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Nieforth LO, Leighton SC. Animal-assisted interventions for military families: a systematic review. Front Public Health 2024; 12:1372189. [PMID: 38813415 PMCID: PMC11135175 DOI: 10.3389/fpubh.2024.1372189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Accepted: 03/14/2024] [Indexed: 05/31/2024] Open
Abstract
Introduction The incorporation of animals into interventions focused on military families is a relatively new concept. Though animal-assisted interventions (AAIs) have been studied in the context of military veterans, few studies incorporate members of the military family or focus on the family members' experiences. Methods This systematic review investigates the effects of AAIs on the wellbeing of military family members beyond the veteran themselves through three aims: (1) by describing the characteristics of AAIs for military family members, (2) by evaluating the quality of the methodology present within the current literature, and (3) by identifying key concepts and knowledge gaps within the findings reported to date. Results A total of nine articles met the criteria to be included in the review. Though the inclusion criteria and search terms included all types of animal-assisted interventions, the only interventions represented were service dogs (n = 4) and equine-assisted services (n = 5). Discussion Findings suggest AAIs could be beneficial in areas such as communication, relational bonds, and psychosocial well-being. Though additional research is necessary, AAIs may be an effective complementary intervention for military families.
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Affiliation(s)
- Leanne O. Nieforth
- Department of Comparative Pathobiology, Purdue University, West Lafayette, IN, United States
| | - Sarah C. Leighton
- Department of Psychology, College of Science, University of Arizona, Tucson, AZ, United States
- College of Veterinary Medicine, University of Arizona, Tucson, AZ, United States
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Darmour CA, Luk JW, LaCroix JM, Perera KU, Goldston DB, Soumoff AA, Weaver JJ, Ghahramanlou-Holloway M. Social Support and Social Stress Among Suicidal Inpatients at Military Treatment Facilities: A Multidimensional Investigation. J Nerv Ment Dis 2024; 212:261-269. [PMID: 38416406 DOI: 10.1097/nmd.0000000000001761] [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: 02/29/2024]
Abstract
ABSTRACT The associations between social support and stress with internalizing symptoms (depressive symptoms and hopelessness) and hazardous drinking were tested in an inpatient sample of suicidal military personnel. Baseline data from a randomized clinical trial were analyzed. Different sources of support and stressors in the social context of military personnel were differentially linked to internalizing symptoms and hazardous drinking. In the full sample ( n = 192), family and nonfamily support were both inversely associated with internalizing symptoms but not hazardous drinking. Family stress was positively associated with internalizing symptoms. In a subsample of service members who had a history of deployment ( n = 98), postdeployment social support was protective against internalizing symptoms, whereas deployment harassment was associated with increased odds of hazardous drinking. Results underscore the need for assessment of various dimensions of social support and stress to guide case formulation and optimize strategies to support patients' mental well-being and adaptive coping.
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Affiliation(s)
- Charles A Darmour
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Jeremy W Luk
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Jessica M LaCroix
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Kanchana U Perera
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | | | - Alyssa A Soumoff
- Walter Reed National Military Medical Center, Bethesda, Maryland
| | | | - Marjan Ghahramanlou-Holloway
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences, Bethesda, Maryland
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3
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Cooper DC, Campbell MS, Case SR, Fraine MC, Jones RA, Klein IF, Hoyt T. Outcome metrics utilized in evaluations of programs and interventions for combat and operational stress: A review of psychometric properties. MILITARY PSYCHOLOGY 2024; 36:227-237. [PMID: 38377250 PMCID: PMC10880499 DOI: 10.1080/08995605.2022.2117537] [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] [Received: 01/13/2021] [Accepted: 08/23/2022] [Indexed: 10/15/2022]
Abstract
The Department of Defense has mandated combat and operational stress control (COSC) efforts for the Services since 1999. Although several COSC-related programs have been implemented, few have undergone evaluation, and no standardized metrics have been established to assess their effectiveness and utility. The purpose of this review was to characterize the content and psychometrics of measures that have been utilized as outcome metrics in evaluations of COSC-related programs and interventions. Systematic literature searches were conducted for publications that: a) evaluated at least one measure from U.S. service members who participated in a program or intervention to prevent or reduce the adverse effects of combat and operational stress; and b) reported U.S. data on the internal consistency, test-retest reliability, convergent validity, and sensitivity/specificity of the identified measures. This process identified 15 measures for which psychometric properties were reviewed for acceptability based on recommended criteria. Identified measures varied from well-validated measures to newer instruments for which more data is needed on one or more of the target psychometric properties. Aside from internal consistency, psychometric data from U.S. military samples were sparse. Results further suggested that some measures might have reduced sensitivity in service members under certain conditions, such as large-scale screening. Additional studies are needed to validate COSC-relevant measures in service members. Future evaluations of programs and interventions for combat and operational stress should select measures that will increase the consistency of the literature, allow comparisons across studies, and ensure alignment with the objectives of identified programs.
