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Sullivan KS, Park Y, Richardson S, Stander V, Jaccard J. The role of problem solving appraisal and support in the relationship between stress exposure and posttraumatic stress symptoms of military spouses and service member partners. Stress Health 2024; 40:e3371. [PMID: 38183368 PMCID: PMC11285057 DOI: 10.1002/smi.3371] [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: 05/16/2023] [Revised: 11/15/2023] [Accepted: 12/27/2023] [Indexed: 01/08/2024]
Abstract
Using a stress process lens, this paper considers the interrelationship between individual and family-level stress exposures and military spouse resources, including problem-solving appraisals and problem-solving support (PSS), and their associations with posttraumatic stress symptoms (PTSS) among both partners in military marital dyads. The study employs data from the Millennium Cohort Family Study, a longitudinal survey of married military dyads, with an initial panel of 9,872 spouses enroled from 2011 to 2013. A structural equation model explored the associations between service member and spouse childhood maltreatment exposure, nonmilitary and military stressors, as well as interactions with spouse resources on self-reported PTSS among both service member (SM) and spouse (SP). Among our findings, spouse childhood maltreatment muted later self-reported problem-solving appraisal and support. Spouse resources, in turn, had both protective (problem-solving appraisal) and promotive (problem-solving support) effects on PTSS for both service members and spouses. These findings emphasise the central role of spouses in military families, as more psychological resources among spouses appeared to buffer against the deleterious effects of stress exposure on both their own and their partners mental health.
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Affiliation(s)
| | - Yangjin Park
- School of Social Work, University of Texas at Arlington, Arlington, Texas, USA
| | - Sabrina Richardson
- Center For Deployment Health Research, Naval Health Research Center, San Diego, California, USA
- Leidos, Inc., San Diego, California, USA
| | - Valerie Stander
- Center For Deployment Health Research, Naval Health Research Center, San Diego, California, USA
| | - James Jaccard
- Silver School of Social Work, New York University, New York, New York, USA
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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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3
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Guérin E, Richer I. Piloting the home ship: Understanding the deployment experience of Canadian Special Operations Forces Command spouses. MILITARY PSYCHOLOGY 2024; 36:168-183. [PMID: 38377246 PMCID: PMC10880494 DOI: 10.1080/08995605.2022.2153548] [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: 10/29/2021] [Accepted: 10/04/2022] [Indexed: 12/24/2022]
Abstract
Special Operations Forces (SOF) members are frequently deployed to hostile environments for prolonged periods of time, and their families are exposed to unique difficulties and stressors. The purpose of this study was to describe the lived experience of Canadian Special Operations Forces Command (CANSOFCOM) spouses as it relates to the intensity of the SOF deployment process. As part of a larger study, semi-structured interviews were conducted with 29 spouses of CANSOFCOM members. The interviews were coded and analyzed using thematic analysis to identify the central dimensions of spouses' experience with deployment. Participants reflected on their experiences, from pre-deployment to post-deployment, and as they transitioned between deployments, across social/relational, practical/instrumental, and psychological/emotional dimensions. The findings raised important concerns regarding perpetual transitions for the family unit and exhaustion among spouses faced with a deployment loop that never closes. Although results echoed previous studies, in terms of the strain of solo-parenting and coping with children's emotional needs, communication and maintaining connections, these aspects were uniquely affected by repeated deployments, prolonged time away, operations security, and high organizational demands. Although many spouses acquired the strength and skills to cope with the lifestyle, the findings suggest several opportunities to tailor resources and support services to their dynamic needs.
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Affiliation(s)
- Eva Guérin
- Department of National Defence, Director General Military Personnel Research and Analysis, Ottawa, Ontario, Canada
| | - Isabelle Richer
- Department of National Defence, Director General Military Personnel Research and Analysis, Ottawa, Ontario, Canada
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Sullivan KS, Park Y, Richardson S, Cederbaum J, Stander V, Jaccard J. Early and recent military and nonmilitary stressors associated with posttraumatic stress symptoms among military service members and their spouses. J Trauma Stress 2023; 36:943-954. [PMID: 37467117 PMCID: PMC10592439 DOI: 10.1002/jts.22958] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 05/24/2023] [Accepted: 06/09/2023] [Indexed: 07/21/2023]
Abstract
Disparities in posttraumatic stress symptoms (PTSS) have been observed among military service members (SMs) and spouses (SPs) compared to their civilian peers, but exposure to military stressors does not adequately explain observed differences. Using a stress process framework, this study considered the associations between early and recent military and nonmilitary stressors and PTSS among SMs and SPs. We analyzed data from 3,314 SM-SP dyads in the Millennium Cohort and Millennium Cohort Family Studies. Accounting for covariates, multiple linear regression and dominance analyses were employed to consider the effects of SM and SP childhood maltreatment, recent nonmilitary stressors (e.g., financial difficulties), and recent military stressors (e.g., deployment) on their own and their partner's self-reported PTSS. For both SMs and SPs, childhood maltreatment was the strongest predictor of their own PTSS, followed by nonmilitary stressors. Couple crossover dynamics were evident as SP maltreatment and nonmilitary stressors significantly predicted SM PTSS, and SM maltreatment predicted SP PTSS. Maltreatment also multiplied the effects of SM, product term B = 0.92, p = .031, and SP, product term B = 0.75, p = .004, nonmilitary stressors. The findings emphasize the essential role of exposure to early adversity in understanding PTSS among SMs and SPs, as childhood maltreatment strongly predicted PTSS and exacerbated the effects of other stressors on PTSS. Providers should assess for early adversity among both SMs and SPs and consider the provision of services at the couple level given the potential for the transmission of stress within couples.
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Affiliation(s)
| | - Yangjin Park
- School of Social Work, University of Texas at Arlington, Arlington, Texas, USA
| | - Sabrina Richardson
- Center for Deployment Health Research, Naval Health Research Center, San Diego, California, USA
- Leidos, Inc., San Diego, California, USA
| | - Julie Cederbaum
- Suzanne Dworak-Peck School of Social Work; University of Southern California, Los Angeles; Los Angeles, California, USA
| | - Valerie Stander
- Center for Deployment Health Research, Naval Health Research Center, San Diego, California, USA
| | - James Jaccard
- Silver School of Social Work, New York University, New York, New York, USA
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5
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Runge CE, Moss KM, Dean JA, Wallera M. Australian military personnel perspectives on family, service, and deployment: An analysis of open-ended survey data. JOURNAL OF MILITARY, VETERAN AND FAMILY HEALTH 2023. [DOI: 10.3138/jmvfh-2022-0054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/03/2023]
Abstract
LAY SUMMARY Most research on military family health has involved talking to spouses, but what do military personnel think? Personnel may identify different issues that have not had the attention of research or armed forces. This study used the “Any other comments?” question in a military family survey to get their thoughts. Australian Defence Force regular and reserve personnel who were in the army, navy, or air force completed the survey. There were 264 personnel who talked about families, and key issues and views were identified from their responses. These included the challenge of living away from families for service reasons and a feeling of “talk, not action” on work and family balance. Responses revealed that non-family-friendly practices affected the health of families. They also caused personnel to leave regular service or the military altogether. Armed forces should work to match practices with policies. This study also shows how open-ended-comment questions in surveys are useful for research and give military personnel a chance to have their say.
