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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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Waddell E, Rioseco P, Van Hooff M, Daraganova G, Lawrence D, Rikkers W, Roberts L, Beks T, Sharp T, Wadham B, Lawn S. Families' experiences of supporting Australian veterans to seek help for a mental health problem: a linked data analysis of national surveys with families and veterans. J Ment Health 2023; 32:899-909. [PMID: 36880331 DOI: 10.1080/09638237.2023.2182418] [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: 05/21/2022] [Revised: 11/11/2022] [Accepted: 11/16/2022] [Indexed: 03/08/2023]
Abstract
BACKGROUND Families play a critical role in supporting currently serving and transitioned veterans' wellbeing and help-seeking for mental health concerns; however, little is known about families' experiences. AIMS This study used Australian national survey linked-data (n = 1217) from families (Family Wellbeing Study-FWS) and veterans (Mental Health Wellbeing Transition Study-MHWTS) to understand veteran-family help-seeking relationships. METHODS Veterans' and family members' responses to mental health and help-seeking questions in FWS and MHWTS datasets from perspective of family members were cross-tabulated. Help-seeking support provided by family members was compared by veterans' probable disorder. RESULTS Results highlighted high levels of involvement and continuous assistance provided by families. Two in three family members thought the veteran had probable mental health concerns although they have never been diagnosed or treated. Clear disparities between family and veteran perspectives regarding mental health concerns indicates the extent of non-treatment seeking in this population, missed opportunities for early intervention, and need for greater support to families to promote help-seeking. CONCLUSIONS Encouraging help-seeking is complex for veteran families particularly where veterans' reluctance to seek help may lead to family relationship strain and conflict. Families need early information, support, and recognition by service agencies of the role of the family in encouraging help-seeking.
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Affiliation(s)
- Elaine Waddell
- Flinders University, Adelaide, South Australia, Australia
- Open Door Initiative, Flinders University, Adelaide, South Australia, Australia
| | - Pilar Rioseco
- Australian Institute of Family Studies, Melbourne, Victoria, Australia
| | - Miranda Van Hooff
- Military and Emergency Services Health Australia (MESHA), The Hospital Research Foundation Group, Adelaide, South Australia, Australia
- University of South Australia Adelaide, South Australia, Australia
- University of Adelaide, Adelaide, South Australia
| | - Galina Daraganova
- Australian Institute of Family Studies, Melbourne, Victoria, Australia
- South-Eastern Melbourne Primary Health Network, Melbourne, Victoria, Australia
| | - David Lawrence
- Open Door Initiative, Flinders University, Adelaide, South Australia, Australia
- Curtin University, Perth, Western Australia, Australia
| | - Wavne Rikkers
- Curtin University, Perth, Western Australia, Australia
| | - Louise Roberts
- Flinders University, Adelaide, South Australia, Australia
- Open Door Initiative, Flinders University, Adelaide, South Australia, Australia
| | - Tiffany Beks
- Open Door Initiative, Flinders University, Adelaide, South Australia, Australia
- University of Calgary, Calgary, Alberta, Canada
| | - Tiffany Sharp
- Flinders University, Adelaide, South Australia, Australia
- Open Door Initiative, Flinders University, Adelaide, South Australia, Australia
| | - Ben Wadham
- Flinders University, Adelaide, South Australia, Australia
- Open Door Initiative, Flinders University, Adelaide, South Australia, Australia
| | - Sharon Lawn
- Flinders University, Adelaide, South Australia, Australia
- Open Door Initiative, Flinders University, Adelaide, South Australia, Australia
- Lived Experience Australia Ltd, Adelaide, South Australia, Australia
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Senior E, Clarke A, Wilson-Menzfeld G. The military spouse experience of living alongside their serving/veteran partner with a mental health issue: A systematic review and narrative synthesis. PLoS One 2023; 18:e0285714. [PMID: 37200312 DOI: 10.1371/journal.pone.0285714] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 05/01/2023] [Indexed: 05/20/2023] Open
