08; NOC age M = 37.87, SD = 9.23) completed structured intake interviews, the PTSD Checklist for the DSM-5 (PCL-5) and the Child PTSD Symptom Scale (CPSS; Child-Report and NOC-Report). Analytic strategies included point-biserial correlation coefficient calculations, linear regression analyses, and Analyses of Covariance (ANCOVAs). NOCs' levels of STS were impacted by their relationships with the initiators of the abuse and their own trauma histories. NOCs' self-reported STS symptomatology mirrored their estimates of their children's PTSD symptomatology. The discrepancy scores between children's self-reports of their PTSD symptomatology and NOCs' estimates of children's PTSD symptomatology were impacted by children's ages and genders. Clinical practitioners should note the importance of examining children's PTSD symptomatology and NOCs' STS symptomatology concurrently when making recommendations for trauma-informed evidence-based treatments.
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Affiliation(s)
- Ani Mangold
- Department of Psychological Sciences, University of North Dakota, Grand Forks, ND USA
- Red River Children’s Advocacy Center, Fargo, ND USA
| | - Alan R. King
- Department of Psychological Sciences, University of North Dakota, Grand Forks, ND USA
| | - Nicola A. Herting
- Department of Psychological Sciences, University of North Dakota, Grand Forks, ND USA
- Red River Children’s Advocacy Center, Fargo, ND USA
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7
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Bei E, Mashevich K, Rotem-Mindali O, Galin-Soibelman S, Kalter-Leibovici O, Schifter T, Vilchinsky N. Extremely Distant and Incredibly Close: Physical Proximity, Emotional Attachment and Caregiver Burden. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19148722. [PMID: 35886574 PMCID: PMC9323703 DOI: 10.3390/ijerph19148722] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 07/12/2022] [Accepted: 07/14/2022] [Indexed: 12/05/2022]
Abstract
Informal caregivers are at risk of caregiver burden, and physical proximity to the care recipient may add to this negative outcome. Yet, individual differences in emotional proximity to the care recipient such as attachment orientations may contribute to caregivers’ comfort towards different degrees of physical proximity, leading to varying levels of burden. The current study is the first to explore the role of physical proximity on caregiver burden as moderated by attachment orientations. A sample of 162 Israeli caregivers who are active users of the Camoni website completed our online survey. Sociodemographic characteristics, including a self-reported questionnaire on the physical proximity to the care recipient, were collected. Caregivers’ attachment orientations were assessed with the Experiences in Close Relationships–Relationship Structures questionnaire. Caregiver burden was assessed using the Caregiver Burden Inventory. Multiple regression and simple slope analyses were conducted. Attachment anxiety and avoidance were positively associated with burden, whereas physical proximity was not. Attachment avoidance, but not attachment anxiety, moderated the association between physical proximity and caregiver burden, with caregivers who live closer to their care recipient experiencing greater burden when high levels of avoidance were present. Our findings reveal the complex dynamics between attachment orientations and physical proximity in the context of informal care, highlighting the need for better integration of these two interlinked constructs in both care research and practice.
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Affiliation(s)
- Eva Bei
- Department of Psychology, Faculty of Social Sciences, Bar-Ilan University, Ramat Gan 5290002, Israel; (K.M.); (S.G.-S.); (N.V.)
- Correspondence: ; Tel.: +30-69-8204-1162
| | - Karin Mashevich
- Department of Psychology, Faculty of Social Sciences, Bar-Ilan University, Ramat Gan 5290002, Israel; (K.M.); (S.G.-S.); (N.V.)
| | - Orit Rotem-Mindali
- Department of Geography and Environment, Bar-Ilan University, Ramat Gan 5290002, Israel;
| | - Shira Galin-Soibelman
- Department of Psychology, Faculty of Social Sciences, Bar-Ilan University, Ramat Gan 5290002, Israel; (K.M.); (S.G.-S.); (N.V.)
| | - Ofra Kalter-Leibovici
- The Gertner Institute, Sheba Medical Center, Ramat Gan 5290002, Israel; (O.K.-L.); (T.S.)
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv P.O. Box 39040, Israel
| | - Tami Schifter
- The Gertner Institute, Sheba Medical Center, Ramat Gan 5290002, Israel; (O.K.-L.); (T.S.)
| | - Noa Vilchinsky
- Department of Psychology, Faculty of Social Sciences, Bar-Ilan University, Ramat Gan 5290002, Israel; (K.M.); (S.G.-S.); (N.V.)
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8
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Juengst SB, Perrin PB, Klyce DW, O’Neil-Pirozzi TM, Herrera S, Wright B, Lengenfelder J, Lercher K, Callender L, Arango-Lasprilla JC. Caregiver Characteristics of Adults with Acute Traumatic Brain Injury in the United States and Latin America. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:5717. [PMID: 35565112 PMCID: PMC9102876 DOI: 10.3390/ijerph19095717] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 04/29/2022] [Accepted: 05/05/2022] [Indexed: 12/04/2022]
Abstract
Objectives: To compare characteristics of caregivers of adults with acute traumatic brain injury (TBI) in the U.S. and Latin America (Mexico and Colombia). Design: Secondary data analysis of two cohorts. Cohort 1: English-speaking caregivers of adults with TBI in the U.S. (n = 80). Cohort 2: Spanish-speaking caregivers of adults with TBI in Mexico or Colombia (n = 109). Results: Similarities between the U.S. and Latin American caregiver groups, respectively, were: predominantly women (81.3%, 81.7%, respectively); spouses/domestic partners (45%, 31.2%); and motor vehicle accident (41.5%, 48.6%) followed by fall etiologies (40%, 21.1%). Differences between U.S. and Latin American caregivers were: age (49.5 years, 41.5 years, p < 0.001); employment status ((Χ52 = 59.63, p < 0.001), full-time employment (63.7%, 25.7%), homemaker (2.5%, 31.2%), and retired (17.5%, 1.8%)); violence-related etiology (2.5%, 15.6%); and severity of depressive symptoms (M = 7.9, SD = 5.8; M = 5.8, SD = 5.7; p = 0.014). Conclusions: TBI caregivers in the U.S. were older and employed full-time or retired more often than those in Latin America. Violence-related etiology was nearly five times more common in Latin America, raising concerns for potential implications of post-traumatic stress and family adjustment after injury. Although both groups likely could use mental health support, this was particularly true of the U.S. cohort, maybe due to differential demographics, mechanisms of injury, or family and community support.
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Affiliation(s)
- Shannon B. Juengst
- Department of Physical Medicine & Rehabilitation, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA; (S.H.); (B.W.)
- TIRR Memorial Hermann Brain Injury Research Center, Houston, TX 77030, USA
- Department of Physical Medicine & Rehabilitation, UT Health Sciences Center at Houston, Houston, TX 77030, USA
| | - Paul B. Perrin
- Department of Psychology, Virginia Commonwealth University, Richmond, VA 23284, USA;
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, VA 23284, USA
- Central Virginia Veterans Affairs Health Care System, Richmond, VA 23249, USA;
| | - Daniel W. Klyce
- Central Virginia Veterans Affairs Health Care System, Richmond, VA 23249, USA;
- Virginia Commonwealth University Health System, Richmond, VA 23284, USA
- Sheltering Arms Institute, Richmond, VA 23233, USA
| | - Therese M. O’Neil-Pirozzi
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Boston, MA 02129, USA;
- Department of Communication Sciences and Disorders, Northeastern University, Boston, MA 02115, USA
| | - Susan Herrera
- Department of Physical Medicine & Rehabilitation, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA; (S.H.); (B.W.)
| | - Brittany Wright
- Department of Physical Medicine & Rehabilitation, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA; (S.H.); (B.W.)