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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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7
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Sharp ML, Solomon N, Harrison V, Gribble R, Cramm H, Pike G, Fear NT. The mental health and wellbeing of spouses, partners and children of emergency responders: A systematic review. PLoS One 2022; 17:e0269659. [PMID: 35704626 PMCID: PMC9200352 DOI: 10.1371/journal.pone.0269659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 05/26/2022] [Indexed: 11/18/2022] Open
Abstract
Emergency responders (ERs), often termed First Responders, such as police, fire and paramedic roles are exposed to occupational stressors including high workload, and exposure to trauma from critical incidents, both of which can affect their mental health and wellbeing. Little is known about the impact of the ER occupation on the mental health and wellbeing of their families. The aim of the current study was to investigate what mental health and wellbeing outcomes and experiences have been researched internationally in ER families, and to examine the prevalence and associated risk and protective factors of these outcomes. We conducted a systematic review in accordance with an a priori PROSPERO approved protocol (PROSPERO 2019 CRD42019134974). Forty-three studies were identified for inclusion. The majority of studies used a quantitative, cross-sectional design and were conducted in the United States; just over half assessed police/law enforcement families. Themes of topics investigated included: 1) Spousal/partner mental health and wellbeing; 2) Couple relationships; 3) Child mental health and wellbeing; 4) Family support and coping strategies; and 5) Positive outcomes. The review identified limited evidence regarding the prevalence of mental health and wellbeing outcomes. Family experiences and risk factors described were ER work-stress spillover negatively impacting spousal/partner wellbeing, couple relationships, and domestic violence. Traumatic exposure risk factors included concerns family had for the safety of their ER partner, the negative impact of an ER partners’ mental health problem on the couples’ communication and on family mental health outcomes. Protective factors included social support; however, a lack of organisational support for families was reported in some studies. Study limitations and future research needs are discussed. Progressing this area of research is important to improve knowledge of baseline needs of ER families to be able to target interventions, improve public health, and support ER’s operational effectiveness.
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Affiliation(s)
- Marie-Louise Sharp
- Department of Psychological Medicine, King’s Centre for Military Health Research, King’s College London, London, United Kingdom
- * E-mail:
| | - Noa Solomon
- Care Quality Commission, London, United Kingdom
| | - Virginia Harrison
- Faculty of Arts and Social Sciences, School of Psychology and Counselling, The Open University, London, United Kingdom
- The Centre for Policing Research and Learning, The Open University, London, United Kingdom
| | - Rachael Gribble
- Department of Psychological Medicine, King’s Centre for Military Health Research, King’s College London, London, United Kingdom
| | - Heidi Cramm
- Faculty of Health Sciences, School of Rehabilitation Therapy, Queen’s University, Kingston, Canada
| | - Graham Pike
- Faculty of Arts and Social Sciences, School of Psychology and Counselling, The Open University, London, United Kingdom
- The Centre for Policing Research and Learning, The Open University, London, United Kingdom
| | - Nicola T. Fear
- Department of Psychological Medicine, King’s Centre for Military Health Research, King’s College London, London, United Kingdom
- Academic Department of Military Mental Health, Department of Psychological Medicine, King’s College London, London, United Kingdom
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8
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Pollmann JB, Skovdal M. “My children do not deserve it”: Understanding how epiphanies instigate support-seeking practices among veteran families living with PTSD in Denmark. SSM - MENTAL HEALTH 2022. [DOI: 10.1016/j.ssmmh.2022.100091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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9
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Ross AM, DeVoe ER, Steketee G, Spencer R, Richter M. "This is not your Life…and it becomes your Life": A Qualitative Exploration of Deployment-related Stress and Support needs in National Guard and Reserve spouses who are Mothers of Young Children. FAMILY PROCESS 2021; 60:1364-1380. [PMID: 33247431 DOI: 10.1111/famp.12622] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
The adverse effects of deployment-related stress (DRS) on military service members, spouses, and children are well documented. Findings from a recent Consensus Report on Military Families by the National Academies of Science, Engineering, and Medicine (2019) underscore the priority of gaining a more comprehensive understanding of the diversity of today's military families and their needs and well-being. While social support is generally regarded as helpful during times of stress, it has not been studied extensively in National Guard/Reserve spouses who are parents of young children. This qualitative study of 30 women examines the unique ways in which DRS affects women who are National Guard/Reserve spouses and mothers of young children, as well as the processes through which they encountered support to manage these stressors. Salient themes spanned experiences involving deployment cycle phases of separation and reintegration and included both anticipated and unanticipated changes in family-related division of labor, dynamics, and communication patterns. These were complicated by geographic, social, and cultural isolation and misguided efforts to support spouses initiated by civilians. Women managed these stressors primarily through seeking, acquiring, and repurposing existing sources of informal social support for themselves and formal supports for their children, with varying degrees of success.
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Affiliation(s)
- Abigail M Ross
- Fordham University Graduate School of Social Service, New York, NY, USA
| | - Ellen R DeVoe
- Boston University School of Social Work, Boston, MA, USA
| | - Gail Steketee
- Boston University School of Social Work, Boston, MA, USA
| | - Renée Spencer
- Boston University School of Social Work, Boston, MA, USA
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10
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Hendrikx LJ, Murphy D. Supporting the Mental Health Needs of Military Partners Through the Together Webinar Program: Pilot Randomized Controlled Trial. JMIR Ment Health 2021; 8:e25622. [PMID: 34636734 PMCID: PMC8548968 DOI: 10.2196/25622] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 05/21/2021] [Accepted: 06/03/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Despite an increased risk of psychological difficulties, there remains a lack of evidence-based support for the mental health needs of military partners. OBJECTIVE This study aims to investigate whether the Together Webinar Programme (TTP-Webinar), a 6-week structured, remote access group intervention would reduce military partners' experience of common mental health difficulties and secondary trauma symptoms. METHODS A pilot randomized controlled trial was used to compare the TTP-Webinar intervention with a waitlist control. The sample was UK treatment-seeking veterans engaged in a mental health charity. A total of 196 military partners (1 male and 195 females; aged mean 42.28, SD 10.82 years) were randomly allocated to the intervention (n=97) or waitlist (n=99) condition. Outcome measures were self-reported measures of common mental health difficulties, secondary trauma symptoms, and overall quality of life rating. RESULTS Compared with the waitlist, military partners in the TTP-Webinar had reduced common mental health difficulties (P=.02) and secondary trauma symptoms (P=.001). However, there was no difference in quality-of-life ratings (P=.06). CONCLUSIONS The results suggest that TTP-Webinar is an effective intervention to support the mental health difficulties of military partners. This study provides promising evidence that webinars may be an appropriate platform for providing group-based support. TRIAL REGISTRATION ClinicalTrials.gov NCT05013398; https://clinicaltrials.gov/ct2/show/NCT05013398.
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Affiliation(s)
| | - Dominic Murphy
- Combat Stress, Leatherhead, United Kingdom
- King's Centre for Military Health Research, King's College London, London, United Kingdom
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11
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Caddick N, Fossey M. Should we give military families a break? A call for research on military family holidays. BMJ Mil Health 2021; 169:269-270. [PMID: 34253644 DOI: 10.1136/bmjmilitary-2021-001844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 06/17/2021] [Indexed: 11/03/2022]
Abstract
While the well-being of the family unit is increasingly acknowledged (eg, in academic research, policy debate and podcast media) as central to the fitness and resilience of the Armed Forces, initiatives to support family well-being have been slow to emerge. One proposed means of support is the provision of holidays (whether abroad or 'staycations') to families who may be struggling to cope with stressors related to military life. Building on evidence from leisure and tourism studies, holidays are understood as providing benefits to family well-being, including rest and recuperation, respite from the stressors of everyday life, and building resilience and social capital. With a view to developing policy and practice, we suggest that research could meaningfully examine the use of holidays as a means of supporting military families. This article aims to stimulate debate regarding how families are supported within the UK Armed Forces.