Abstract
INTRODUCTION Military healthcare studies have reported a wide range of mental health issues amongst military personnel. Globally, mental health issues are one of the main causes of ill health. Military personnel have a greater prevalence of mental health issues than that of the general population. The impact of mental health issues can be wide and far reaching for family and carers. This systematic narrative review explores the military spouse experience of living alongside their serving or veteran partner with a mental health issue. METHODS The systematic review performed was based on the PRISMA guide for searching, screening, selecting papers for data extraction and evaluation. Studies were identified from CINHAL, ASSIA, Proquest Psychology, Proquest Nursing & Allied Health source, Proquest Dissertations & Theses, ETHOS, PsychArticles, Hospital collection, Medline, Science Direct Freedom Collection and hand searching of citations and reference lists. RESULTS Twenty-seven studies were included in the narrative synthesis. Five overarching themes from the experiences of military spouses' living alongside their serving/veteran partners mental health issue were identified: caregiver burden, intimate relationships, psychological/psychosocial effects on the spouse, mental health service provision and spouse's knowledge and management of symptoms. CONCLUSIONS The systematic review and narrative synthesis identified that the majority of studies focused on spouses of veterans, very few were specific to serving military personnel, but similarities were noted. Findings suggest that care burden and a negative impact on the intimate relationship is evident, therefore highlight a need to support and protect the military spouse and their serving partner. Likewise, there is a need for greater knowledge, access and inclusion of the military spouse, in the care and treatment provision of their serving partner's mental health issue.
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Affiliation(s)
- Emma Senior
- Department of Nursing, Midwifery and Health, Northumbria University, Newcastle-Upon-Tyne, United Kingdom
| | - Amanda Clarke
- Department of Nursing, Midwifery and Health, Northumbria University, Newcastle-Upon-Tyne, United Kingdom
| | - Gemma Wilson-Menzfeld
- Department of Nursing, Midwifery and Health, Northumbria University, Newcastle-Upon-Tyne, United Kingdom
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Lawn S, Waddell E, Rikkers W, Roberts L, Beks T, Lawrence D, Rioseco P, Sharp T, Wadham B, Daraganova G, Van Hooff M. Families' experiences of supporting Australian veterans and emergency service first responders (ESFRs) to seek help for mental health problems. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e4522-e4534. [PMID: 35662301 PMCID: PMC10084143 DOI: 10.1111/hsc.13856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 03/26/2022] [Accepted: 05/05/2022] [Indexed: 06/15/2023]
Abstract
The objective of this phenomenological study was to describe families' experiences of supporting veterans and emergency service first responders (ESFRs) (known also as public safety personnel) to seek help for a mental health problem. In-depth semi-structured open-ended interviews were undertaken with 25 family members of Australian veterans and ESFRs. Fourteen participants were family members of police officers. Data were analysed thematically. Participants described a long and difficult journey of supporting the person's help-seeking across six themes. Traumatic exposures, bullying in the workplace and lack of organisational support experienced by veterans/ESFRs caused significant family distress. Families played a vital role in help-seeking but were largely ignored by veteran/ESFR organisations. The research provides a rich understanding of distress and moral injury that is experienced not only by the service members but is transferred vicariously to their family within the mental health help-seeking journey. Veteran and ESFR organisations and mental health services need to shift from a predominant view of distress as located within an individual (intrapsychic) towards a life-course view of distress as impacting families and which is more relational, systemic, cultural and contextual.