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Affiliation(s)
- Denise C. Cooper
- Psychological Health Center of Excellence, Defense Health Agency, Falls Church, Virginia
| | - Marjorie S. Campbell
- Psychological Health Center of Excellence, Defense Health Agency, Falls Church, Virginia
| | - Spencer R. Case
- Psychological Health Center of Excellence, Defense Health Agency, Falls Church, Virginia
| | - Melissa C. Fraine
- Psychological Health Center of Excellence, Defense Health Agency, Falls Church, Virginia
| | - Rebecca A. Jones
- Psychological Health Center of Excellence, Defense Health Agency, Falls Church, Virginia
| | - Ilene F. Klein
- Psychological Health Center of Excellence, Defense Health Agency, Falls Church, Virginia
| | - Tim Hoyt
- Psychological Health Center of Excellence, Defense Health Agency, Falls Church, Virginia
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Monk JK, Ruhlmann L, Goff BSN, Ogan M, Miller MB. Translating Discovery Science. Fostering relationships: Service provider perspectives on community building among veteran families. FAMILY RELATIONS 2023; 72:1351-1367. [PMID: 37583766 PMCID: PMC10424772 DOI: 10.1111/fare.12724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Accepted: 04/25/2022] [Indexed: 08/17/2023]
Abstract
Objective We sought to identify the social process through which communal support can be established among veteran couples and families. Background On the basis of the social organization theory of action and change, a sense of community is crucial for military veterans' well-being and may serve as a resource for intervention. Method We interviewed service providers (n = 8) and corroborated their perspectives by triangulating evaluations from veteran family participants (n = 143). Data were analyzed using grounded theory techniques. Results Providers suggested promoting a sense of community in prevention and intervention programming by (a) establishing a safe and empowering space, (b) bridging existing gaps within family and community systems, and (c) encouraging interpersonal healing by promoting connection and facilitating the sharing of common experiences. Providers also described challenges to facilitating the program, including logistics, time, and funding constraints. Conclusion According to our results, fostering community among veterans and their family members may be achieved by applying an integrative approach that goes beyond siloed individual, couple, and group therapy orchestrated by practitioners. Implications We recommend multicomponent interventions that create synergy between different levels and forms of social support. Providers recommended being intentional about the program structure to focus on community strengths and shared connection.