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Affiliation(s)
- Nick Caddick
- Veterans and Families Institute, Anglia Ruskin University - Rivermead Campus, Chelmsford, UK
| | - M Fossey
- Veterans and Families Institute, Anglia Ruskin University, Chelmsford, UK
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12
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Roche R, Manzi J, Bard K. A Patient-Centered Study Examining Self-Identification of Mental Health Challenges Among Female Military Officers. J Patient Cent Res Rev 2021; 8:134-139. [PMID: 33898646 PMCID: PMC8060039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023] Open
Abstract
Due to the expansion of leadership roles in the military for women, female military personnel now face stressors equal to, and yet unique from, their male counterparts. This pilot study surveyed 73 female U.S. Army officers regarding their experiences of leadership and mental wellness within the military. A mixed-methods survey was distributed via 2 private Facebook groups for female Army officers following an anonymized convenience sampling. This anonymous, patient-centered protocol was used to protect against known stigma surrounding disclosing mental health concerns in the military. Respondents were asked a series of questions including perceived mental health status and access to behavioral health services. Most respondents reported feelings of stress related to their roles as officers (86.6%). Self-reported feelings of anxiety (83.6%) and depression (65.7%) were high. In contrast, only 30.1% had ever received a formal diagnosis of anxiety or depression by a mental health professional. Our survey confirmed a large percentage, 65.7% of respondents, reported avoiding mental/behavioral health services. Female military officers are able to recognize their feelings as symptoms of anxiety and depression; however, many take active steps to hide these symptoms from their family members and senior officers and avoid seeking professional care.
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Affiliation(s)
- Rosellen Roche
- Department of Primary Care, Ohio University Heritage College of Osteopathic Medicine, Cleveland, OH
| | - Joel Manzi
- Department of Primary Care, Ohio University Heritage College of Osteopathic Medicine, Cleveland, OH
| | - Katelyn Bard
- Department of Primary Care, Ohio University Heritage College of Osteopathic Medicine, Cleveland, OH
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13
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Rossiter AG, Ling CG. Building resilience in US military families: why it matters. BMJ Mil Health 2021; 168:91-94. [PMID: 33785586 DOI: 10.1136/bmjmilitary-2020-001735] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 03/04/2021] [Accepted: 03/15/2021] [Indexed: 11/03/2022]
Abstract
Service members and their families have endured significant stressors over the past 19 years in support of the nation's engagement in the wars in Iraq and Afghanistan. 'Resilience' is the term most commonly used to describe the military spouse and military-connected child. However, due to a paucity of research on military families, little is known about the impact of spousal/parental military service on the military family. The ability of the healthcare provider is critical to ensuring the success of the military spouse and military-connected child. Providers can support the physical and psychological health needs of military families through (1) identification of military family members in clinical practice and (2) providing culturally competent care that correlates the unique lifestyle and physical and psychological health exposures associated with spousal/parental military service. Historically, in the United States, there has been a proud legacy of generational military service in families-upwards of 80% of new recruits have a family member who has served in the military. The leading factor associated with retention of the service member on Active Duty or in the Reserve or National Guard is the satisfaction of the at-home spouse. Disenfranchising the military spouse and lack of services and support for military-connected children could create a gap in meeting recruitment goals creating a threat to national security in the United States.
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Affiliation(s)
| | - C G Ling
- School of Nursing, Johns Hopkins University, Baltimore, Maryland, USA
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14
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Mallonee S, Riggs D, Stander V. The impact of family stressors and resources on military spouse's perception of post-deployment reunion stress. MILITARY PSYCHOLOGY 2020; 32:369-379. [PMID: 38536293 PMCID: PMC10013365 DOI: 10.1080/08995605.2020.1785268] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2019] [Accepted: 06/15/2020] [Indexed: 10/23/2022]
Abstract
Much of the prior research on variables impacting spouses' perceptions of reunion stress have focused on individual variables and have not examined these variables within their shared context, despite the indication from some research and theory that this is a key component of understanding couple's responses to stressors. The present study examined the impact of various family stressors and resources, both independently and in conjunction with each other, on spouses' perceptions of reunion stress. To examine these variables, the present study utilized cross-sectional data from a representative sample of 1,558 military service members and their spouses participating in the Millennium Cohort Family Study. Results indicated that poorer mental health among spouses and service members was associated with increased reunion stress as reported by spouses across all models tested. In addition, stressful communication during deployment was significantly associated with spouses' perceptions of reunion stress. These results can help guide more targeted prevention and intervention efforts to decrease spouses' sense of reunion stress.
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Affiliation(s)
- Sybil Mallonee
- Department of Medical & Clinical Psychology, Uniformed Services University, Bethesda, Maryland
| | - David Riggs
- Department of Medical & Clinical Psychology, Uniformed Services University, Bethesda, Maryland
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15
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Franz MR, Kaiser AP, Phillips RJ, Lee LO, Lawrence AE, Taft CT, Vasterling JJ. Associations of warzone veteran mental health with partner mental health and family functioning: Family Foundations Study. Depress Anxiety 2020; 37:1068-1078. [PMID: 32805764 PMCID: PMC8252135 DOI: 10.1002/da.23083] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2020] [Revised: 07/01/2020] [Accepted: 07/06/2020] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION Warzone participation is associated with increased risk of stress-related psychopathology, including posttraumatic stress disorder (PTSD) and depression. Prior research suggests that the mental health of spouses of warzone veterans (WZVs) is linked to that of their partners. Additionally, PTSD among WZVs has been associated with marital dysfunction. Less is known about the effects of depression among WZVs on partner mental health and family relationships. We sought in this study to examine associations between WZV PTSD and depression and partner mental health and relationship outcomes. METHODS Using a nationally dispersed sample of Iraq and Afghanistan veterans and their married and unmarried intimate partners, 245 dyads completed structured psychiatric interviews and psychometric surveys assessing family functioning and relationship aggression. RESULTS Adjusted regression analyses indicated that depression among WZVs was associated with partner depression and anxiety disorders. WZV PTSD and depression were also associated with partner-reported relationship dysfunction, dissatisfaction, and communication issues, and higher rates of intimate partner aggression victimization and perpetration. CONCLUSIONS Mental health consequences of war extend beyond WZVs to the mental health of their intimate partners and their relationships with intimate partners.
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Affiliation(s)
- Molly R. Franz
- National Center for PTSD, VA Boston Healthcare System, Boston, Massachusetts,Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts
| | - Anica Pless Kaiser
- National Center for PTSD, VA Boston Healthcare System, Boston, Massachusetts,Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts,Psychology Service, VA Boston Healthcare System, Boston, Massachusetts
| | | | - Lewina O. Lee
- National Center for PTSD, VA Boston Healthcare System, Boston, Massachusetts,Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts,Psychology Service, VA Boston Healthcare System, Boston, Massachusetts
| | - Amy E. Lawrence
- Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts,Psychology Service, VA Boston Healthcare System, Boston, Massachusetts
| | - Casey T. Taft
- National Center for PTSD, VA Boston Healthcare System, Boston, Massachusetts,Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts,Psychology Service, VA Boston Healthcare System, Boston, Massachusetts
| | - Jennifer J. Vasterling
- National Center for PTSD, VA Boston Healthcare System, Boston, Massachusetts,Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts,Psychology Service, VA Boston Healthcare System, Boston, Massachusetts
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16
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Sullivan KS, Hawkins SA, Gilreath TD, Castro CA. Preliminary Psychometrics and Potential Big Data Uses of the U.S. Army Family Global Assessment Tool. ACTA ACUST UNITED AC 2020; 8:74-85. [PMID: 32884854 DOI: 10.1080/21635781.2019.1676334] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The purpose of the present study is to explore the psychometric properties of the U.S. Army's Family Global Assessment Tool (GAT), which assesses the psychosocial fitness of Army families. With data from 1,692 Army spouses, we examined the structure, reliability and validity of the GAT, using confirmatory factor analysis (CFA) and two validity studies. Fifty-three items and 9 factors were retained following CFA. This model provided a good fit, and scales demonstrated strong internal consistency. Bivariate correlations and results from a theoretically driven model provide preliminary evidence of validity. Findings support the usefulness of the GAT for measuring psychosocial fitness of Army spouses.