| | - Jean Lengenfelder
- Department of Physical Medicine & Rehabilitation, Rutgers-New Jersey Medical School, Newark, NJ 07101, USA;
- Kessler Foundation, East Hanover, NJ 07936, USA
| | - Kirk Lercher
- Department of Physical Medicine & Rehabilitation, JFK Johnson Rehabilitation Institute, Hackensack Meridian Health, Edison, NJ 08820, USA;
| | - Librada Callender
- Baylor Scott & White Institute for Rehabilitation, Dallas, TX 75246, USA;
| | - Juan Carlos Arango-Lasprilla
- BioCruces Bizkaia Health Research Institute, 48903 Barakaldo, Spain;
- IKERBASQUE, Basque Foundation for Science, 48009 Bilbao, Spain
- Department of Cell Biology and Histology, University of the Basque Country, 48940 Leioa, Spain
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9
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Tekin S, Glover N, Greene T, Lamb D, Murphy D, Billings J. Experiences and views of frontline healthcare workers' family members in the UK during the COVID-19 pandemic: a qualitative study. Eur J Psychotraumatol 2022; 13:2057166. [PMID: 35432783 PMCID: PMC9009898 DOI: 10.1080/20008198.2022.2057166] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND The COVID-19 pandemic has had a well-documented negative impact on the mental health and wellbeing of frontline healthcare workers (HCWs). Whilst no research has to date been carried out to explore the challenges experienced by the families of HCWs, some previous research has been conducted with military families, demonstrating that family members of deployed military personnel may also be affected seriously and negatively. OBJECTIVES This study aimed to explore the experiences, views, and mental health impact on frontline HCWs' families during the COVID-19 pandemic in the UK and what support the families of frontline HCWs may need. METHOD Close family members and friends of HCWs were interviewed. Transcripts were analysed in line with the principles of reflexive thematic analysis. RESULTS We completed fourteen interviews with three siblings, one mother, one friend, and nine spouses of HCWs. Family members were highly motivated to support healthcare workers and felt an intense sense of pride in their work. However, they also experienced increased domestic responsibilities and emotional burden due to anxiety about their loved ones' work. The fact that sacrifices made by family members were not noticed by society, the anxiety they felt about their family's physical health, the impact of hearing about traumatic experiences, and the failure of healthcare organisations to meet the needs of the HCWs all negatively affected the family members. CONCLUSIONS We have an ethical responsibility to attend to the experiences and needs of the families of healthcare professionals. This study emphasises the experiences and needs of family members of healthcare professionals, which have hitherto been missing from the literature. Further research is needed to hear from more parents, siblings and friends, partners in same sex relationships, as well as children of HCWs, to explore the variety of family members and supporters' experiences more fully. HIGHLIGHTS • COVID19 has impacted families of HCWs as well as workers themselves. They have experienced more anxiety, increased practical burden, significant physical health risks and been exposed vicariously to workers' traumatic experiences. We must ensure HCW families are better supported.
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Affiliation(s)
- Sahra Tekin
- Division of Psychiatry, University College London, London, UK
| | - Naomi Glover
- Division of Psychiatry, University College London, London, UK
| | - Talya Greene
- Department of Community Mental Health, University of Haifa, Haifa, Israel
| | - Dannielle Lamb
- Department of Applied Health Research, University College London, London, UK
| | - Dominic Murphy
- Combat Stress, Tyrwhitt House, Leatherhead, UK.,The King's Centre for Military Health Research, King's College London, London, UK
| | - Jo Billings
- Division of Psychiatry, University College London, London, UK
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10
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Tsur N, Haller CS. Self-Rated Health Among Patients With Severe Traumatic Brain Injury and Their Close Relatives: The Role of Posttraumatic Stress Symptoms. Psychosom Med 2021; 83:449-456. [PMID: 33883538 DOI: 10.1097/psy.0000000000000946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Severe traumatic brain injury (sTBI) is accompanied by significant declines in self-rated health (SRH). Although such deteriorations in SRH are related to various consequences of sTBI, the effect of posttraumatic reactions (i.e., posttraumatic stress [PTS] symptoms) has been tested insufficiently to date, especially among civilians. The present investigation is based on Trajectories of Recovery After Severe Traumatic brain injury-Matters In families (TRAST-MI), a unique study among civilians with sTBI and their families. Previous research revealed that civilian sTBI has effects beyond the injured patient, influencing their close relatives as well. The aim of this study was to assess the association between PTS symptoms and SRH among patients with civilian sTBI and their close relatives. METHODS Patients with sTBI (assessed by an Abbreviated Injury Scale of the head region score >3) and their close relatives participated in TRAST-MI. One hundred twenty-six patient-relative dyads were assessed at 3, 6, and 12 months after the injury. RESULTS Multilevel modeling revealed that patients' PTS symptoms were associated with consequent SRH (slope = 0.42; p < .001), and relatives' PTS symptoms were associated with their respective SRH (slope = 0.2; p = .012). CONCLUSIONS The findings of this study reveal that SRH of both patients with sTBI and their relatives are negatively affected by their own PTS symptoms. These findings underline the understanding that sTBI is not merely a medical trauma but rather a comprehensive psychosocial trauma, which has consequences for the whole family system.
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Affiliation(s)
- Noga Tsur
- From the Bob Shapell School of Social Work (Tsur), Tel Aviv University, Tel Aviv, Israel; Department of Psychology (Haller), Harvard University, Cambridge; Division of Public Psychiatry, Massachusetts Mental Health Center (Haller), Harvard Medical School, Boston; and Cognicreate LLC (Haller), Cambridge, Massachusetts
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11
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Carlozzi NE, Lange RT, Kallen MA, Boileau NR, Sander AM, Massengale JP, Nakase-Richardson R, Tulsky D, French LM, Hahn EA, Ianni PA, Miner JA, Hanks R, Brickell TA. Assessing vigilance in caregivers after traumatic brain injury: TBI-CareQOL Caregiver Vigilance. Rehabil Psychol 2020; 65:418-431. [PMID: 31971432 PMCID: PMC7375946 DOI: 10.1037/rep0000302] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
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).
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Affiliation(s)
- Noelle E. Carlozzi
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI
| | - Rael T. Lange
- Defense and Veterans Brain Injury Center, Walter Reed National Military Medical Center, Bethesda, MD
- National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Michael A. Kallen
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Nicholas R. Boileau
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI
| | - Angelle M. Sander
- H. Ben Taub Department of Physical Medicine and Rehabilitation, Baylor College of Medicine/Harris Health System, Houston, TX
- Brain Injury Research Center, TIRR Memorial Hermann, Houston, TX
| | | | - Risa Nakase-Richardson
- MHBS, James A. Haley Veterans’ Hospital, Tampa, FL
- Defense and Veterans Brain Injury Center, James A. Haley Veterans’ Hospital, Tampa, FL
- Department of Internal Medicine, Morsani College of Medicine, University of South Florida, Tampa, FL
| | - David Tulsky
- Center for Health Assessment Research and Translation, and Departments of Physical Therapy and Psychological Brain Sciences, University of Delaware, Newark, DE
| | - Louis M. French
- Defense and Veterans Brain Injury Center, Walter Reed National Military Medical Center, Bethesda, MD
- National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD
- Uniformed Services University of the Health Sciences, Bethesda, MD
| | - Elizabeth A. Hahn
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Phillip A. Ianni
- Michigan Institute for Clinical and Health Research, University of Michigan, Ann Arbor, MI
| | - Jennifer A. Miner
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI
| | - Robin Hanks
- Department of Psychology and Neuropsychology, Rehabilitation Institute of Michigan, Detroit, MI
- Department of Physical Medicine and Rehabilitation, Wayne State University, Detroit, MI
| | - Tracey A. Brickell
- Defense and Veterans Brain Injury Center, Walter Reed National Military Medical Center, Bethesda, MD
- National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD
- Uniformed Services University of the Health Sciences, Bethesda, MD
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12
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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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13
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Zamir O, Gewirtz AH, Cheng CH, Zhang N, Lavee Y. Psychological distress and communication quality in military couples after deployment to war. JOURNAL OF FAMILY PSYCHOLOGY : JFP : JOURNAL OF THE DIVISION OF FAMILY PSYCHOLOGY OF THE AMERICAN PSYCHOLOGICAL ASSOCIATION (DIVISION 43) 2020; 34:383-391. [PMID: 31424234 PMCID: PMC8869849 DOI: 10.1037/fam0000589] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
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).