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Affiliation(s)
- J. Kale Monk
- Department of Human Development and Family Science, University of Missouri, Columbia, MO
| | - Lauren Ruhlmann
- Department of Human Development and Family Science, Auburn University, Auburn, AL
| | | | - Matthew Ogan
- Department of Human Development and Family Science, University of Missouri, Columbia, MO
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Glorieux V, Lo Bue S, Euwema M. Reintegration of crisis services employees: a systematic literature review. JOURNAL OF GLOBAL MOBILITY: THE HOME OF EXPATRIATE MANAGEMENT RESEARCH 2023. [DOI: 10.1108/jgm-06-2022-0020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/07/2023]
Abstract
PurposeCrisis services personnel are frequently deployed around the globe under highly demanding conditions. This raises the need to better understand the deployment process and more especially, sustainable reintegration after deployment. Despite recent research efforts, the study of the post-deployment stage, more specifically the reintegration process, remains fragmented and limited. To address these limitations, this review aims at (1) describing how reintegration is conceptualised and measured in the existing literature, (2) identifying what dimensions are associated with the reintegration process and (3) identifying what we know about the process of reintegration in terms of timing and phases.Design/methodology/approachFollowing the preferred reporting items for systematic reviews and meta-analyses (PRISMA) protocol, the authors identified 5,859 documents across several scientific databases published between 1995 and 2021. Based on predefined eligibility criteria, 104 documents were yielded.FindingsResearch has primarily focused on descriptive studies of negative individual and interpersonal outcomes after deployment. However, this review indicates that reintegration is dynamic, multi-sector, multidimensional and dual. Each of its phases and dimensions is associated with distinct challenges.Originality/valueTo the authors’ knowledge, this is the first research that investigates reintegration among different crisis services and provides an integrative social-ecological framework that identifies the different dimensions and challenges of this process.
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Sullivan KS, Dodge J, Park Y, Kale C, Merrill JC, Clarke-Walper K, Castro CA, Riviere LA. Predictors of reintegration adjustment among female U.S. Army spouses: A preliminary exploration. JOURNAL OF MILITARY, VETERAN AND FAMILY HEALTH 2022. [DOI: 10.3138/jmvfh-2021-0125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
LAY SUMMARY Little is known about how military families navigate the challenges they experience during reintegration, the period after a deployment separation when a service member returns home and families must readjust to their presence. This study considers how family risk factors such as the mental health of both partners and protective factors such as social support and participation in military-sponsored training influence family adjustment during reintegration. Military spouses who reported having more social support were likely to report that their families adjusted more quickly during reintegration. However, spouses who expressed concern about a partner’s mental health were less likely to feel prepared for reintegration and, in turn, were more likely to report that their families adjusted more slowly. The results of this study suggest that supporting military spouses in feeling more prepared for reintegration may be an important means to shorten the adjustment period after a deployment.
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Affiliation(s)
- Kathrine S. Sullivan
- Silver School of Social Work, New York University, New York, New York, United States
| | - Jessica Dodge
- Center for Clinical Management Research, Ann Arbor Veterans Affairs Hospital, Ann Arbor, Michigan, United States
| | - Yangjin Park
- Silver School of Social Work, New York University, New York, New York, United States
| | - Caroline Kale
- Silver School of Social Work, New York University, New York, New York, United States
| | - Julie C. Merrill
- U.S. Army Medical Research Directorate-West, Walter Reed Army Institute of Research, Joint Base Lewis-McChord, Washington, District of Columbia, United States
| | - Kristina Clarke-Walper
- Center for Military Psychiatry & Neuroscience, Walter Reed Army Institute of Research, Silver Spring, Maryland, United States
| | - Carl A. Castro
- Center for Innovation and Research on Veterans and Military Families, University of Southern California, Los Angeles, California, United States
| | - Lyndon A. Riviere
- Center for Military Psychiatry & Neuroscience, Walter Reed Army Institute of Research, Silver Spring, Maryland, United States
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Senecal G, Adorno RL, LaFleur R, McNamara KA. Autoethnographic Family Case Study: Combat Veteran PTSD and its Effects on Familial Dynamics, Parenting, and Marriage. JOURNAL OF VETERANS STUDIES 2022. [DOI: 10.21061/jvs.v8i3.309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Vest BM, Goodell EMA, Homish DL, Homish GG. Effects of Social Network Characteristics on Mental Health Outcomes Among United States Army Reserve and National Guard Soldiers. Community Ment Health J 2022; 58:1268-1278. [PMID: 34981277 PMCID: PMC9250539 DOI: 10.1007/s10597-021-00935-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 12/12/2021] [Indexed: 11/30/2022]
Abstract
We sought to examine the relative salience of multiple social network structural characteristics (e.g., size, composition, quality, substance use) for understanding soldiers' mental health symptoms (anger, anxiety, depression, PTSD). Data are drawn from soldiers (N = 421) participating in the Operation: SAFETY study. Negative binomial regression models examined the relationship between ten social network characteristics and mental health outcomes, controlling for age, sex, years of military service, and deployment history. Greater number of close network ties was associated with fewer symptoms of anger, anxiety, and depression (ps < 0.05), but not PTSD. Having more illicit drug-using network ties was associated with greater severity of anxiety symptoms (p < 0.05). Finally, more days spent drinking with network members was related to higher levels of anger (p < 0.05). Interpersonal relationships that entail substance use are associated with greater anxiety and anger while a greater number of close ties is associated with fewer anger, anxiety, and depression symptoms.