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Affiliation(s)
- Kathrine S Sullivan
- New York University, Silver School of Social Work, 1 Washington Square North, New York, NY 10003
| | - Stacy A Hawkins
- Research Facilitation Laboratory, Army Analytics Group, 20 Ryan Ranch Road, Suite 170, Monterey, CA 93940
| | - Tamika D Gilreath
- Transdisciplinary Center for Health Equity Research, Texas A&M University Department of Health and Kinesiology, College Station, TX 77843
| | - Carl A Castro
- Center for Innovation and Research on Veterans and Military Families, University of Southern California School of Social Work, 1150 S. Olive Street, Suite 1400, Los Angeles, CA 90015
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17
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Gribble R, Mahar AL, Keeling M, Sullivan K, McKeown S, Burchill S, Fear NT, Castro CA. Are we family? A scoping review of how military families are defined in mental health and substance use research. JOURNAL OF MILITARY, VETERAN AND FAMILY HEALTH 2020. [DOI: 10.3138/jmvfh-2019-0054] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Introduction: While some families may experience poor mental health, substance use, and poor school performance due to service life, the usefulness and applicability of these research findings may be affected by how representative study participants are of the broader population. This article aims to examine how research on mental health and substance use defines a “military family” to understand if the current body of evidence reflects the increasing diversity of this population. Methods: A systematic search of academic articles was conducted in Ovid MEDLINE, Ovid Embase, Ovid PsycINFO, Ebsco CINAHL and ProQuest PILOTS using database-specific subject headings and keyword searches for ‘military’, ‘family’, ‘mental health’ and ‘substance use’. Sociodemographic and military characteristics of study participants were extracted to identify who was and was not included. Results: The most commonly represented family structure was the traditional, heteronormative family comprised of a male service member married to a female civilian with whom they have children. Military couples without children, dual-serving couples, families of LGBTQ personnel, unmarried and new relationships, single parents, male spouses/partners, Veterans not seeking Veterans Affairs (VA) services, and families with additional challenges were regularly not reflected in the research due to implicit or explicit exclusion from studies. Discussion: Research on mental health and substance use among the family members of service personnel continues to reflect the traditional, heteronormative family. Future studies should consider more inclusive definitions of family and creative approaches to recruitment to ensure research in this area reflects the experiences, needs, and strengths of an increasingly diverse military community.
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Affiliation(s)
- Rachael Gribble
- King’s Centre for Military Health Research (KCMHR), Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, United Kingdom
| | - Alyson L. Mahar
- Manitoba Centre for Health Policy, Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Mary Keeling
- Center for Innovation and Research on Veterans and Military Families, University of Southern California, Los Angeles, California, USA
- Centre for Appearance Research, University of the West of England, Frenchay Campus, Bristol, United Kingdom
| | - Kate Sullivan
- Center for Innovation and Research on Veterans and Military Families, University of Southern California, Los Angeles, California, USA
- Silver School of Social Work, New York University, New York, New York, USA
| | - Sandra McKeown
- Bracken Health Sciences Library, Queen’s University, Kingston, Ontario, Canada
| | - Susan Burchill
- Manitoba Centre for Health Policy, Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Nicola T. Fear
- King’s Centre for Military Health Research (KCMHR), Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, United Kingdom
- Academic Department of Military Mental Health, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, United Kingdom
| | - Carl A. Castro
- Center for Innovation and Research on Veterans and Military Families, University of Southern California, Los Angeles, California, USA
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18
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Roche R, Manzi J, Bard K. A Double Bind for the Ties that Bind: A Pilot Study of Mental Health Challenges among Female US Army Officers and Impact on Family Life. JOURNAL OF VETERANS STUDIES 2020. [DOI: 10.21061/jvs.v6i1.164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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19
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Hendrikx LJ, Murphy D. Exploring the Acceptability of The Together Webinar Programme for Military Partners: A Qualitative Study. Telemed J E Health 2020; 26:1475-1482. [PMID: 32074478 DOI: 10.1089/tmj.2019.0309] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Military partners appear at risk for developing psychological difficulties such as depression, generalized anxiety, and secondary trauma symptoms. Yet, evidence suggests that participants report an array of barriers that prevent them from seeking and engaging with mental health support. This includes stigma-related beliefs, work and childcare responsibilities, and distance to venue where support is offered. Introduction: The Together Webinar Programme (TTP-Webinar) was developed to increase the accessibility of mental health support for military partners. The efficacy of this program has been explored in a previous study. Materials and Methods: Data for this study were taken from 68 partners who provided qualitative feedback of the program. Thematic qualitative analysis was used to explore the views of participants about the acceptability of TTP-Webinar. Results: Four main themes were identified, namely perceived benefit, modality, general barriers, and areas for improvement. Discussion: Participants found it favorable to develop a better understanding of veterans' difficulties, to have their own difficulties normalized through sharing and discussion, and to feel part of a wider community. They also found the webinar format favorable as it increased the accessibility of support and provided them with an interactive safe platform. Conclusions: The study provides promising qualitative evidence for the use of TTP-Webinar in supporting the mental health needs of military partners.
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Affiliation(s)
| | - Dominic Murphy
- Research Department, Combat Stress, Leatherhead, United Kingdom.,King's Centre for Military Health Research, King's College London, London, United Kingdom
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20
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Kulak JA, Fillo J, Homish DL, Kahn L, Homish GG. Substance use and mental health among military spouses and partners. ACTA ACUST UNITED AC 2019; 7:257-267. [PMID: 31844559 DOI: 10.1080/21635781.2019.1591314] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Research on the behavioral health of military spouses/partners is essential, yet lacking. Data on 344 civilian spouses were drawn from a study of U.S. Army Reserve/National Guard soldier couples. This project characterizes civilian spouses' behavioral health symptoms. Regression analyses assessed the relationship between substance use and mental health symptoms. Overall, findings indicate civilian spouses had behavioral health impairments. Mental health, alcohol use, and tobacco use did not differ by soldiers' deployment history; illicit drug use and non-medical use of prescription drugs did at trend level. Support initiatives focusing on all military spouses, not just those of deployed soldiers, are needed.
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Affiliation(s)
- Jessica A Kulak
- University at Buffalo - The State University of New York, Family Medicine, Buffalo, New York.,Buffalo State College - The State University of New York, Health, Nutrition, and Dietetics, Buffalo, New York
| | - Jennifer Fillo
- University at Buffalo - The State University of New York, Clinical and Research Institute on Addictions, Buffalo, New York
| | - D Lynn Homish
- University at Buffalo - The State University of New York, Community Health and Health Behavior, Buffalo, New York
| | - Linda Kahn
- University at Buffalo - The State University of New York, Family Medicine, Buffalo, New York
| | - Gregory G Homish
- University at Buffalo - The State University of New York, Community Health and Health Behavior, Buffalo, New York
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21
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Blamey H, Phillips A, Hess DC, Fear NT. The impact of parental military service on child well-being. JOURNAL OF MILITARY, VETERAN AND FAMILY HEALTH 2019. [DOI: 10.3138/jmvfh.2019-0014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Introduction: The aim of this review is to evaluate the literature on the association between parental military-related factors and child well-being. Methods: We conducted a literature search for research published from 2000–2017 from NATO and Partnership for Peace (PfP) countries in the English language only. Eligible studies were those that included topics of military personnel and children’s well-being; papers that included child maltreatment/abuse were excluded. Search databases included Embase, Medline, PsycINFO, ScienceDirect, Web of Science, Google Scholar, and PubMed. Results: Thirty-six predominantly United States (US)-based studies were included in the review: 27 of cross-sectional study design, 4 longitudinal, and 5 retrospective cohort studies. Discussion: The parental military-specific factors that affect child well-being are cumulative deployment months, frequent relocation, and factors related to relocation such as expanded household responsibility, disrupted daily routines, academic interruption, and disruption to social networks. These factors are associated with military children having higher levels of emotional and behavioural difficulties – such as symptoms of depression – than their civilian counterparts. Limitations of the review include the large proportion of studies with a cross-sectional design, as well as studies with small sample sizes. Indications for future research include looking at children from dual military families and the use of longitudinal study designs.