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Affiliation(s)
- Sharon Lawn
- Flinders UniversityAdelaideSouth AustraliaAustralia
- Lived Experience Australia LtdAdelaideSouth AustraliaAustralia
- Flinders UniversityOpen Door InitiativeAdelaideSouth AustraliaAustralia
| | - Elaine Waddell
- Flinders UniversityAdelaideSouth AustraliaAustralia
- Flinders UniversityOpen Door InitiativeAdelaideSouth AustraliaAustralia
| | - Wavne Rikkers
- Curtin UniversityPerthWestern AustraliaAustralia
- University of Western AustraliaPerthWestern AustraliaAustralia
| | - Louise Roberts
- Flinders UniversityAdelaideSouth AustraliaAustralia
- Flinders UniversityOpen Door InitiativeAdelaideSouth AustraliaAustralia
| | | | - David Lawrence
- Curtin UniversityPerthWestern AustraliaAustralia
- University of Western AustraliaPerthWestern AustraliaAustralia
| | - Pilar Rioseco
- Australian Institute of Family StudiesMelbourneVictoriaAustralia
| | | | - Ben Wadham
- Flinders UniversityAdelaideSouth AustraliaAustralia
- Flinders UniversityOpen Door InitiativeAdelaideSouth AustraliaAustralia
| | - Galina Daraganova
- Australian Institute of Family StudiesMelbourneVictoriaAustralia
- South‐Eastern Melbourne Primary Health NetworkMelbourneVictoriaAustralia
| | - Miranda Van Hooff
- Military and Emergency Services Health Australia (MESHA)The Hospital Research Foundation GroupAdelaideSouth AustraliaAustralia
- University of South Australia AdelaideSouth AustraliaAustralia
- University of AdelaideAdelaideSouth AustraliaAustralia
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A qualitative exploration of the physical and psychological wellbeing of family carers of veterans in Australia. PLoS One 2022; 17:e0269012. [PMID: 35657935 PMCID: PMC9165811 DOI: 10.1371/journal.pone.0269012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Accepted: 05/12/2022] [Indexed: 11/29/2022] Open
Abstract
Family carers of veterans have a tendency not to seek support for their own wellbeing concerns. Understanding the barriers and enablers that family carers face in attending to their own wellbeing and in their caring role generally, is key to supporting family carers of veterans. This qualitative study sought to explore family carers’ experiences and perceptions of their caring role, using semi-structured interviews. Questions were designed to capture concepts related to the barriers and enablers family carers face in attending to their own wellbeing. Twenty-two family carers participated in interviews. Thematic analysis facilitated the identification of key themes including the impact of the caring role; a perceived lack of recognition or appreciation of the caring role; expressed preferences for support; and consideration of the family unit. Findings suggest a need for accessible and multi-faceted support services for family carers of veterans, that target the drivers of physical and psychological wellbeing.
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Post D, van Agteren J, Kasai D, Barrett A, Doyle M, Kernot J, Baker A, Parfitt G. Caring for carers: Understanding the physical and psychological well-being of carers of veterans in Australia. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e793-e803. [PMID: 34046983 DOI: 10.1111/hsc.13449] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 04/07/2021] [Accepted: 04/28/2021] [Indexed: 06/12/2023]
Abstract
Carers of veterans tend to put their own physical and psychological well-being needs behind the needs of the person they are caring for and often do not seek assistance for their own physical and psychological well-being. Combined, these factors lead to increased risk of acute and chronic illness and mental health issues. It is acknowledged that physical activity independently contributes to improved physical and mental health and may be a driver for mental well-being in carers. The aim of this pilot research was to understand how movement behaviour and health behaviours of carers of veterans in Australia relate to carers' physical and psychological well-being. Assessment occurred between February and July 2019 and included objective, validated measures to examine physical and psychological well-being. To assess the association between physical and psychological factors, correlational analyses were performed. Twenty-eight carers participated in the pilot study (96% female, mean age 61.6 years). Exercise capacity varied, and 84% of carers met the recommended 150 min of physical activity per week, with carers spending 8.6% of their time in moderate-to-vigorous physical activity; and 37.9% of the day sedentary. Psychological health outcomes reflect a population with high distress levels and lower than average mental well-being, but with normal resilience scores. Carers with higher levels of resilience had greater exercise capacity, covering further distance in the 6-min walk test, and as resilience increased, number of sedentary bouts decreased. This research demonstrates that there is a relationship between health behaviours and psychological well-being in carers of veterans and serving personnel. Based on the findings of this pilot study, programmes to support family carers should include information about physical activity, reducing sedentary time, and increasing resilience. Interventions designed to improve physical and psychological well-being should be trialled and evaluated for effectiveness.