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Affiliation(s)
- Osnat Zamir
- Paul Baerwald School of Social Work and Social Welfare
| | | | | | - Na Zhang
- Department of Family Social Science
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14
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Tsur N, Haller CS. Physical and Mental Health and Functioning Among Traumatic Brain Injury Close Relatives: The Role of Posttraumatic Stress Symptoms. FAMILY PROCESS 2020; 59:666-680. [PMID: 31013369 DOI: 10.1111/famp.12454] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Severe Traumatic brain injury (sTBI) often instigates widespread long-lasting disability and is accompanied by extensive rehabilitation. Unsurprisingly, sTBI also holds malignant consequences for patients' close relatives. The burden caused by the injury and its severity explains some of the ramifications for the relatives. Additionally, some findings demonstrate that patients with sTBI and their relatives develop posttraumatic stress (PTS) symptoms. However, although the link between PTS symptoms and physical and mental health is well-documented in literature, the effect of PTS symptoms on relatives of patients with sTBI has barely been examined. This study examines the influence of PTS symptoms of patients with sTBI and their relatives on the physical and mental health and functioning of the relatives. Patients who sustained a severe sTBI (Abbreviated Injury Scale of the head region > 3) and close relatives were included in a multi-center, prospective cohort study (TRAST-MI). One-hundred patients and their relatives were assessed at 2, 6, and 12 months post injury. Outcome variables included health-related quality of life (SF-12) as well as emotional, cognitive, interpersonal, and total functioning (PCRS). Relatives' physical health was predicted by relatives' PTS symptoms (Slope=-1.76; p = .043), and mental health was predicted by both patients' (Slope=-2.77; p = .034) and relatives' (Slope=-6.59; p < .001) PTS symptoms. Functioning level was only predicted by patients' PTS symptoms (Slope=-.25; p< .001). The findings emphasize that TBI should be considered a comprehensive traumatic experience reaching further than mere physical damage to the brain and its direct consequences, affecting the injured individual and close relatives.
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Affiliation(s)
- Noga Tsur
- Bob Shapell School of Social Work, Tel Aviv University, Tel Aviv, Israel
| | - Chiara S Haller
- Department of Psychology, Harvard University, Cambridge, MA
- Division of Public Psychiatry, Massachusetts Mental Health Center, Harvard Medical School, Boston, MA
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15
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Cohen A, Dan O, Asraf K, Haimov I. The Sleepiness Curve of Young Men With and Without Attention-Deficit Hyperactivity Disorder (ADHD). Behav Sleep Med 2020; 18:321-333. [PMID: 30806088 DOI: 10.1080/15402002.2019.1583564] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Objectives: The present study aimed at comparing the sleepiness curve of young men with attention-deficit hyperactivity disorder (ADHD) to that of young men without ADHD before, during, and after a night of sleep deprivation. Participants: Thirty young men (age 18-30) of whom 14 were diagnosed with ADHD combined type (ADHD-C) and 16 without ADHD. Methods: The participants' sleep was monitored for 5 days via actigraphy. Subsequently, the participants were kept continuously awake in a controlled environment for 25 hr (8:00 a.m.-9:00 a.m.). The sleepiness of the participants was assessed every hour by the Karolinska Sleepiness Scale (KSS) in order to obtain the sleepiness curve of both study groups. Results: Actigraphy data demonstrated that the two groups did not differ in their total sleep time, sleep onset latency, or sleep efficiency during the 5 nights preceding the experimental session. However, during the experimental session, the ADHD group demonstrated higher sleepiness scores, particularly following midnight and on the morning following the night of sleep deprivation. Moreover, on the morning following sleep deprivation the proportion of participants reporting extreme levels of sleepiness (KSS > 7) was significantly higher in the ADHD group than in the control group. Conclusions: Young men with ADHD suffer from sleepiness more than their counterparts from the general population, and are particularly vulnerable to the effects of sleep deprivation on sleepiness. As excessive daytime sleepiness negatively affects cognition and increases the risk for motor vehicle crash and other accidents, these findings may have important clinical implications.
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Affiliation(s)
- Ami Cohen
- Psychology Department, The Center for Psychobiological Research, The Max Stern Yezreel Valley College, Emek Yezreel, Israel
| | - Ori Dan
- Psychology Department, The Center for Psychobiological Research, The Max Stern Yezreel Valley College, Emek Yezreel, Israel
| | - Kfir Asraf
- Psychology Department, The Center for Psychobiological Research, The Max Stern Yezreel Valley College, Emek Yezreel, Israel
| | - Iris Haimov
- Psychology Department, The Center for Psychobiological Research, The Max Stern Yezreel Valley College, Emek Yezreel, Israel
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16
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Moore C, Baharikhoob P, Khodadadi M, Tator CH. Bicycling-related concussions leading to postconcussion syndrome in adults. BMJ Open Sport Exerc Med 2020; 6:e000746. [PMID: 32341802 PMCID: PMC7173986 DOI: 10.1136/bmjsem-2020-000746] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/15/2020] [Indexed: 12/29/2022] Open
Abstract
Background Concussions among adult bicyclists are common, but little is known about the long-term effects of the consequences of these concussions such as postconcussion syndrome (PCS) including its occurrence, clinical features and recovery potential. Indeed, our study is the first to examine PCS due to bicycling in any age group. Objectives We examined patient demographics, concussion mechanisms and persistent symptoms as factors leading to PCS in adults and the potential for recovery. Methods We conducted a retrospective chart review of 28 patients age 18 or older who sustained a concussion while bicycling and were referred to the Canadian Concussion Centre for management of PCS. Results Eighteen patients (64.3%) fell from their bicycles due to loss of control, attempts to avoid a crash or collision with an object. Eight patients (28.6%) were struck by a motor vehicle, and two patients (7.1%) were injured by collision with another bicycle. The mean duration of PCS was 23.7 months and at the time of the last follow-up, 23 (82.1%) patients had failed to recover completely. Patients with one or more previous concussions had a significantly longer duration of PCS (p=0.042). Bicycling concussions resulted in a greater mean duration of PCS (23.7 months) than a comparison group of patients with PCS due to collision sports (16.1 months) (p=0.07). Conclusion Adults who sustain bicycling-related concussions and develop PCS often have long-lasting symptoms; greater attention should be given to prevention strategies such as improved bicycling infrastructure and safer bicycling practices to reduce concussions in adult bicyclists.
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Affiliation(s)
- Connor Moore
- Canadian Concussion Centre, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Paria Baharikhoob
- Canadian Concussion Centre, Toronto Western Hospital, Toronto, Ontario, Canada.,Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Mozhgan Khodadadi
- Canadian Concussion Centre, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Charles H Tator
- Canadian Concussion Centre, Toronto Western Hospital, Toronto, Ontario, Canada.,Division of Neurosurgery, Toronto Western Hospital and University of Toronto, Toronto, Ontario, Canada
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17
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Turgoose D, Murphy D. A systematic review of interventions for supporting partners of military Veterans with PTSD. JOURNAL OF MILITARY VETERAN AND FAMILY HEALTH 2019. [DOI: 10.3138/jmvfh.2018-0035] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Introduction: Partners of military Veterans with post-traumatic stress disorder (PTSD) and other mental health difficulties can themselves develop difficulties with stress, well-being, and secondary trauma. Various interventions exist which involve partners of military personnel, but very few with an explicit focus on the partners’ well-being. This article aims to conduct a systematic review of these interventions and outline the range of interventions and the outcomes measured. Methods: We conducted a systematic literature search, from which 25 papers were reviewed. Papers were included if they described any form of intervention in which a partner was involved, where the Veteran was described as having PTSD, and where the aim of the intervention was aimed at least partly at improving the well-being of partners. Results: We found various types of interventions, such as group-based interventions, residential retreats, couples therapies, Internet-based interventions, and family-based interventions. Of the 25 studies reviewed, 21 reported on well-being outcomes, either via randomized controlled trials (RCTs), evaluations, or case studies. In most cases, interventions reported improvements in the well-being of partners, although there were very few controlled studies. Only a small number of interventions were aimed solely at partners. The most common feature of interventions was psychoeducation on topics such as communication, problem solving, and emotion regulation. Many papers described the advantages of group processes such as social support and normalization, gained from partners sharing experiences with one another. Discussion: A wide range of formats exist of interventions for improving the well-being of military partners. The literature would benefit from more robust experimental research into their effectiveness, and exploration of interventions aimed directly at the well-being of partners.