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Affiliation(s)
- Helen Blamey
- King’s Centre for Military Health Research, and Academic Department of Military Mental Health, King’s College London, London, United Kingdom
| | - Ava Phillips
- King’s Centre for Military Health Research, and Academic Department of Military Mental Health, King’s College London, London, United Kingdom
| | - Donabelle C. Hess
- 470th Air Base Squadron, Department of the Air Force, Geilenkirchen NATO Air Base, Germany
| | - Nicola T. Fear
- King’s Centre for Military Health Research, and Academic Department of Military Mental Health, King’s College London, London, United Kingdom
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22
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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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23
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Sinclair RR, Paulson AL, Riviere LA. The Resilient Spouse: Understanding Factors Associated With Dispositional Resilience Among Military Spouses. ACTA ACUST UNITED AC 2019. [DOI: 10.1080/21635781.2019.1608876] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Robert R. Sinclair
- Department of Military Psychiatry, Center for Military Psychiatry and Neurosciences, Silver Spring, Maryland
- Department of Psychology, Clemson University, Clemson, South Carolina
| | | | - Lyndon A. Riviere
- Department of Military Psychiatry, Center for Military Psychiatry and Neurosciences, Silver Spring, Maryland
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24
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Toomey R, Alpern R, Reda DJ, Baker DG, Vasterling JJ, Blanchard M, Eisen SA. Mental health in spouses of U.S. Gulf War veterans. Psychiatry Res 2019; 275:287-295. [PMID: 30953873 DOI: 10.1016/j.psychres.2019.03.043] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Revised: 03/25/2019] [Accepted: 03/25/2019] [Indexed: 11/27/2022]
Abstract
Veterans' spouses are at risk for mental distress and substance use. We examined long term psychological functioning in spouses from a national cohort of 1991 Gulf War era veterans. From clinical interviews, spouses of deployed veterans (n = 488) did not have a greater prevalence of post-war mental disorders compared to spouses of non-deployed veterans (n = 536); however, in couples that were living together since the war, there was an increased risk of anxiety disorders or any one disorder. On questionnaires, the impact varied but was most consistently observed in more severe depression and greater functional impairment in spouses of deployed compared to non-deployed veterans. If a veteran developed post-war anxious/depressive disorders or any one mental disorder, the matched spouse was more likely to develop post-war anxious/depressive disorders or any one mental disorder, respectively. Veteran combat exposure did not similarly increase the risk of spouse post-war mental disorders. Greater spouse self-reported symptomatology was observed in spouses of veterans with anxious/depressive disorders even when controlling for deployment. In summary, the war conferred greater risk for spouse mental disorders and distress for spouses of veterans with mental health disorders, with some increased risk for spouses of deployed veterans, especially in couples together since the war.
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Affiliation(s)
- Rosemary Toomey
- Department of Psychological and Brain Sciences, College of Arts and Sciences, Boston University, 900 Commonwealth Ave., Boston, MA, USA.
| | - Renee Alpern
- Cooperative Study Program Coordinating Center, Edward Hines Jr. VA Hospital, Hines, IL, USA
| | - Domenic J Reda
- Cooperative Study Program Coordinating Center, Edward Hines Jr. VA Hospital, Hines, IL, USA
| | - Dewleen G Baker
- VA Center of Excellence for Stress and Mental Health and VA San Diego Healthcare System, San Diego, CA, USA; Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
| | - Jennifer J Vasterling
- National Center for PTSD and Psychology Service, VA Boston Healthcare System, Boston, MA, USA; Department of Psychiatry, School of Medicine, Boston University, Boston, Massachusetts, USA
| | | | - Seth A Eisen
- School of Medicine, Washington University, St. Louis, MO, USA
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25
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Monney MK. Resilience Among Spouses of United States Service Members During Deployment. Issues Ment Health Nurs 2019; 40:362-364. [PMID: 30570342 DOI: 10.1080/01612840.2018.1491657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Meghan K Monney
- a School of Nursing , University of Texas Health Science Center , San Antonio , Texas , USA
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26
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Cox DW, Baugh LM, McCloskey KD, Iyar M. Social causation or social erosion? Evaluating the association between social support and PTSD among Veterans in a transition program. JOURNAL OF MILITARY VETERAN AND FAMILY HEALTH 2019. [DOI: 10.3138/jmvfh.2017-0040] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Introduction: Social support’s association with posttraumatic stress disorder (PTSD) in Veterans is well established. One explanation for this link is social causation – support inhibits PTSD. Inversely, within the social erosion model, PTSD erodes support. The aim of the present study was to examine if the social causation or social erosion model better explained the association between support and PTSD within a psychosocial intervention context. Methods: Veterans ( N = 218) participating in a multimodal transition program were assessed pre-program, post-program, and at 3-month follow-up on their perceived social support and PTSD symptoms. We used path analysis to conduct a three-wave cross-lagged panel model to compare the social erosion and social causation models. Results: PTSD symptoms were associated with attenuated improvements in social support, while social support was not associated with increased reductions in PTSD symptoms. This association was observed from pre- to post-program and from post-program to follow-up. Discussion: These findings support the social erosion model over the social causation model. Clinical implications of PTSD inhibiting interpersonal gains are discussed.
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Affiliation(s)
- Daniel W. Cox
- Counselling Psychology Program, University of British Columbia, Vancouver, British Columbia, Canada
| | - Leah M. Baugh
- Counselling Psychology Program, University of British Columbia, Vancouver, British Columbia, Canada
| | - Katherine D. McCloskey
- Counselling Psychology Program, University of British Columbia, Vancouver, British Columbia, Canada
| | - Megumi Iyar
- Counselling Psychology Program, University of British Columbia, Vancouver, British Columbia, Canada
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27
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Godier-McBard LR, Ibbitson L, Hooks C, Fossey M. Military spouses with deployed partners are at greater risk of poor perinatal mental health: a scoping review. J ROY ARMY MED CORPS 2019; 165:363-370. [PMID: 30612103 DOI: 10.1136/jramc-2018-001069] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Revised: 11/27/2018] [Accepted: 11/28/2018] [Indexed: 11/04/2022]
Abstract
BACKGROUND Poor mental health in the perinatal period is associated with a number of adverse outcomes for the individual and the wider family. The unique circumstances in which military spouses/partners live may leave them particularly vulnerable to developing perinatal mental health (PMH) problems. METHODS A scoping review was carried out to review the literature pertaining to PMH in military spouses/partners using the methodology outlined by Arksey and O'Malley (2005). Databases searched included EBSCO, Gale Cengage Academic OneFile, ProQuest and SAGE. RESULTS Thirteen papers fulfilled the inclusion criteria, all from the USA, which looked a PMH or well-being in military spouses. There was a strong focus on spousal deployment as a risk factor for depressive symptoms and psychological stress during the perinatal period. Other risk factors included a lack of social/emotional support and increased family-related stressors. Interventions for pregnant military spouses included those that help them develop internal coping strategies and external social support. CONCLUSIONS US literature suggests that military spouses are particularly at risk of PMH problems during deployment of their serving partner and highlights the protective nature of social support during this time. Further consideration needs to be made to apply the findings to UK military spouses/partners due to differences in the structure and nature of the UK and US military and healthcare models. Further UK research is needed, which would provide military and healthcare providers with an understanding of the needs of this population allowing effective planning and strategies to be commissioned and implemented.