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Affiliation(s)
- Bonnie M Vest
- Department of Family Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, 77 Goodell Street, Suite 220, Buffalo, NY, 14203, USA.
| | - Erin M Anderson Goodell
- Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - D Lynn Homish
- Department of Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo, The State University of New York, Buffalo, NY, USA
| | - Gregory G Homish
- Department of Family Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, 77 Goodell Street, Suite 220, Buffalo, NY, 14203, USA
- Department of Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo, The State University of New York, Buffalo, NY, USA
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Barnett A, Savic M, Forbes D, Best D, Sandral E, Bathish R, Cheetham A, Lubman DI. Transitioning to civilian life: The importance of social group engagement and identity among Australian Defence Force veterans. Aust N Z J Psychiatry 2022; 56:1025-1033. [PMID: 34541871 DOI: 10.1177/00048674211046894] [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] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Veterans transitioning to civilian life after leaving the military face unique health concerns. Although there is a significant body of research exploring veterans' experiences of transition and predictors of well-being, there are limited studies examining how social group engagement influences veterans' transition. We explored how Australian Defence Force veterans' social group engagement and identity influenced their adjustment to civilian life and well-being. METHODS Forty Australian veterans (85% male; mean age = 37 years, range = 25-57 years) took part in in-depth, semi-structured interviews. Participants completed two mapping tasks (a social network map and life course map) that provided a visual component to the interviews. Interview transcripts were analysed thematically and interpreted by adopting a social identity approach. RESULTS Joining the military involved a process of socialisation into military culture that for most participants led to the development of a military identity. An abrupt or difficult discharge from defence was often associated with a negative impact on social group engagement and well-being in civilian life. Veterans' social group memberships may act not only as positive psychological resources during transition but also as a potential source of conflict, especially when trying to re-engage with civilian groups with different norms or beliefs. Military values inscribed within a veteran's sense of self, including a strong sense of service, altruism and giving back to their community, may operate as positive resources and promote social group engagement. CONCLUSION Engaging with supportive social groups can support transition to civilian life. Reintegration may be improved via effective linkage with programmes (e.g. volunteering, ex-service support organisations) that offer supportive social networks and draw upon veterans' desire to give back to community. Social mapping tasks that visualise veterans' social group structures may be useful for clinicians to explore the roles and conflicts associated with veterans' social group memberships during transition.