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Affiliation(s)
- Dannielle Post
- Allied Health and Human Performance, Alliance for Research in Exercise, Nutrition, and Activity (ARENA), University of South Australia, Adelaide, SA, Australia
| | - Joep van Agteren
- South Australian Health and Medical Research Institute (SAHMRI) Wellbeing and Resilience Centre, Adelaide, SA, Australia
| | - Daiki Kasai
- Allied Health and Human Performance, Alliance for Research in Exercise, Nutrition, and Activity (ARENA), University of South Australia, Adelaide, SA, Australia
| | - Alison Barrett
- Allied Health and Human Performance, Alliance for Research in Exercise, Nutrition, and Activity (ARENA), University of South Australia, Adelaide, SA, Australia
| | - Matthew Doyle
- Allied Health and Human Performance, Alliance for Research in Exercise, Nutrition, and Activity (ARENA), University of South Australia, Adelaide, SA, Australia
| | - Jocelyn Kernot
- Allied Health and Human Performance, Alliance for Research in Exercise, Nutrition, and Activity (ARENA), University of South Australia, Adelaide, SA, Australia
| | - Amy Baker
- Allied Health and Human Performance, University of South Australia, Adelaide, SA, Australia
| | - Gaynor Parfitt
- Allied Health and Human Performance, Alliance for Research in Exercise, Nutrition, and Activity (ARENA), University of South Australia, Adelaide, SA, Australia
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Waddell E, Lawn S, Roberts L, Henderson J, Venning A, Redpath P. "Why do you stay?": The lived-experience of partners of Australian veterans and first responders with Posttraumatic Stress Disorder. HEALTH & SOCIAL CARE IN THE COMMUNITY 2020; 28:1734-1742. [PMID: 32291885 DOI: 10.1111/hsc.12998] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 02/19/2020] [Accepted: 03/18/2020] [Indexed: 06/11/2023]
Abstract
This study examined the multidimensional nature of experiences of being an intimate partner of an Australian veteran or emergency service first responder (ESFR) with posttraumatic stress disorder (PTSD). Using a qualitative phenomenological approach, inductive thematic analysis was undertaken on data collected in 2017-2018 through individual interviews with a purposive sample of 22 partners of veterans, paramedics, fire and police officers living in Australia. Analysis revealed that the key concern of the participants was to protect their family unit and the intimate relationship, highlighting the ways in which they adapted, managed and coped with the changes that PTSD brought to the relationship. However, lack of understanding by healthcare providers, government, military and emergency service organizations of their daily lives, and of the strength of commitment to their relationship, resulted in a sense of invisibility and was revealed as the key barrier to the support they crave. The findings underscore the importance of recognizing the significance of the intimate relationship in trauma recovery and of responding to the support needs of the intimate partner.