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Affiliation(s)
| | - L Ibbitson
- Veterans and Families Institute, Anglia Ruskin University, Chelmsford, UK
| | - C Hooks
- School of Nursing and Midwifery, Anglia Ruskin University, Chelmsford, UK
| | - M Fossey
- Veterans and Families Institute, Anglia Ruskin University, Chelmsford, UK
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28
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Gribble R, Goodwin L, Fear NT. Mental health outcomes and alcohol consumption among UK military spouses/partners: a comparison with women in the general population. Eur J Psychotraumatol 2019; 10:1654781. [PMID: 31632615 PMCID: PMC6781255 DOI: 10.1080/20008198.2019.1654781] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 07/12/2019] [Accepted: 07/31/2019] [Indexed: 01/13/2023] Open
Abstract
Background: Military families can experience unique stressors that may contribute towards poorer well-being among the spouses/partners of Service personnel. However, there is little UK research regarding mental health or alcohol consumption among this population. Objective: This study examined mental health outcomes (probable depression and post-traumatic stress disorder (PTSD)) and alcohol consumption among UK military spouses/partners compared to women in the general population. Associations with military and socio-demographic characteristics were examined. Method: Survey data from 405 female spouses/partners of current and former UK Service personnel participating in a study of military-connected children (2010-2012) was analysed. Comparisons to women in the general population were made using the 2007 Adult Psychiatric Morbidity Survey (n = 1594). Results: Compared to women from the general population, military spouses/partners were significantly more likely to meet criteria for probable depression (adj. OR 2.50 (95% CI 1.52-4.11)). There was no significant difference regarding probable PTSD. Spouses/partners were significantly more likely to meet criteria for hazardous alcohol consumption (adj. OR 2.55 (95% CI 1.87-3.47)) and more likely to report episodes of weekly, daily or almost daily binge-drinking (adj. OR 2.15 (95% CI 1.28-3.61)) than women in the general population. Binge-drinking was significantly higher among spouses/partners of Service personnel reporting family separations of more than 2 months in the last 2 years compared to those reporting no, or shorter, separations (adj. OR 1.88 (95% CI 1.08-3.27)). Conclusion: This is the first study to examine mental health and alcohol consumption among UK military spouses/partners. The significantly higher prevalence of probable depression, hazardous alcohol consumption, and binge-drinking compared to women in the general population suggests further research is needed into the drivers of poor mental health and alcohol consumption among this population and in identifying or developing prevention campaigns to reduce alcohol use and support their well-being.
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Affiliation(s)
- Rachael Gribble
- King's Centre for Military Health Research, Institute of Psychiatry, Psychology and Neuroscience, King's College, London, UK
| | - Laura Goodwin
- Psychological Sciences, University of Liverpool, Liverpool, UK
| | - Nicola T Fear
- King's Centre for Military Health Research, Institute of Psychiatry, Psychology and Neuroscience, King's College, London, UK
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29
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Goodell EMA, Homish DL, Homish GG. Characteristics of U.S. Army Reserve and National Guard couples who use family readiness programs. MILITARY BEHAVIORAL HEALTH 2018; 7:185-197. [PMID: 31763064 PMCID: PMC6874377 DOI: 10.1080/21635781.2018.1515131] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Use of family readiness programs (FRPs) by military families is not well understood. This work uses the Gelberg-Andersen Behavioral Model to identify characteristics of Reserve and National Guard (R/NG) couples who access FRPs. Data are from Operation: SAFETY, a study of R/NG soldiers and partners. Logistic regression models examined odds of accessing FRPs based on predisposing, enabling, and need factors. Greater length of military service, greater presence of non-military social ties, and civilian partner reports of adequate support during deployment were associated with higher likelihood of accessing FRPs. Results provide information on FRP utilization and may help inform outreach efforts.
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Affiliation(s)
- Erin M. Anderson Goodell
- Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD
| | - 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
| | - Gregory G. 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
- Department of Family Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo – The State University of New York, Buffalo, NY
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30
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Schuy K, Dors S, Brants L, Horzetzky M, Willmund G, Ströhle A, Zimmermann P, Rau H, Siegel S. Stigma and its impact on the families of former soldiers of the German Armed Forces: an exploratory study. Mil Med Res 2018; 5:40. [PMID: 30486881 PMCID: PMC6263547 DOI: 10.1186/s40779-018-0188-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Accepted: 11/12/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Military families who have a family member with a mental illness see themselves confronted with many demands. Stigmatization is one of these challenges. Stigmatization affects not only the individual who suffers from a mental illness but also other family members via stigma by association and vicarious stigma. Stigma by association occurs when mental illness stigma spills over to individuals associated with an individual with a mental illness. Vicarious stigma describes the suffering of family members when they note the impact of stigma on their relative with mental illness. As a societal phenomenon, stigma plays out in social interactions and might therefore influence the social networks of families. It is also associated with healthcare utilization. METHOD Narrative interviews were conducted with 15 family members (partners, spouses, parents and children) of former soldiers of the German Armed Forces with a service-induced mental illness. The transcribed interview data were analyzed using a thematic analysis approach, in which codes were formed and emerging themes were systemized. Relationships between stigma, the families' reactions to it, its effects on their social relationships and its interference with their healthcare utilization were analyzed. RESULTS This study provides a detailed description of how relatives of former German soldiers with mental health problems experience stigma by association and vicarious stigma. Their perceptions are shown in a model that describes stigma-related attitudes, reactions to them and their effects on the social relationships of former soldiers' families. These families felt stigmatized because of the former soldiers' mental illness (mental illness stigma) and the military context in which it occurred (former soldier stigma). They reacted with nondisclosure, anger, acceptance and self-blame. Stigma was associated with smaller and weaker social networks that were characterized by social exclusion, self-segregation and conflicts with extended family, friends and colleagues. Stigma also affected the families' healthcare utilization. CONCLUSIONS Urgently needed anti-stigma campaigns, particularly in the civilian context, should address the stigmatization of both mental illness and the military participation of the families affected. They should consider the needs of both former soldiers with a mental illness and their families.