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Affiliation(s)
- David Turgoose
- Department of Psychology, University of Roehampton, Whitelands College, London, United Kingdom
| | - Dominic Murphy
- Combat Stress, Psychology, Tyrwhitt House, Leatherhead, Surrey, United Kingdom of Great Britain and Northern Ireland
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18
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Lahav Y, Price N, Crompton L, Laufer A, Solomon Z. Sexual Satisfaction in Spouses of Ex-POWs: The Role of PTSD Symptoms and Self-Differentiation. JOURNAL OF SEX & MARITAL THERAPY 2019; 45:755-766. [PMID: 30924723 DOI: 10.1080/0092623x.2019.1594478] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Spouses of former prisoners-of-war (ex-POWs) are at risk for posttraumatic stress symptoms (PTSS) and marital distress. This study assessed the implications of PTSS and self-differentiation for sexual satisfaction among 90 ex-POWs' spouses and 75 matched combatants' spouses from the 1973 Yom Kippur War. Standardized questionnaires were used. Ex-POWs' spouses had elevated PTSS and imbalanced self-differentiation. PTSS were associated with poorer self-differentiation and lower sexual satisfaction. Imbalanced self-differentiation mediated the association between PTSS and sexual satisfaction. The findings imply that PTSS and imbalanced self-differentiation contribute to low sexual satisfaction among spouses of primary trauma survivors.
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Affiliation(s)
- Yael Lahav
- Bob Shapell School of Social Work, Tel Aviv University , Tel Aviv, Israel
- I-CORE Research Center for Mass Trauma, Tel Aviv University , Tel Aviv, Israel
| | - Naomi Price
- Bob Shapell School of Social Work, Tel Aviv University , Tel Aviv, Israel
| | - Laura Crompton
- Bob Shapell School of Social Work, Tel Aviv University , Tel Aviv, Israel
- I-CORE Research Center for Mass Trauma, Tel Aviv University , Tel Aviv, Israel
| | - Avital Laufer
- School of Behavioral Sciences, Netanya Academic College , Netanya, Israel
| | - Zahava Solomon
- Bob Shapell School of Social Work, Tel Aviv University , Tel Aviv, Israel
- I-CORE Research Center for Mass Trauma, Tel Aviv University , Tel Aviv, Israel
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19
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Doncaster E, Hiskey S, McPherson S, Andrews L. "I'm Still Fighting for the Two of Us": How Partners of UK Veterans Construct Their Experience of Living with Combat-Related Trauma. JOURNAL OF MARITAL AND FAMILY THERAPY 2019; 45:464-479. [PMID: 29876957 DOI: 10.1111/jmft.12340] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
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.
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Affiliation(s)
| | - Syd Hiskey
- Essex Partnership University NHS Foundation Trust
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20
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Abstract
OBJECTIVES Much is known about adult children caring for their aging parents, yet the potentially unique experience of offspring caring for traumatized parents is underexplored. Therefore, the current studies assessed filial anxiety and sense of obligation among offspring of Holocaust survivors (OHS) in caring for their parents. METHOD In Study 1, we interviewed 10 OHS (mean age = 61.0) in order to extract themes of filial anxiety. Based on Study 1's data, a newly constructed scale of filial anxiety was administered in Study 2 to 59 adult offspring (mean age = 56.4): 28 OHS and 31 comparisons. Study 3 included 143 dyads of parents and offspring (mean age = 55.4 and 81.7, respectively): 86 Holocaust dyads and 57 comparison dyads. Parents reported posttraumatic stress disorder (PTSD) symptoms and offspring reported filial anxiety and sense of obligation. RESULTS In Study 1, interviewees referred to concerns about parent experiencing decline alongside caregiving difficulties. In Study 2, OHS reported higher filial anxiety and sense of obligation relative to comparisons. This group difference was mediated by sense of obligation. In Study 3, OHS with parental PTSD reported higher filial anxiety and sense of obligation relative to comparisons. Once more, filial sense of obligation served as a mediator. In Studies 2-3, results remained significant after adjusting for offspring symptoms. CONCLUSION Parental exposure to the Holocaust, and especially parental PTSD, related to higher filial obligation, which in turn was related to higher filial anxiety. These findings bear important implications for practitioners working with survivors' families.
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Affiliation(s)
- Amit Shrira
- a The Interdisciplinary Department of Social Sciences , Bar-Ilan University , Israel
| | - Ravit Menashe
- b Department of Criminology , Bar-Ilan University , Israel
| | - Moshe Bensimon
- b Department of Criminology , Bar-Ilan University , Israel
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21
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Stadtmann MP, Maercker A, Binder J, Schnepp W. Mastering life together - symptom management, views, and experiences of relatives of persons with CPTSD: a grounded theory study. J Patient Rep Outcomes 2018. [PMCID: PMC6195499 DOI: 10.1186/s41687-018-0070-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background Complex posttraumatic stress disorder is described as a chronic condition with several severe and concurrent symptoms. Symptoms influence and impair not only the affected individuals but also their social surroundings and their relatives. The literature describes relatives as a key factor in managing symptoms, both as a barrier and a facilitator. Aim This research aimed to explore and to reconstruct the views, perceptions, experiences, facilitations and barriers of relatives who support the symptom management of persons with CPTSD in everyday life. Methods A theoretical sampling was used to recruit for an interview 18- to 65-year-old relatives of patients with diagnosed CPTSD. The 17 semi-structured interviews were audio-recorded and transcribed verbatim. The transcriptions were uploaded into MAXQDA, and a Grounded Theory method based on that of Corbin and Strauss was used to analyse the data. Results We provide a process model with 5 interacting phases: the initial situation, state of permanence, being an anchor, recognizing limits, and potential outcomes. Each phase is further divided into subcategories. Discussion Participants experienced their condition as unpredictable. Although they mastered different strategies through own exploration and in cooperation, there is a clear need for more education, advice and support for relatives caring for those affected by CPTSD. Health care services should consider providing family support, educational services and increase the involvement of relatives in treatment. Over all, well-supported relatives can play a facilitative, key role in improving symptom management. Trial registration Ethical approval was obtained from the Swiss Cantonal Ethic Commission (Nr 201,500,096). This research was also registered at the World Health Organization Clinical Trials Search Portal through the German Clinical Trial Register, Trial DRKS00012268.
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22
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Crane AL, Bairos-Novak KR, Sacco LH, Ferrari MCO. The socially mediated recovery of a fearful fish paired with periodically replaced calm models. Proc Biol Sci 2018; 285:20180739. [PMID: 30282647 PMCID: PMC6191702 DOI: 10.1098/rspb.2018.0739] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Accepted: 09/11/2018] [Indexed: 12/28/2022] Open
Abstract
Social learning is an important mechanism for acquiring knowledge about environmental risk. However, little work has explored the learning of safety and how such learning outcomes are shaped by the social environment. Here, we exposed minnows, Pimephales promelas, to a high-risk environment to induce behavioural responses associated with fear (e.g. neophobia). We then used the presence of calm conspecific models (low-risk individuals) to weaken these responses. When observers (individuals from the high-risk environment) and models were paired consistently in a one-on-one setting, the observers showed no recovery (i.e. no weakening of the fear responses), and instead the models indirectly acquired those responses (i.e. a socially transmitted state of fear). However, observers paired with models that were periodically replaced with new calm models showed a significant recovery, and each new model showed diminished socially transmitted fear. We argue that our understanding of predation-related fear and social information transfer can prove fruitful in understanding problems with fear and stress across animal taxa, including among humans who experience post-traumatic stress and secondary trauma. Our findings indicate that the periodic replacement of models can promote fear recovery in observers and reduce socially transmitted fear in models.
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Affiliation(s)
- Adam L Crane
- Department of Biology, University of Saskatchewan, 112 Science Place, Saskatoon, SK, Canada S7N 5E2
| | - Kevin R Bairos-Novak
- Department of Biology, University of Saskatchewan, 112 Science Place, Saskatoon, SK, Canada S7N 5E2
| | - Laurel H Sacco
- Department of Biology, University of Saskatchewan, 112 Science Place, Saskatoon, SK, Canada S7N 5E2
| | - Maud C O Ferrari
- Department of Veterinary Biomedical Sciences, University of Saskatchewan, 52 Campus Drive, Saskatoon, SK, Canada S7N 5B4
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23
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Mantell A, Simpson GK, Vungkhanching M, Jones KF, Strandberg T, Simonson P. Social work-generated evidence in traumatic brain injury from 1975 to 2014: A systematic scoping review. HEALTH & SOCIAL CARE IN THE COMMUNITY 2018; 26:433-448. [PMID: 28795463 DOI: 10.1111/hsc.12476] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/19/2017] [Indexed: 06/07/2023]
Abstract
The International Network for Social Workers in Acquired Brain Injury (INSWABI) commissioned a systematic scoping review to ascertain the social work-generated evidence base on people with traumatic brain injury (TBI) of working age. The review aimed to identify the output, impact and quality of publications authored by social workers on this topic. Study quality was evaluated through assessment frameworks drawn from the United Kingdom National Service Framework for Long-Term Conditions. In the 40-year period from 1975 to 2014, 115 items were published that met the search criteria (intervention studies, n = 10; observational studies, n = 52; literature reviews, n = 6; expert opinion or policy analysis, n = 39; and others, n = 8). The publications could be grouped into five major fields of practice: families, social inclusion, military, inequalities and psychological adjustment. There was a significant increase in the number of publications over each decade. Impact was demonstrated in that the great majority of publications had been cited at least once (80.6%, 103/115). Articles published in rehabilitation journals were cited significantly more often than articles published in social work journals. A significant improvement in publication quality was observed across the four decades, with the majority of studies in the last decade rated as high quality.