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Affiliation(s)
- Anthony Barnett
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Frankston, VIC, Australia.,Turning Point, Eastern Health, Richmond, VIC, Australia
| | - Michael Savic
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Frankston, VIC, Australia.,Turning Point, Eastern Health, Richmond, VIC, Australia
| | - David Forbes
- Phoenix Australia Centre for Posttraumatic Mental Health, Department of Psychiatry, The University of Melbourne, Melbourne, VIC, Australia
| | - David Best
- Criminal and Social Sciences, Social, Cultural and Legal Research Centre, University of Derby, Derby, UK
| | - Emma Sandral
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Frankston, VIC, Australia.,Turning Point, Eastern Health, Richmond, VIC, Australia
| | - Ramez Bathish
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Frankston, VIC, Australia.,Turning Point, Eastern Health, Richmond, VIC, Australia
| | - Alison Cheetham
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Frankston, VIC, Australia.,Turning Point, Eastern Health, Richmond, VIC, Australia
| | - Dan I Lubman
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Frankston, VIC, Australia.,Turning Point, Eastern Health, Richmond, VIC, Australia
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Easterbrook B, Brown A, Millman H, Van Blyderveen S, Lanius R, Heber A, McKinnon M, O'Connor C. The mental health experience of treatment-seeking military members and public safety personnel: a qualitative investigation of trauma and non-trauma-related concerns. Health Promot Chronic Dis Prev Can 2022; 42:252-260. [PMID: 35766914 PMCID: PMC9388056 DOI: 10.24095/hpcdp.42.6.03] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
INTRODUCTION Paramedics, firefighters, police officers and other public safety personnel (PSP) as well as Canadian Armed Forces (CAF) members are frequently exposed to stressors and demanding work environments. Although their specific work-related tasks may vary, a commonality between these occupations is the significant likelihood of repeated exposure to potentially psychologically traumatic events (PPTE) over the course of their careers. Due in part to these repeated exposures, CAF members and PSP are at an elevated risk of mental health concerns including posttraumatic stress disorder. The purpose of this study was to obtain a more in-depth understanding of the trauma- and non-trauma-related experiences of active or retired PSP and CAF members that may be implicated in mental health issues and resultant treatment and recovery. METHODS Study participants were recruited during inpatient treatment at a private mental health and addictions inpatient hospital in Canada. We conducted and audiotaped semistructured focus groups and transcribed the discussions. Interpretive phenomenological analysis and thematic coding generated a coding scheme from which to identify concepts and linkages in the data. RESULTS Analysis generated four primary themes: interpersonal relationships, personal identity, mental health toll and potential moral injury. A variety of subthemes were identified, including family dynamics, inability to trust, feelings of professional/personal betrayal, stigma within the CAF/PSP culture, increased negative emotions about self/others, and a reliance on comradery within the service. CONCLUSION The information gathered is critical to understanding the perspectives of PSP and military members as the career stressors and related exposure to PPTE of these occupations are unique.
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Affiliation(s)
| | - Andrea Brown
- McMaster University, Hamilton, Ontario, Canada
- Homewood Research Institute, Guelph, Ontario, Canada
- Homewood Health Centre, Guelph, Ontario, Canada
| | | | | | - Ruth Lanius
- Homewood Research Institute, Guelph, Ontario, Canada
- Western University, London, Ontario, Canada
| | | | - Margaret McKinnon
- McMaster University, Hamilton, Ontario, Canada
- Homewood Research Institute, Guelph, Ontario, Canada
- Homewood Health Centre, Guelph, Ontario, Canada
- St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
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Characteristics of Responders and Nonresponders in a Military Postconcussion Rehabilitation Program. J Head Trauma Rehabil 2022; 37:E458-E466. [PMID: 35617677 DOI: 10.1097/htr.0000000000000792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To characterize treatment responders and nonresponders as measured by the Neurobehavioral Symptom Inventory (NSI) in order to understand whether certain traits in our patient population would characterize favorable response. SETTING Brain Injury Rehabilitation Service at Brooke Army Medical Center, Fort Sam Houston, San Antonio, Texas. PATIENTS In total, 655 active duty military patients with a diagnosis of mild traumatic brain injury (mTBI) who received treatment between 2007 and 2020 and completed self-report measures as part of routine care. DESIGN Observational retrospective analysis of outpatient clinical outcomes data. MAIN MEASURES The primary outcome measure was the NSI, divided into the responder and nonresponder groups. Responders were defined by reliable change in NSI total score (decrease of ≥8 points from intake to discharge). FINDINGS Responders (n = 395) reported a higher level of symptom burden at intake on the NSI. Women responded proportionally more (70%) than men (58%). After treatment, responders reported improvements on all measures evaluated while nonresponders reported no change or slightly worse symptoms. Logistic regression analysis showed that posttraumatic stress symptoms at intake decreased odds of favorable treatment response while satisfaction with social relationships increased odds of favorable treatment response. CONCLUSION The results from this process improvement project suggested that posttraumatic symptoms warrant programmatic attention in TBI clinics while social relationships may be a protective factor that can be capitalized to enhance troop readiness. Systematic examination of these characteristics should be conducted on a larger population within the military health system.