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Affiliation(s)
- Katrin Schuy
- Department of Psychiatry and Psychotherapy, Campus Charité Mitte, Charité-Universitätsmedizin Berlin, 10117, Berlin, Germany.
| | - Simone Dors
- Department of Psychiatry and Psychotherapy, Campus Charité Mitte, Charité-Universitätsmedizin Berlin, 10117, Berlin, Germany
| | - Loni Brants
- Department of Psychiatry and Psychotherapy, Campus Charité Mitte, Charité-Universitätsmedizin Berlin, 10117, Berlin, Germany
| | - Marie Horzetzky
- Department of Psychiatry and Psychotherapy, Campus Charité Mitte, Charité-Universitätsmedizin Berlin, 10117, Berlin, Germany
| | - Gerd Willmund
- Psychotraumazentrum, Military Hospital, 10115, Berlin, Germany
| | - Andreas Ströhle
- Department of Psychiatry and Psychotherapy, Campus Charité Mitte, Charité-Universitätsmedizin Berlin, 10117, Berlin, Germany
| | | | - Heinrich Rau
- Psychotraumazentrum, Military Hospital, 10115, Berlin, Germany
| | - Stefan Siegel
- Department of Psychiatry and Psychotherapy, Campus Charité Mitte, Charité-Universitätsmedizin Berlin, 10117, Berlin, Germany
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Berzins TL, Van Dulmen MHM, Deluca H. Alcohol use affects sleep duration among military couples. MILITARY PSYCHOLOGY 2018. [DOI: 10.1080/08995605.2018.1521684] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
| | | | - Haylee Deluca
- Department of Psychological Sciences, Kent State University, Kent, Ohio
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Pflieger JC, LeardMann CA, McMaster HS, Donoho CJ, Riviere LA. The Impact of Military and Nonmilitary Experiences on Marriage: Examining the Military Spouse's Perspective. J Trauma Stress 2018; 31:719-729. [PMID: 30338551 DOI: 10.1002/jts.22321] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Revised: 05/15/2018] [Accepted: 06/02/2018] [Indexed: 11/08/2022]
Abstract
There has been conflicting research regarding direct association between deployments and marital quality, particularly from the military spouse's perspective. In the current study, we sought to extend past research by examining the direct association between both military and nonmilitary experiences and military spouse marital quality using 2011-2013 baseline data from the Millennium Cohort Family Study, a large sample of military couples representing all U.S. service branches and components. Military experiences were assessed using electronic deployment records to capture the number and length of deployments since 2001, and service members reported combat experience and symptoms indicative of posttraumatic stress disorder (PTSD). Military spouses reported on service members' recent time away from home, nonmilitary family stressors, and marital quality. Results of the logistic regression model adjusted for demographic, relationship, and military covariates indicated that most military experiences did not have a direct statistical association with low marital quality except service member PTSD, odds ratio (OR) = 1.54, 95% CI [1.17, 2.04]. Rather, nonmilitary experiences of the military spouse, including lack of social support, OR = 2.68, 95% CI [2.07, 3.47]; caregiver burden, OR = 1.56, 95% CI [1.22, 1.99]; work-family conflict, OR = 1.42, 95% CI [1.18, 1.69]; and financial strain, OR = 1.27, 95% CI [1.03, 1.55], increased odds of low marital quality. Implications of these findings include providing additional supports to address nonmilitary family stressors that are particularly salient to military spouses with an aim to promote marital quality.
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Affiliation(s)
- Jacqueline C Pflieger
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, Maryland, USA.,Military Population Health, Naval Health Research Center, San Diego, California, USA
| | - Cynthia A LeardMann
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, Maryland, USA.,Military Population Health, Naval Health Research Center, San Diego, California, USA
| | - Hope S McMaster
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, Maryland, USA.,Military Population Health, Naval Health Research Center, San Diego, California, USA
| | - Carrie J Donoho
- Military Population Health, Naval Health Research Center, San Diego, California, USA.,Center for Military Psychiatry and Neuroscience Research, Walter Reed Army Institute of Research, Silver Spring, Maryland, USA
| | - Lyndon A Riviere
- Center for Military Psychiatry and Neuroscience Research, Walter Reed Army Institute of Research, Silver Spring, Maryland, USA
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Steenkamp MM, Corry NH, Qian M, Li M, McMaster HS, Fairbank JA, Stander VA, Hollahan L, Marmar CR. Prevalence of psychiatric morbidity in United States military spouses: The Millennium Cohort Family Study. Depress Anxiety 2018; 35:815-829. [PMID: 29745445 DOI: 10.1002/da.22768] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Revised: 03/08/2018] [Accepted: 03/31/2018] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Approximately half of US service members are married, equating to 1.1 million military spouses, yet the prevalence of psychiatric morbidity among military spouses remains understudied. We assessed the prevalence and correlates of eight mental health conditions in spouses of service members with 2-5 years of service. METHOD We employed baseline data from the Millennium Cohort Family Study, a 21-year longitudinal survey following 9,872 military-affiliated married couples representing all US service branches and active duty, Reserve, and National Guard components. Couples were surveyed between 2011 and 2013, a period of high military operational activity associated with Operation Iraqi Freedom and Operation Enduring Freedom. Primary outcomes included depression, anxiety, posttraumatic stress disorder (PTSD), panic, alcohol misuse, insomnia, somatization, and binge eating, all assessed with validated self-report questionnaires. RESULTS A total of 35.90% of military spouses met criteria for at least one psychiatric condition. The most commonly endorsed conditions were moderate-to-severe somatization symptoms (17.63%) and moderate-to-severe insomnia (15.65%). PTSD, anxiety, depression, panic, alcohol misuse, and binge eating were endorsed by 9.20%, 6.65%, 6.05%, 7.07%, 8.16%, and 5.23% of spouses, respectively. Having a partner who deployed with combat resulted in higher prevalence of anxiety, insomnia, and somatization. Spouses had lower prevalence of PTSD, alcohol misuse, and insomnia but higher rates of panic and binge eating than service members. Both members of a couple rarely endorsed having the same psychiatric problem. CONCLUSIONS One third of junior military spouses screened positive for one or more psychiatric conditions, underscoring the need for high-quality prevention and treatment services.
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Affiliation(s)
- Maria M Steenkamp
- New York University School of Medicine,, Steven and Alexandra Cohen Veterans Center for the Study of Post-Traumatic Stress and Traumatic Brain Injury, New York, USA, NY
| | | | - Meng Qian
- New York University School of Medicine,, Steven and Alexandra Cohen Veterans Center for the Study of Post-Traumatic Stress and Traumatic Brain Injury, New York, USA, NY
| | - Meng Li
- New York University School of Medicine,, Steven and Alexandra Cohen Veterans Center for the Study of Post-Traumatic Stress and Traumatic Brain Injury, New York, USA, NY
| | - Hope Seib McMaster
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA
| | - John A Fairbank
- Mid-Atlantic (VISN 6) Mental Illness Research, Education and Clinical Center (MIRECC), Durham VA Medical Center, and UCLA-Duke University National Center for Child Traumatic Stress (NCCTS), Duke University School of Medicine, Durham, NC, USA
| | | | - Laura Hollahan
- New York University School of Medicine,, Steven and Alexandra Cohen Veterans Center for the Study of Post-Traumatic Stress and Traumatic Brain Injury, New York, USA, NY
| | - Charles R Marmar
- New York University School of Medicine,, Steven and Alexandra Cohen Veterans Center for the Study of Post-Traumatic Stress and Traumatic Brain Injury, New York, USA, NY
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Thandi G, Greenberg N, Fear NT, Jones N. Perceived effect of deployment on families of UK military personnel. Occup Med (Lond) 2018; 67:562-568. [PMID: 29016941 DOI: 10.1093/occmed/kqx132] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background In the UK, little is known about the perceived effects of deployment, on military families, from military personnel in theatre. Aims To investigate military personnel's perceptions of the impact of deployment on intimate relationships and children. Methods Deployed service personnel who were in a relationship, and who had children, completed a survey while deployed on combat operations. Data were taken from four mental health surveys carried out in Iraq in 2009 and Afghanistan in 2010, 2011 and 2014. Results Among 4265 participants, after adjusting for military and social-demographic covariates, perceiving that deployment had a negative impact on intimate relationships and children was associated with psychological distress, and traumatic stress symptoms. Military personnel who reported being in danger of being injured or killed during deployment, were more likely to report a perceived negative effect of deployment on their intimate relationships. Reservists were less likely to report a perceived negative impact of deployment on their children compared with regulars. Military personnel who themselves planned to separate from their partner were more likely to report psychological distress, and stressors at home. Perceived insufficient support from the Ministry of Defence was associated with poor mental health, and holding a junior rank. Conclusions Deployed UK military personnel with symptoms of psychological distress, who experienced stressors at home, were especially likely to perceive that their family were inadequately supported by the military. Those planning to separate from their partner were at increased risk of suffering with mental health problems while deployed.