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Affiliation(s)
- Andy Mantell
- School of Health and Social Care, London South Bank University, London, UK
| | - Grahame Kenneth Simpson
- Brain Injury Rehabilitation Research Group, Ingham Institute of Applied Medical Research, Sydney, Australia
- Liverpool Brain Injury Rehabilitation Unit, Liverpool Hospital, Sydney, Australia
| | - Martha Vungkhanching
- Department of Social Work Education, California State University, Fresno, CA, USA
| | | | - Thomas Strandberg
- The Swedish Institute for Disability Research, Örebro University, Örebro, Sweden
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Moriarty H, Winter L, Short TH, True G. Exploration of Factors Related to Depressive Symptomatology in Family Members of Military Veterans With Traumatic Brain Injury. JOURNAL OF FAMILY NURSING 2018; 24:184-216. [PMID: 29848196 DOI: 10.1177/1074840718773470] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
Traumatic brain injury (TBI) is a family affair, affecting those with the injury and their families. Psychological distress, often measured as depression or depressive symptoms, is highly prevalent among family members. Predictors of depression in family members of civilians with TBI have been examined, but predictors of depression in family members of military veterans have received very little research attention and are poorly understood. To address the knowledge gap, this study explored factors related to depressive symptoms in family members of veterans in the United States, using an ecological framework. Baseline data from 83 family members were used. Family members with higher caregiver burden, presence of a veteran with posttraumatic stress disorder (PTSD), and greater financial difficulty experienced significantly more depressive symptoms. Findings suggest that efforts to support family members and decrease their depression should aim to reduce caregiver burden and financial difficulty, and help family members cope with veteran PTSD and TBI. Family-focused interventions are needed.
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Affiliation(s)
- Helene Moriarty
- 1 Villanova University, Villanova, PA, USA
- 2 Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, PA, USA
| | - Laraine Winter
- 2 Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, PA, USA
| | | | - Gala True
- 4 Tulane University, New Orleans, Louisiana, USA
- 5 South Central Mental Illness Research, Education and Clinical Center, Southeast Louisiana Veterans Health Care System, New Orleans, Louisiana, USA
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Ruhlmann LM, Gallus KL, Beck AR, Goff BSN, Durtschi JA. A Pilot Study Exploring PTSD Symptom Clusters as Mediators between Trauma Exposure and Attachment Behaviors in Married Adults. JOURNAL OF COUPLE & RELATIONSHIP THERAPY-INNOVATIONS IN CLINICAL AND EDUCATIONAL INTERVENTIONS 2017. [DOI: 10.1080/15332691.2017.1399848] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Lauren M. Ruhlmann
- School of Family Studies and Human Services, Kansas State University, Manhattan, Kansas, United States
| | - Kami L. Gallus
- Human Development and Family Science, Oklahoma State University, Stillwater, Oklahoma, United States
| | - Austin R. Beck
- School of Family Studies and Human Services, Kansas State University, Manhattan, Kansas, United States
| | - Briana S. Nelson Goff
- School of Family Studies and Human Services, Kansas State University, FSHS, Manhattan, Kansas, United States
| | - Jared A. Durtschi
- School of Family Studies and Human Services, Kansas State University, Family Studies and Human Services, Manhattan, Kansas, United States
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Hershkowitz M, Dekel R, Fridkin S, Freedman S. Posttraumatic Stress Disorder, Parenting, and Marital Adjustment among a Civilian Population. Front Psychol 2017; 8:1655. [PMID: 29085311 PMCID: PMC5649139 DOI: 10.3389/fpsyg.2017.01655] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Accepted: 09/08/2017] [Indexed: 11/25/2022] Open
Abstract
While psychopathology in general is linked to poorer marital and parental satisfaction, there is a paucity of data regarding these interactions in parents with Posttraumatic stress disorder (PTSD). The current study addresses this issue among a civilian population. Two hundred trauma-exposed parents, mean age of 37.2, 62% mothers, were assessed using self-report questionnaires, for background variables, PTSD symptoms using the Posttraumatic Stress Diagnostic Scale (PDS), depression symptoms (Beck Depression Inventory, BDI), marital satisfaction (Dyadic Adjustment Scale, DAS-7), parenting behavior (Alabama Parenting Questionnaire, APQ-9), and parenting satisfaction (Parenting Satisfaction Questionnaire). We hypothesized that positive parenting behavior and parenting satisfaction would be negatively correlated with PTSD symptom levels, and that this relationship would be mediated by marital satisfaction; the independent effects of depression on marital and parenting functioning were also examined. Data was analyzed using structural equation modeling (SEM). Results indicated that PTSD was related to poorer parenting behavior (B = 0.089, p = 0.033), depression had a negative impact on parenting satisfaction (B = 0.983, p = 0.003), and marital satisfaction (B = -0.672, p = 0.004), and marital satisfaction fully mediated the relationship between depression and parenting. The findings demonstrated that the effects of PTSD can cast a pall not only over the individual but over the entire family. Interventions are needed to address these issues.
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Affiliation(s)
| | | | | | - Sara Freedman
- School of Social Work, Bar Ilan University, Ramat Gan, Israel
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Lahav Y, Levin Y, Bensimon M, Kanat-Maymon Y, Solomon Z. Secondary Traumatization and Differentiation Among the Wives of Former POWs: A Reciprocal Association. J Trauma Stress 2017; 30:399-408. [PMID: 28696563 DOI: 10.1002/jts.22204] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Revised: 04/03/2017] [Accepted: 04/10/2017] [Indexed: 11/11/2022]
Abstract
Repercussions of war captivity may transmit to spouses of former prisoners of war (POW) via posttraumatic stress symptoms (PTSS). Overidentification with their partners underlies the PTSS experienced by former wives of POWs, thus implying impaired self-differentiation. Although wives' indirect exposure to their husbands' captivity and subsequent PTSS has been associated with the wives' PTSS and differentiation, the combined effects remain unclear. Furthermore, previous cross-sectional studies could not illuminate directionality. This prospective study investigates (a) the moderating role of indirect exposure to captivity in the association between husbands' PTSS and wives' PTSS and differentiation; and (b) the directionality of the association between wives' differentiation and PTSS over time. The wives of both former POWs (n = 143) and combatants (n = 102) were assessed 30 (T1) and 38 (T2) years after the 1973 Yom Kippur War. The wives of former POWs endorsed higher PTSS and fusion differentiation, η2p = .06 to .14. Indirect exposure to captivity moderated the associations between husbands' PTSS and wives' PTSS, Cohen's f2 = .01 to .03. The association between the wives' differentiation and PTSS over time was bidirectional, β = -0.18 to 0.68; R2 = .54 to .73. Results suggest a vicious cycle between PTSS and differentiation, and the need for clinical interventions that further differentiation for spouses of prolonged trauma victims.