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Affiliation(s)
- Elaine Waddell
- Paramedic Unit, College of Medicine and Public Health, Flinders University, Bedford Park, SA, Australia
| | - Sharon Lawn
- Paramedic Unit, College of Medicine and Public Health, Flinders University, Bedford Park, SA, Australia
| | - Louise Roberts
- Paramedic Unit, College of Medicine and Public Health, Flinders University, Bedford Park, SA, Australia
| | - Julie Henderson
- College of Nursing and Health Sciences, Flinders University, Bedford Park, SA, Australia
| | - Anthony Venning
- Paramedic Unit, College of Medicine and Public Health, Flinders University, Bedford Park, SA, Australia
| | - Paula Redpath
- Paramedic Unit, College of Medicine and Public Health, Flinders University, Bedford Park, SA, Australia
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Waddell E, Lawn S, Roberts L, Henderson J, Venning A, Redpath P, Godwin TS. “Their pain is our pain”: The lived experience of intimate partners in Veteran recovery from PTSD. JOURNAL OF MILITARY, VETERAN AND FAMILY HEALTH 2020. [DOI: 10.3138/jmvfh-2019-0037] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Introduction: Social support, particularly support from an intimate partner, is both a significant protective factor for trauma-exposed Veterans and critical for recovery in mental health, yet we know little about the experiences and support needs of their partners, particularly in the Australian context. This study examined the multidimensional nature of experiences of being an intimate partner of a contemporary Veteran with posttraumatic stress disorder (PTSD). Methods: The authors used a qualitative phenomenological approach to conduct an inductive thematic analysis of data collected through individual interviews with a purposive sample of 10 partners of contemporary Veterans living in Australia. Interviewees were recruited through a range of community support organizations. Results: Analysis revealed intimate partners are crucial participants in supporting the recovery journey for traumatized Veterans, effectively managing day-to-day care, encouraging autonomy and instilling hope. However, descriptions highlighted that lack of understanding of partners’ daily lives, and particularly their commitment to maintaining their intimate relationship, by health care providers and government results in a sense of invisibility and is the key barrier to receiving the support they need in order to support recovery in their Veteran partners. Discussion: The findings underscore the importance of recognizing the role of intimate relationships in trauma recovery and of responding to the support needs of intimate partners. In particular, the findings have clear implications for improving the engagement by health care providers of partners of Veterans with PTSD in Veteran clinical treatment. More formal recognition of the indirect impact of PTSD on partners of Veterans is also needed within organizational policies and procedures. Finally, there is clearly a need for continuing education of health care providers, government staff and the general community about the nature of PTSD and its impacts on relationships, particularly the intimate type.
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Affiliation(s)
- Elaine Waddell
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Sharon Lawn
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Louise Roberts
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Julie Henderson
- Nursing and Health Sciences, Flinders University, Adelaide, Australia
| | - Anthony Venning
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Paula Redpath
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
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Hammock AC, Dreyer RE, Riaz M, Clouston SAP, McGlone A, Luft B. Trauma and Relationship Strain: Oral Histories With World Trade Center Disaster Responders. QUALITATIVE HEALTH RESEARCH 2019; 29:1751-1765. [PMID: 30920915 PMCID: PMC7607908 DOI: 10.1177/1049732319837534] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Existing models of couple functioning after trauma are primarily based on the experiences of returning military veterans. In this study, we conducted thematic analysis of a purposive sample of 49 oral histories of responders to the 9/11/01 terrorist attacks to understand how they navigated life with their spouses after the response experience. Use of multiple coders and analytic matrices increased analytic rigor. In the sample, 34.7% disclosed a posttraumatic stress disorder (PTSD) diagnosis and another 22.7% mentioned experiencing at least one trauma symptom. Most responders had not sought mental health intervention, relying instead on their spouses' caregiving. Responders reported limited disclosure to their spouses about the details of their 9/11/01 response work, which may have helped them cope emotionally with repeated 9/11/01 clean-up duties. Shared values regarding the common good and patriotism were important for maintaining an intimate relationship after 9/11/01, and helping partners understand and feel understood by each other.