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Hinton M, O'Donnell M, Cowlishaw S, Kartal D, Metcalf O, Varker T, McFarlane AC, Hopwood M, Bryant RA, Forbes D, Howard A, Lau W, Cooper J, Phelps AJ. Defining post-traumatic stress disorder recovery in veterans: Benchmarking symptom change against functioning indicators. Stress Health 2021; 37:547-556. [PMID: 33336551 DOI: 10.1002/smi.3019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 11/07/2020] [Accepted: 12/11/2020] [Indexed: 11/08/2022]
Abstract
Improved metrics of Post-traumatic stress disorder (PTSD) treatment response that extend beyond a focus on symptom reduction to incorporate meaningful, patient-centred indicators of functioning are needed in veteran populations. The aim of this study was to extend previous research by investigating whether indicators of functioning can successfully distinguish against symptom response categories derived from the Post-Traumatic Stress Disorder Checklist (PCL-5) pre- and post- PTSD treatment. Participants were 472 veterans receiving hospital-based treatment for PTSD. In addition to the PCL-5, measures included quality of life, social relationships, physical health and psychological distress. Four mutually exclusive, progressive response categories were used to define treatment response including: No Response, Response, Response and Below Threshold, and Remission. PTSD symptom reductions were associated with corresponding improvements in broader indicators of functioning. However, it was only when the magnitude of symptom reduction placed the individual in the 'Response and Below Threshold' category that improvement on functioning measures achieved levels indicative of a good end state. Traditional metrics of treatment 'response' in PTSD treatment do not necessarily indicate recovery on important functioning indicators. Only when an individual both responds to treatment and drops below threshold for probable disorder are they likely to report having meaningful levels of functioning.
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Affiliation(s)
- Mark Hinton
- Department of Psychiatry, Phoenix Australia- Centre for Posttraumatic Mental Health, University of Melbourne, Melbourne, Australia
| | - Meaghan O'Donnell
- Department of Psychiatry, Phoenix Australia- Centre for Posttraumatic Mental Health, University of Melbourne, Melbourne, Australia
| | - Sean Cowlishaw
- Department of Psychiatry, Phoenix Australia- Centre for Posttraumatic Mental Health, University of Melbourne, Melbourne, Australia.,Bristol Medical School, University of Bristol, Bristol, UK
| | - Dzenana Kartal
- Department of Psychiatry, Phoenix Australia- Centre for Posttraumatic Mental Health, University of Melbourne, Melbourne, Australia
| | - Olivia Metcalf
- Department of Psychiatry, Phoenix Australia- Centre for Posttraumatic Mental Health, University of Melbourne, Melbourne, Australia
| | - Tracey Varker
- Department of Psychiatry, Phoenix Australia- Centre for Posttraumatic Mental Health, University of Melbourne, Melbourne, Australia
| | - Alexander C McFarlane
- Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
| | - Malcolm Hopwood
- Department of Psychiatry, University of Melbourne, Melbourne, Australia
| | - Richard A Bryant
- School of Psychology, University of New South Wales, Kensington, Australia
| | - David Forbes
- Department of Psychiatry, Phoenix Australia- Centre for Posttraumatic Mental Health, University of Melbourne, Melbourne, Australia
| | - Alexandra Howard
- Department of Psychiatry, Phoenix Australia- Centre for Posttraumatic Mental Health, University of Melbourne, Melbourne, Australia
| | - Winnie Lau
- Department of Psychiatry, Phoenix Australia- Centre for Posttraumatic Mental Health, University of Melbourne, Melbourne, Australia
| | - John Cooper
- Department of Psychiatry, Phoenix Australia- Centre for Posttraumatic Mental Health, University of Melbourne, Melbourne, Australia
| | - Andrea J Phelps
- Department of Psychiatry, Phoenix Australia- Centre for Posttraumatic Mental Health, University of Melbourne, Melbourne, Australia
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Sullivan KS, Hawkins SA, Gilreath TD, Castro CA. Mental Health Outcomes Associated with Risk and Resilience among Military-Connected Youth. FAMILY PROCESS 2021; 60:507-522. [PMID: 32981035 PMCID: PMC7997811 DOI: 10.1111/famp.12596] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
The present study aimed to describe patterns of risk and protective factors affecting U.S. Army families and their association with mental health diagnoses among military-connected children. Wartime military service is associated with increased adverse outcomes for military-connected youth, but few studies have explored the impact of concurrent risk and access to protective factors. Using big data methods to link existing datasets, protective factors (e.g., marital and family functioning) were drawn from a voluntary survey completed by 1,630 US Army spouses. Risk factors (e.g., parent mental health, family moves, deployment) were drawn from Department of Defense (DoD) archival data. Rates of mental health diagnoses among youth were derived from DoD healthcare records. Using the three-step method of latent profile analysis, five profiles emerged with variability across risk and protective factors. The largest group (40% of the sample) had considerable protective factors and limited risk exposure. Statistically significant differences in the prevalence of mental health diagnoses among military-connected youth were observed across profiles (χ2 = 30.067, df = 4, p < .001), with the highest rates (31.1% and 30.5%) observed in the two profiles with the lowest protective factors. Findings suggest most military families are faring well and highlight the importance of a thorough assessment that evaluates both the stressors military families face and the strengths they possess.