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Affiliation(s)
- Yael Lahav
- University of Southern Denmark, Department of Psychology, Odense, Denmark.,I-Core Research Center for Mass Trauma, Bob Shapell School of Social Work, Tel-Aviv University, Tel-Aviv, Israel
| | - Yafit Levin
- I-Core Research Center for Mass Trauma, Bob Shapell School of Social Work, Tel-Aviv University, Tel-Aviv, Israel
| | - Moshe Bensimon
- Department of Criminology, Bar-Ilan University, Ramat-Gan, Israel
| | | | - Zahava Solomon
- I-Core Research Center for Mass Trauma, Bob Shapell School of Social Work, Tel-Aviv University, Tel-Aviv, Israel
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The Roles of Fathers' Posttraumatic Stress Symptoms and Adult Offspring's Differentiation of the Self in the Intergenerational Transmission of Captivity Trauma. J Clin Psychol 2017; 73:848-863. [DOI: 10.1002/jclp.22377] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Revised: 05/28/2016] [Accepted: 08/14/2016] [Indexed: 11/07/2022]
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Monk JK, Oseland LM, Nelson Goff BS, Ogolsky BG, Summers K. Integrative Intensive Retreats for Veteran Couples and Families: A Pilot Study Assessing Change in Relationship Adjustment, Posttraumatic Growth, and Trauma Symptoms. JOURNAL OF MARITAL AND FAMILY THERAPY 2017; 43:448-462. [PMID: 28394016 DOI: 10.1111/jmft.12230] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
We assessed a brief, systemic retreat-style intervention that was developed to address concerns about the utilization of services for veterans coping with traumatic stress. A total of 76 dyads (N = 152) were assessed before and after a 4-day retreat, which included psychoeducation, group and conjoint therapeutic sessions, and recreational relaxation components. Overall, participants reported a reduction in trauma symptoms, but only support persons experienced a significant increase in posttraumatic growth from pretest to posttest. Both veterans and their romantic partners reported an increase in relationship adjustment after the retreat. Opportunities to address the needs of this population by removing barriers to treatment and reducing feelings of isolation, as well as implications for similar treatments are discussed.
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Winter L, Moriarty HJ. Quality of relationship between veterans with traumatic brain injury and their family members. Brain Inj 2017; 31:493-501. [PMID: 28340316 DOI: 10.1080/02699052.2017.1283534] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVES The quality of the relationship between patients with many illnesses and their family members has been shown to affect the well-being of both. Yet, relationship quality has not been studied in traumatic brain injury (TBI), and giving and receiving aspects have not been distinguished. The present study of veterans with TBI examined associations between relationship quality and caregiver burden, satisfaction with caregiving, and veterans' competence in interpersonal functioning, rated by veterans and family members. METHOD In this cross-sectional study, 83 veterans and their family members were interviewed at home. Measures of quality of relationship, veterans' interpersonal competence and sociodemographics were collected for both, caregiver burden and satisfaction for family members only. RESULTS As predicted, veteran-rated Qrel/Giving was associated with family-rated Qrel/Receiving, and veteran-rated Qrel/Receiving with family-rated Qrel/Giving. Lower caregiver burden and higher caregiving satisfaction were associated with higher Qrel/Receiving scores but not with Qrel/Giving scores. Veterans' interpersonal competence was associated with total Qrel as rated by either veterans or family members. CONCLUSIONS Relationship quality should be included in family research in TBI, and giving and receiving aspects should be differentiated. Findings suggest that lower caregiver burden and greater satisfaction should be more achievable by increasing caregivers' sense of benefits received from the relationship.
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Affiliation(s)
- Laraine Winter
- a Nursing Service, Corporal Michael J. Crescenz Veterans Affairs Medical Center , Philadelphia , PA , USA.,b Philadelphia Research and Education Foundation, Corporal Michael J. Crescenz Veterans Affairs Medical Center , Philadelphia , PA , USA
| | - Helene J Moriarty
- a Nursing Service, Corporal Michael J. Crescenz Veterans Affairs Medical Center , Philadelphia , PA , USA.,c Villanova University, College of Nursing , Villanova , PA , USA
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Silove DM, Tay AK, Steel Z, Tam N, Soares Z, Soares C, Dos Reis N, Alves A, Rees S. Symptoms of post-traumatic stress disorder, severe psychological distress, explosive anger and grief amongst partners of survivors of high levels of trauma in post-conflict Timor-Leste. Psychol Med 2017; 47:149-159. [PMID: 27682000 DOI: 10.1017/s0033291716002233] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Little is known about the mental health of partners of survivors of high levels of trauma in post-conflict countries. METHOD We studied 677 spouse dyads (n = 1354) drawn from a community survey (response 82.4%) in post-conflict Timor-Leste. We used culturally adapted measures of post-traumatic stress disorder (PTSD), psychological distress, explosive anger and grief. RESULTS Latent class analysis identified three classes of couples: class 1, comprising women with higher trauma events (TEs), men with intermediate TEs (19%); class 2, including men with higher TEs, women with lower TEs (23%); and class 3, comprising couples in which men and women had lower TE exposure (58%) (the reference group). Men and women partners of survivors of higher TE exposure (classes 1 and 2) had increased symptoms of explosive anger and grief compared with the reference class (class 3). Women partners of survivors of higher TE exposure (class 2) had a 20-fold increased rate of PTSD symptoms compared with the reference class, a pattern that was not evident for men living with women exposed to higher levels of trauma (class 1). CONCLUSIONS Men and women living with survivors of higher levels of trauma showed an increase in symptoms of grief and explosive anger. The manifold higher rate of PTSD symptoms amongst women living with men exposed to high levels of trauma requires replication. It is important to assess the mental health of partners when treating survivors of high levels of trauma in post-conflict settings.
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Affiliation(s)
- D M Silove
- Academic Mental Health Unit and Ingham Institute,University of New South Wales and South Western Sydney Local Health District,Level 2, Mental Health Centre,Liverpool Hospital,Sydney, NSW 2170,Australia
| | - A K Tay
- Academic Mental Health Unit and Ingham Institute,University of New South Wales and South Western Sydney Local Health District,Level 2, Mental Health Centre,Liverpool Hospital,Sydney, NSW 2170,Australia
| | - Z Steel
- St John of God Richmond Hospital,School of Psychiatry,University of New South Wales,North Richmond,NSW 2754,Australia
| | - N Tam
- Academic Mental Health Unit and Ingham Institute,University of New South Wales and South Western Sydney Local Health District,Level 2, Mental Health Centre,Liverpool Hospital,Sydney, NSW 2170,Australia
| | - Z Soares
- Alola Foundation,Dili, Timor-Leste
| | - C Soares
- Alola Foundation,Dili, Timor-Leste
| | | | - A Alves
- Alola Foundation,Dili, Timor-Leste
| | - S Rees
- Academic Mental Health Unit and Ingham Institute,University of New South Wales and South Western Sydney Local Health District,Level 2, Mental Health Centre,Liverpool Hospital,Sydney, NSW 2170,Australia
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Waddell E, Pulvirenti M, Lawn S. The Lived Experience of Caring for an Australian Military Veteran With Posttraumatic Stress Disorder. QUALITATIVE HEALTH RESEARCH 2016; 26:1603-1613. [PMID: 26329422 DOI: 10.1177/1049732315601398] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
There is limited literature on the experience of caring for an intimate partner with a mental health condition. Posttraumatic stress disorder (PTSD) is a common mental health condition for military veterans; yet, little is known about how partners experience and cope with these caring relationships. Using an interpretive phenomenological approach, we collected data through individual interviews with 20 female partners of male veterans diagnosed with PTSD living in South Australia. We found the emotional features of caring to be directly derived from the strength of commitment these carers had to their relationships. We show that lack of understanding of carers' lives, particularly by health providers and government, has resulted in a sense of social disconnect and invisibility that has contributed to stress and is a barrier to coping. Of vital importance to these carers was that partners of younger veterans should not have to suffer the same experiences.
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Affiliation(s)
| | | | - Sharon Lawn
- Flinders University, South Australia, Australia
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Lahav Y, Stein JY, Solomon Z. Keeping a healthy distance: Self-differentiation and perceived health among ex-prisoners-of-war's wives. J Psychosom Res 2016; 89:61-8. [PMID: 27663112 DOI: 10.1016/j.jpsychores.2016.08.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Revised: 08/17/2016] [Accepted: 08/19/2016] [Indexed: 11/29/2022]
Abstract
OBJECTIVE War captivity may affect spouses of former-prisoners-of-war (ex-POWs) in many ways, including posttraumatic stress symptoms (PTSS) and somatic difficulties manifested in negative perceived health. This is generally known as secondary traumatization. Theory suggests that development of secondary traumatization occurs through the relationship with the primary trauma survivor Figley (1986) , thus implying that the ability to keep balanced emotional distance in the relationship may play a pivotal role. Notwithstanding, the contribution of self-differentiation to secondary somatic disturbances remains largely uninvestigated. The current study fills this gap. METHODS Ex-POWs' wives (n=143) and control former-combatants' wives (n=102), were assessed prospectively 30 (T1) and 38 (T2) years after the 1973 Yom Kippur War. Self-differentiation and PTSS were assessed at both time-points, while perceived health measures were assessed at T2. RESULTS Wives of ex-POWs endorsed higher PTSS, lower self-differentiation and negative perceived health, compared to control wives. Indirect exposure to war captivity was related to low self-differentiation and elevated PTSS, which predicted negative perceived health. Furthermore, self-differentiation characterized by fusion-with-others fully mediated the relation between indirect exposure to war captivity and perceived health, beyond the effects of PTSS as a mechanism. CONCLUSION Results suggest that tendencies towards fusion-with-others within the marital relationship, act as a risk factor not only for psychological distress but also for somatic distress among secondary trauma survivors. Hence, clinical interventions may seek to improve indirect trauma survivor's self-differentiation capacities, thus potentially facilitating the prevention of secondary somatic distress.