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Affiliation(s)
| | | | - Mishal Riaz
- Stony Brook University, Stony Brook, New York, USA
| | | | - Ashlee McGlone
- Stony Brook WTC Wellness Program, Commack, New York, USA
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Lester P, Rauch P, Loucks L, Sornborger J, Ohye B, Karnik NS. Posttraumatic Stress Disorder and Military-Connected Families: The Relevance of a Family-Centered Approach. FOCUS (AMERICAN PSYCHIATRIC PUBLISHING) 2017; 15:420-428. [PMID: 31975873 PMCID: PMC6519530 DOI: 10.1176/appi.focus.20170027] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Since the September 11, 2001, terrorist attacks, military service in the United States has been linked to a range of behavioral health and physical injuries in a significant number of the almost three million service members who have returned from wartime deployment. These injuries have occurred in the larger context of wartime military service, which is characterized by an array of stressors that have been associated with increased risk for behavioral health problems not only for service members but also for their family members. For the past 15 years, military-connected (defined as active-duty, reserve component, and veteran) family members have shared their own experiences of military service, including multiple deployments in the context of danger, high operational stress within their communities, and living with the physical and behavioral health injuries and ongoing care needs of a loved one. This article provides an overview of the evolving research on the specific impact of posttraumatic stress disorder (PTSD) and other war zone-related behavioral health problems among families in the context of contemporary warfare, as well as research on the impact of family adjustment on veteran recovery and care. We propose an empirically supported, family-centered framework to inform a continuum of prevention and care for veterans with PTSD and their families. Gaps in the current continuum of behavioral health services for veterans with PTSD are identified, as well as efforts underway to develop trauma-informed, family-centered screening, prevention, and treatment approaches. Future research recommendations are provided.
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Affiliation(s)
- Patricia Lester
- Dr. Lester is with the Nathanson Family Resilience Center, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles (UCLA). Dr. Rauch is with the Department of Psychiatry, Massachusetts General Hospital, Boston. Dr. Loucks is with the Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta. Dr. Sornborger is with Operation Mend, UCLA Health. Dr. Ohye is with the Massachusetts General Hospital Program, Harvard Medical School, Boston. Dr. Karnik is with the Department of Psychiatry, Rush University Medical Center, Chicago
| | - Paula Rauch
- Dr. Lester is with the Nathanson Family Resilience Center, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles (UCLA). Dr. Rauch is with the Department of Psychiatry, Massachusetts General Hospital, Boston. Dr. Loucks is with the Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta. Dr. Sornborger is with Operation Mend, UCLA Health. Dr. Ohye is with the Massachusetts General Hospital Program, Harvard Medical School, Boston. Dr. Karnik is with the Department of Psychiatry, Rush University Medical Center, Chicago
| | - Laura Loucks
- Dr. Lester is with the Nathanson Family Resilience Center, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles (UCLA). Dr. Rauch is with the Department of Psychiatry, Massachusetts General Hospital, Boston. Dr. Loucks is with the Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta. Dr. Sornborger is with Operation Mend, UCLA Health. Dr. Ohye is with the Massachusetts General Hospital Program, Harvard Medical School, Boston. Dr. Karnik is with the Department of Psychiatry, Rush University Medical Center, Chicago
| | - Jo Sornborger
- Dr. Lester is with the Nathanson Family Resilience Center, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles (UCLA). Dr. Rauch is with the Department of Psychiatry, Massachusetts General Hospital, Boston. Dr. Loucks is with the Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta. Dr. Sornborger is with Operation Mend, UCLA Health. Dr. Ohye is with the Massachusetts General Hospital Program, Harvard Medical School, Boston. Dr. Karnik is with the Department of Psychiatry, Rush University Medical Center, Chicago
| | - Bonnie Ohye
- Dr. Lester is with the Nathanson Family Resilience Center, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles (UCLA). Dr. Rauch is with the Department of Psychiatry, Massachusetts General Hospital, Boston. Dr. Loucks is with the Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta. Dr. Sornborger is with Operation Mend, UCLA Health. Dr. Ohye is with the Massachusetts General Hospital Program, Harvard Medical School, Boston. Dr. Karnik is with the Department of Psychiatry, Rush University Medical Center, Chicago
| | - Niranjin S Karnik
- Dr. Lester is with the Nathanson Family Resilience Center, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles (UCLA). Dr. Rauch is with the Department of Psychiatry, Massachusetts General Hospital, Boston. Dr. Loucks is with the Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta. Dr. Sornborger is with Operation Mend, UCLA Health. Dr. Ohye is with the Massachusetts General Hospital Program, Harvard Medical School, Boston. Dr. Karnik is with the Department of Psychiatry, Rush University Medical Center, Chicago
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