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Affiliation(s)
| | - Stacy Ann Hawkins
- Research Facilitation Laboratory, Army Analytics Group, Monterey, CA, USA
| | - Tamika D Gilreath
- Department of Health and Kinesiology, Transdisciplinary Center for Health Equity Research, Texas A&M University, College Station, TX, USA
| | - Carl A Castro
- Center for Innovation and Research on Veterans and Military Families, University of Southern California Suzanne Dworak-Peck School of Social Work, Los Angeles, CA, USA
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Geuzinge R, Visse M, Duyndam J, Vermetten E. Social Embeddedness of Firefighters, Paramedics, Specialized Nurses, Police Officers, and Military Personnel: Systematic Review in Relation to the Risk of Traumatization. Front Psychiatry 2020; 11:496663. [PMID: 33408646 PMCID: PMC7779596 DOI: 10.3389/fpsyt.2020.496663] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2019] [Accepted: 11/20/2020] [Indexed: 11/13/2022] Open
Abstract
Background: Firefighters, paramedics, specialized nurses working in Intensive Care Units (ICUs), Operating Rooms (OR), and Emergency Rooms (ER), police officers and military personnel are more frequently exposed to potentially traumatic events than the general population; they are considered high-risk professionals. To reduce the risk of traumatization it is of great importance to be embedded in a social environment with supportive relationships. Methods: We performed a systematic review (based on the PRISMA-Guidelines) looking for social connections within the environment in which high-risk professionals are embedded (work, home, community), to obtain evidence on the impact of these connections on the risk of traumatization. Additionally, we aim to identify relevant supportive relationships in the professionals' environments. We identified the relevant scientific literature by searching, without time, and language restriction, five electronic bibliographic databases: MEDLINE, PsycINFO, Sociological Abstracts, CINAHL, and Web of Science. These databases were last searched in January 2019. Results: A qualitative analysis of the 89 eligible (out of 9,047 screened) studies shows that for firefighters, paramedics, and emergency nurses social connections in their work environment are predominantly supportive relationships and may protect them against traumatization. In other occupations (OR-nurses, ICU-nurses, police officers), however, social connections at work are not only a source of support but are also a source of stress. For military personnel study results are inconclusive as to whether their social connections at work or at home support them against traumatization. In so far as connections are supportive, their sources vary greatly from one occupational group to another; they differ between work vs. home as well as within work between peers vs. supervisor. Conclusions: Being embedded in a social environment, i.e., having social connections, is important but not always sufficient to protect high-risk professionals against traumatization. For, while these connections may be the antecedents of supportive relationships, they can also be the antecedents of damaging relationships. Additionally, the sources of supportive relationships differ among groups. This suggests that knowledge of how the social structures of the occupational groups differ may increase our understanding of the impact of social connections and relationships, including socialization, on the risk of traumatization of high-risk professionals.