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Affiliation(s)
- Yael Lahav
- University of Southern Denmark, Department of Psychology, Odense, Denmark; I-Core Research Center for Mass Trauma, Tel-Aviv University, Israel.
| | - Jacob Y Stein
- I-Core Research Center for Mass Trauma, Tel-Aviv University, Israel; Bob Shapell School of Social Work, Tel-Aviv University, Israel
| | - Zahava Solomon
- I-Core Research Center for Mass Trauma, Tel-Aviv University, Israel; Bob Shapell School of Social Work, Tel-Aviv University, Israel
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Chara PJ, Chara KA. Survivors of a Kamikaze Attack: PTSD and Perceived Adjustment to Civilian Life. Psychol Rep 2016; 99:971-80. [PMID: 17305223 DOI: 10.2466/pr0.99.3.971-980] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
30 survivors of the U.S.S. Emmons ( M age = 81.3 yr., SD = 2.3), which was sunk by kamikaze attacks during World War II, were given an adapted form of the Posttraumatic Stress Disorder Checklist-Civilian and a set of questions regarding the effects of their World War II experiences on seven clusters of 42 interpersonal and personal characteristics (Adjustment Characteristics). Participants were categorized into two groups, those who served on the Emmons at any given time during World War II (Any Service), and those who were serving on the Emmons when it was sunk during the battle for Okinawa (Okinawa). Analyses using Mann-Whitney U tests indicated that the Okinawa group reported higher checklist scores, but the scores were unrelated to 41 of the 42 Adjustment Characteristics. Also, Spearman rank-order correlations were statistically insignificant for all comparisons between checklist scores and Adjustment Characteristic clusters, and the total number of positive responses to the 42 characteristics. In contrast, Mann-Whitney U and chi square analyses comparing the Any Service and Okinawa groups indicated statistically significant differences for 14 Adjustment Characteristics, 4 clusters of those characteristics, and the total number of positive responses: The Okinawa group reported poorer outcomes in each comparison. Many of these differences were among Adjustment Characteristics evocative of the attributes of Lee's Agape love style. The findings suggest that for the survivors of the Emmons, the presence or absence of a traumatic event was a better predictor of adjustment to civilian life than the reported severity of PTSD symptoms.
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Affiliation(s)
- Paul J Chara
- Psychology Department, Northwestern College, 3003 Snelling Avenue North, Saint Paul, MN 55113, USA.
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Abstract
This review addresses how changes in the Diagnostic and Statistical Manual of Mental Disorders (DSM)-5 posttraumatic stress disorder (PTSD) criteria has the potential to affect the care and careers of those who have served in the military, where the diagnosis often determines fitness for duty and veterans' benefits. PTSD criteria changes were intended to integrate new knowledge acquired since previous DSM editions. Many believe the changes will improve diagnosis and treatment, but some worry these could have negative clinical, occupational, and legal consequences. We analyze the changes in classification, trauma definition, symptoms, symptom clusters, and subtypes and possible impacts on the military (e.g., over- and under-diagnosis, "drone" video exposure, subthreshold PTSD, and secondary PTSD). We also discuss critiques and proposals for future changes. Our objectives are to improve the screening, diagnosis, and treatment of those service members who have survived trauma and to improve policies related to the military mental healthcare and disability systems.
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Crane AL, Mathiron AGE, Ferrari MCO. Social learning in a high-risk environment: incomplete disregard for the 'minnow that cried pike' results in culturally transmitted neophobia. Proc Biol Sci 2016; 282:20150934. [PMID: 26180068 DOI: 10.1098/rspb.2015.0934] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Many prey species rely on conspecifics to gather information about unknown predation threats, but little is known about the role of varying environmental conditions on the efficacy of social learning. We examined predator-naive minnows that had the opportunity to learn about predators from experienced models that were raised in either a low- or high-risk environment. There were striking differences in behaviour among models; high-risk models showed a weaker response to the predator cue and became neophobic in response to the control cue (a novel odour, NO). Observers that were previously paired with low-risk models acquired a strong antipredator response only to the predator cue. However, observers that interacted with high-risk models, displayed a much weaker response to the predator odour and a weak neophobic response to the NO. This is the first study reporting such different outcomes of social learning under different environmental conditions, and suggests high-risk environments promote the cultural transmission of neophobia more so than social learning. If such a transfer can be considered similar to secondary traumatization in humans, culturally transmitted neophobia in minnows may provide a good model system for understanding more about the social ecology of fear disorders.
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Affiliation(s)
- Adam L Crane
- Department of Biology, University of Saskatchewan, 112 Science Place, Saskatoon, Saskatoon, Canada S7N 5E2
| | - Anthony G E Mathiron
- Department of Veterinary Biomedical Science, University of Saskatchewan, 52 Campus Drive, Saskatoon, Saskatoon, Canada S7N 5B4
| | - Maud C O Ferrari
- Department of Veterinary Biomedical Science, University of Saskatchewan, 52 Campus Drive, Saskatoon, Saskatoon, Canada S7N 5B4
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Wilson HMN, Murray CD. The Experience of Deployment for Partners of Military Personnel: A Qualitative Meta-Synthesis. JOURNAL OF COUPLE & RELATIONSHIP THERAPY 2016. [DOI: 10.1080/15332691.2014.986699] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Oseland L, Gallus KS, Nelson Goff BS. Clinical Application of the Couple Adaptation to Traumatic Stress (CATS) Model: A Pragmatic Framework for Working With Traumatized Couples. JOURNAL OF COUPLE & RELATIONSHIP THERAPY 2016. [DOI: 10.1080/15332691.2014.938284] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Saban KL, Hogan NS, Hogan TP, Pape TLB. He Looks Normal But … Challenges of Family Caregivers of Veterans Diagnosed with a Traumatic Brain Injury. Rehabil Nurs 2015; 40:277-85. [DOI: 10.1002/rnj.182] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/02/2014] [Indexed: 11/07/2022]
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Zerach G, Greene T, Solomon Z. Secondary Traumatization and Marital Adjustment among Former Prisoners of War Wives. JOURNAL OF LOSS & TRAUMA 2014. [DOI: 10.1080/15325024.2014.885270] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Crum-Cianflone NF, Fairbank JA, Marmar CR, Schlenger W. The Millennium Cohort Family Study: a prospective evaluation of the health and well-being of military service members and their families. Int J Methods Psychiatr Res 2014; 23:320-30. [PMID: 24912670 PMCID: PMC6878226 DOI: 10.1002/mpr.1446] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2013] [Accepted: 10/15/2013] [Indexed: 11/08/2022] Open
Abstract
The need to understand the impact of war on military families has never been greater than during the past decade, with more than three million military spouses and children affected by deployments to Operations Iraqi Freedom and Enduring Freedom. Understanding the impact of the recent conflicts on families is a national priority, however, most studies have examined spouses and children individually, rather than concurrently as families. The Department of Defense (DoD) has recently initiated the largest study of military families in US military history (the Millennium Cohort Family Study), which includes dyads of military service members and their spouses (n > 10,000). This study includes US military families across the globe with planned follow-up for 21+ years to evaluate the impact of military experiences on families, including both during and after military service time. This review provides a comprehensive description of this landmark study including details on the research objectives, methodology, survey instrument, ancillary data sets, and analytic plans. The Millennium Cohort Family Study offers a unique opportunity to define the challenges that military families experience, and to advance the understanding of protective and vulnerability factors for designing training and treatment programs that will benefit military families today and into the future.
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Affiliation(s)
- Nancy F Crum-Cianflone
- Deployment Health Research Department, Naval Health Research Center, San Diego, CA, USA; Department of Medicine, Naval Medical Center San Diego, San Diego, CA, USA
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Yambo TW, Hamilton R, Johnson ME. Ethical Considerations in the Recruitment of Military Partners in Combat-Related Posttraumatic Stress Disorder Research. Nurs Forum 2014; 50:164-70. [PMID: 25154767 DOI: 10.1111/nuf.12104] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND The recruitment of military partners in combat-related posttraumatic disorder (PTSD) research necessitates nurses' awareness to their unique ethical concerns. Safeguarding the ethical rights of partners living with veterans with PTSD is crucial to the development and implementation of quality, rigorous research designs. Nurses should understand the unique ethical considerations that pertain to partners' participation in PTSD research. OBJECTIVE To describe the ethical considerations relating to the recruitment of partners in PTSD research. METHOD A succinct discussion of the recent concerns in the recruitment of military partners in PTSD research. RESULTS The ethical guidelines of the American Psychiatric Association are employed to describe implications for researchers, educators, and administrators. For clinical nurses, the American Nurses Association's initiative to support military families is used to guide our discussion. Nurses are in a leading position to advocate for the ethical recruitment of military partners in PTSD research.
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Affiliation(s)
| | - Rebekah Hamilton
- Women, Children, and Family Health Nursing, College of Nursing, Rush University, Chicago, IL
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Abstract
The deployment of US military personnel to recent conflicts has been a significant stressor for their families; yet, we know relatively little about the long-term family effects of these deployments. Using data from prior military service eras, we review our current understanding of the long-term functioning and needs of military families. These data suggest that overseas deployment, exposure to combat, experiencing or participating in violence during war deployment, service member injury or disability, and combat-related post-traumatic stress disorder (PTSD) all have profound impacts on the functioning of military families. We offer several recommendations to address these impacts such as the provision of family-centered, trauma-informed resources to families of veterans with PTSD and veterans who experienced high levels of combat and war violence. Recent efforts to address the needs of caregivers of veterans should be evaluated and expanded, as necessary. We should also help military families plan for predictable life events likely to challenge their resilience and coping capacities. Future research should focus on the following: factors that mediate the relationship between PTSD, war atrocities, caregiver burden, and family dysfunction; effective family-centered interventions that can be scaled-up to meet the needs of a dispersed population; and system-level innovations necessary to ensure adequate access to these interventions.
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Meffert SM, Henn-Haase C, Metzler TJ, Qian M, Best S, Hirschfeld A, McCaslin S, Inslicht S, Neylan TC, Marmar CR. Prospective study of police officer spouse/partners: a new pathway to secondary trauma and relationship violence? PLoS One 2014; 9:e100663. [PMID: 24987848 PMCID: PMC4079247 DOI: 10.1371/journal.pone.0100663] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2013] [Accepted: 05/29/2014] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION It has been reported that posttraumatic stress disorder (PTSD) is associated with secondary spouse/partner (S/P) emotional distress and relationship violence. OBJECTIVE To investigate the relationships between PTSD, S/P emotional distress and relationship violence among police recruits using a prospective design. METHODS Two hypotheses were tested in 71 S/Ps: (1) Police officer reports of greater PTSD symptoms after 12 months of police service will be associated with greater secondary trauma symptoms among S/Ps; (2) Greater secondary trauma symptoms among S/Ps at 12 months will be associated with S/P reports of greater relationship violence. METHODS 71 police recruits and their S/Ps were assessed at baseline and 12 months after the start of police officer duty. Using linear and logistic regression, we analyzed explanatory variables for 12 month S/P secondary traumatic stress symptoms and couple violence, including baseline S/P variables and couple violence, as well as exposure and PTSD reports from both S/P and officer. RESULTS S/P perception of officer PTSD symptoms predicted S/P secondary traumatic stress. OS/P secondary trauma was significantly associated with both total couple violence (.34, p = .004) and S/P to officer violence (.35, p = .003). CONCLUSIONS Although results from this relatively small study of young police officers and their S/Ps must be confirmed by larger studies in general populations, findings suggest that S/P perception of PTSD symptoms may play a key role in the spread of traumatic stress symptoms across intimate partner relationships and intimate partner violence in the context of PTSD.
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Affiliation(s)
- Susan M. Meffert
- Department of Psychiatry, University of California San Francisco, San Francisco, California, United States of America
- * E-mail:
| | - Clare Henn-Haase
- Department of Psychiatry, New York University, New York, New York, United States of America
| | - Thomas J. Metzler
- Mental Health Service, San Francisco Veterans Administration Medical Center, San Francisco, California, United States of America
| | - Meng Qian
- Department of Psychiatry, New York University, New York, New York, United States of America
| | - Suzanne Best
- Graduate School of Education and Counseling, Lewis and Clark College, Portland, Oregon, United States of America
| | - Ayelet Hirschfeld
- Mental Health Service, San Francisco Veterans Administration Medical Center, San Francisco, California, United States of America
| | - Shannon McCaslin
- Dissemination and Training Division, National Center for PTSD, Palo Alto, California, United States of America
| | - Sabra Inslicht
- Department of Psychiatry, University of California San Francisco, San Francisco, California, United States of America
- Mental Health Service, San Francisco Veterans Administration Medical Center, San Francisco, California, United States of America
| | - Thomas C. Neylan
- Department of Psychiatry, University of California San Francisco, San Francisco, California, United States of America
- Mental Health Service, San Francisco Veterans Administration Medical Center, San Francisco, California, United States of America
| | - Charles R. Marmar
- Department of Psychiatry, New York University, New York, New York, United States of America
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Abstract
This paper addresses the question of gendered receptivity to Secondary Traumatic Syndrome (STS) in the family. Unlike other manifestations of distress in the family, where gender comparisons are a matter of course, very few such comparisons are made in studies of STS. Review of the findings of 12 studies, the only studies, to date, that provide data enabling the comparison of STS in males and females, shows that females in the family, whether daughters, wives, or mothers, are consistently more likely than the males, whether sons, husbands, or fathers, to experience the Posttraumatic Stress Disorder (PTSD) symptoms of a traumatized family member without having experienced the traumatic event itself. This pattern pertains to whether the event that precipitated the primary trauma was a collective or individual trauma and whether the STS sufferer was a child or adult or living or not living with the PTSD casualty. The Discussion points out that gender is an important factor in the development of STS, whether in interaction with role, beyond role, or both.
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Affiliation(s)
- Nehami Baum
- The Louis and Gabi Weisfeld School of Social Work, Bar Ilan University, Ramat Gan, Israel
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47
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Wick S, Nelson Goff BS. A Qualitative Analysis of Military Couples With High and Low Trauma Symptoms and Relationship Distress Levels. JOURNAL OF COUPLE & RELATIONSHIP THERAPY 2014. [DOI: 10.1080/15332691.2014.865983] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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48
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Church D, Brooks AJ. CAM and Energy Psychology Techniques Remediate PTSD Symptoms in Veterans and Spouses. Explore (NY) 2014; 10:24-33. [DOI: 10.1016/j.explore.2013.10.006] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2013] [Indexed: 11/30/2022]
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49
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Couple and Family Therapy with Five Physical Rehabilitation Populations: A Scoping Review. THE AUSTRALIAN JOURNAL OF REHABILITATION COUNSELLING 2012. [DOI: 10.1017/jrc.2012.13] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
This article provides a scoping review with a focus on the substantive and methodological issues of the research pertaining to couple and family therapy (CFT) with five physical medical rehabilitation populations. We searched for literature concerned with five populations: spinal cord injury, stroke, multiple sclerosis, traumatic brain injury and amputations. A detailed review of CINAHL, PubMed, and PsycINFO databases identified 14 publications that researched couple/family therapy interventions with these populations. We synthesised the data by outlining and charting the substantive and methodological issues with this research. Findings suggest that individuals who have sustained an injury or are diagnosed with an illness requiring extensive rehabilitation experience increased relationship distress and decreased family functioning. While the literature clearly points to the impact on spouses and families, CFT was primarily used to engage families in efforts to assist health care workers improve physical functioning.
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50
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Collura GL, Lende DH. POST-TRAUMATIC STRESS DISORDER AND NEUROANTHROPOLOGY: STOPPING PTSD BEFORE IT BEGINS. ANNALS OF ANTHROPOLOGICAL PRACTICE 2012. [DOI: 10.1111/j.2153-9588.2012.01096.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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