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Affiliation(s)
- Renate Geuzinge
- Humanism and Social Resilience, University of Humanistic Studies, Utrecht, Netherlands
| | - Merel Visse
- Care Ethics, University of Humanistic Studies, Utrecht, Netherlands
| | - Joachim Duyndam
- Humanism and Social Resilience, University of Humanistic Studies, Utrecht, Netherlands
| | - Eric Vermetten
- Department of Psychiatry, Leiden University Medical Center, Leiden, Netherlands
- Ministry of Defense, Military Mental Health Research Center, Utrecht, Netherlands
- ARQ National Psychotrauma Center, Diemen, Netherlands
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Hoopsick RA, Benson KR, Homish DL, Homish GG. Resiliency factors that protect against post-deployment drug use among male US Army Reserve and National Guard soldiers. Drug Alcohol Depend 2019; 199:42-49. [PMID: 30981048 PMCID: PMC7370314 DOI: 10.1016/j.drugalcdep.2019.02.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 02/05/2019] [Accepted: 02/07/2019] [Indexed: 01/22/2023]
Abstract
BACKGROUND Service members who have been deployed are at risk for substance use, especially Reserve/Guard troops. However, it is unclear what modifiable factors protect against substance use in this at-risk population. Our objective was to examine the effects of pre-, peri-, and post-deployment resiliency factors on post-deployment drug use. METHODS Data were drawn from Operation: SAFETY (Soldiers and Families Excelling Through the Years), an ongoing study examining the health of US Army Reserve/National Guard (USAR/NG) soldiers. This sample consisted of male USAR/NG soldiers with at least one combat deployment (N = 228). At baseline, we assessed the following as potential protective factors: deployment preparation, unit support and support from family/friends during soldiers' most recent deployment, and marital satisfaction. We examined the relations between each of these resiliency factors with drug use at the first follow-up assessment using the NIDA modified ASSIST 2.0. RESULTS Greater unit support (AOR = 0.56, 95% CI: 0.34, 0.92; p < 0.05) and support from family/friends during deployment (AOR = 0.64, 95% CI: 0.43, 0.96; p < 0.05) were associated with lower odds of drug use, controlling for age, rank, years of military service, combat exposure, traumatic brain injury, time since last deployment, and baseline drug use. Deployment preparation and marital satisfaction were not associated with drug use (ps > 0.05). CONCLUSIONS Social support provided to soldiers during deployment, either by his unit or his family/friends, showed evidence of protection against post-deployment drug use. In addition to existing post-deployment efforts, we recommend interventions that facilitate stronger interpersonal relationships during deployment.
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Affiliation(s)
- Rachel A. Hoopsick
- Department of Community Health & Health Behavior, University at Buffalo, The State University of New York, Buffalo, NY, USA,Corresponding Author: Rachel A. Hoopsick, MS, MPH, CHES, Department of Community Health & Health Behavior, University at Buffalo, The State University of New York, 3435 Main Street, 335 Kimball Tower, Buffalo, NY 14214, USA. Phone: 716-829-4731,
| | - Katelyn R. Benson
- Department of Community Health & Health Behavior, University at Buffalo, The State University of New York, Buffalo, NY, USA
| | - D. Lynn Homish
- Department of Community Health & Health Behavior, University at Buffalo, The State University of New York, Buffalo, NY, USA
| | - Gregory G. Homish
- Department of Community Health & Health Behavior, University at Buffalo, The State University of New York, Buffalo, NY, USA
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16
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Ketcheson F, King L, Richardson JD. Association between social support and mental health conditions in treatment-seeking Veterans and Canadian Armed Forces personnel. JOURNAL OF MILITARY, VETERAN AND FAMILY HEALTH 2018. [DOI: 10.3138/jmvfh.2017-0001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
| | - Lisa King
- Parkwood Operational Stress Injury Clinic, London, Ontario, Canada
| | - J Don Richardson
- Parkwood Operational Stress Injury Clinic, London, Ontario, Canada
- Department of Psychiatry, Western University, London, Ontario, Canada
- Department of Psychiatry and Behavioural Neuroscience, McMaster University, Hamilton, Ontario, Canada
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