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Affiliation(s)
- G Thandi
- King's College London, Academic Department of Military Mental Health, 10 Cutcombe Road, Weston Education Centre, Denmark Hill, London SE5 9RJ, UK
| | - N Greenberg
- King's College London, Academic Department of Military Mental Health, 10 Cutcombe Road, Weston Education Centre, Denmark Hill, London SE5 9RJ, UK
| | - N T Fear
- King's College London, Academic Department of Military Mental Health, 10 Cutcombe Road, Weston Education Centre, Denmark Hill, London SE5 9RJ, UK
| | - N Jones
- King's College London, Academic Department of Military Mental Health, 10 Cutcombe Road, Weston Education Centre, Denmark Hill, London SE5 9RJ, UK
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Fulton E, Wild D, Hancock J, Fernandez E, Linnane J. Transition from service to civvy street: the needs of armed forces veterans and their families in the UK. Perspect Public Health 2018; 139:49-58. [PMID: 29975177 DOI: 10.1177/1757913918785650] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
AIMS: Although many veterans make the transition from military to civilian life without difficulty, a small proportion struggle due to an impact on mental and physical wellbeing. Stigma and a reluctance to seek help further exacerbate this problem. The Armed Forces Covenant outlines the importance of ensuring that public services are aware of the specific needs of veterans; however, evidence suggests that knowledge among professional staff may be limited. METHODS: This exploratory study included three phases. Phase 1 (questionnaires) explored the needs of veterans and their families in Warwickshire (UK) regarding information about their health and wellbeing and the barriers and facilitators to accessing local public health services. Also in Phase 1, health and public services staff knowledge of veterans' needs and the Covenant is explored. In Phase 2, both samples attended a related focus group for a more in-depth exploration of the issues identified in Phase 1; in order to inform a Phase 3 workshop to co-develop an intervention. RESULTS: Veterans, their families and friends, wanted more information about what services do, how and when to access them and what to expect. Confusion over when to seek help for mental health 'symptoms' was highlighted. More support for families was identified, alongside a need for health and social care staff to have a better understanding of the unique experiences and needs of veterans. Only 35% of staff reported a good understanding of the Armed Forces Covenant and their responsibilities to uphold it. CONCLUSIONS: Public health teams within UK local authorities are well placed to ensure veterans have more knowledge about and access to public services. Interventions to address stigma and veterans' reluctance to seek help were needed. To this end, interventions for local veterans, their loved ones and staff in public services, designed in co-creation with these groups, is discussed.
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Affiliation(s)
- E Fulton
- Health Behaviour and Interventions Research, Faculty of Health & Life Sciences, Coventry University, Priory Street, Coventry CV1 5FB, UK.,Public Health Warwickshire, Warwickshire County Council, Warwick, UK
| | - D Wild
- Health Behaviour and Interventions Research, Faculty of Health & Life Sciences, Coventry University, Coventry, UK
| | - J Hancock
- Health Behaviour and Interventions Research, Faculty of Health & Life Sciences, Coventry University, Coventry, UK
| | - E Fernandez
- Public Health Warwickshire, Warwickshire County Council, Warwick, UK
| | - J Linnane
- Public Health Warwickshire, Warwickshire County Council, Warwick, UK
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Wooten NR, Brittingham JA, Pitner RO, Tavakoli AS, Jeffery DD, Haddock KS. Purchased Behavioral Health Care Received by Military Health System Beneficiaries in Civilian Medical Facilities, 2000-2014. Mil Med 2018; 183:e278-e290. [PMID: 29420772 PMCID: PMC6027075 DOI: 10.1093/milmed/usx101] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Revised: 08/25/2017] [Accepted: 11/15/2017] [Indexed: 11/15/2022] Open
Abstract
Introduction Behavioral health conditions are a significant concern for the U.S. military and the Military Health System (MHS) because of decreased military readiness and increased health care utilization. Although MHS beneficiaries receive direct care in military treatment facilities, a disproportionate majority of behavioral health treatment is purchased care received in civilian facilities. Yet, limited evidence exists about purchased behavioral health care received by MHS beneficiaries. This longitudinal study (1) estimated the prevalence of purchased behavioral health care and (2) identified patient and visit characteristics predicting receipt of purchased behavioral health care in acute care facilities from 2000 to 2014. Materials and Methods Medical claims with Major Diagnostic Code 19 (mental disorders/diseases) or 20 (alcohol/drug disorders) as primary diagnoses and TRICARE as the primary/secondary payer were analyzed for MHS beneficiaries (n = 17,943) receiving behavioral health care in civilian acute care facilities from January 1, 2000, to December 31, 2014. The primary dependent variable, receipt of purchased behavioral health care, was modeled for select mental health and substance use disorders from 2000 to 2014 using generalized estimating equations. Patient characteristics included time, age, sex, and race/ethnicity. Visit types included inpatient hospitalization and emergency department (ED). Time was measured in days and visits were assumed to be correlated over time. Behavioral health care was described by both frequency of patients and visit type. The University of South Carolina Institutional Review Board approved this study. Results From 2000 to 2014, purchased care visits increased significantly for post-traumatic stress disorder, adjustment, anxiety, mood, bipolar, tobacco use, opioid/combination opioid dependence, nondependent cocaine abuse, psychosocial problems, and suicidal ideation among MHS beneficiaries. The majority of care was received for mental health disorders (78.8%) and care was most often received in EDs (56%). Most commonly treated diagnoses included mood, tobacco use, and alcohol use disorders. ED visits were associated with being treated for anxiety (excluding post-traumatic stress disorder; Adjusted odds ratio [AOR]: 9.14 [95% confidence interval (CI): 8.26, 10.12]), alcohol use disorders (AOR = 1.67 [95% CI: 1.53, 1.83]), tobacco use (AOR = 1.16 [95% CI: 1.06, 1.26]), nondependent cocaine abuse (AOR = 5.47 [95% CI: 3.28, 9.12]), nondependent mixed/unspecified drug abuse (AOR = 7.30 [95% CI: 5.11, 10.44]), and psychosis (AOR = 1.38 [95% CI: 1.20, 1.58]). Compared with adults age 60 yr and older, adolescents (ages 12-17 yr), and adults under age 60 yr were more likely to be treated for suicidal ideation, adjustment, mood, bipolar, post-traumatic stress disorder, nondependent cocaine, and mixed/unspecified drug abuse. Adults under age 60 yr also had increased odds of being treated for tobacco use disorders, alcohol use disorders, and opioid/combination opioid dependence compared with adults age 60 yr and older. Conclusions Over the past 15 yr, purchased behavioral health care received by MHS beneficiaries in acute care facilities increased significantly. MHS beneficiaries received the majority of purchased behavioral health care for mental health disorders and were treated most often in the ED. Receiving behavioral health care in civilian EDs raises questions about access to outpatient behavioral health care and patient-centered care coordination between civilian and military facilities. Given the influx of new Veterans Health Administration users from the MHS, findings have implications for military, veteran, and civilian facilities providing behavioral health care to military and veteran populations.
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Affiliation(s)
- Nikki R Wooten
- College of Social Work, University of South Carolina, Hamilton College, Columbia, SC
| | - Jordan A Brittingham
- Arnold School of Public Health, University of South Carolina, 921 Assembly St., Columbia, SC
| | - Ronald O Pitner
- College of Social Work, University of South Carolina, Hamilton College, Columbia, SC
| | - Abbas S Tavakoli
- College of Nursing, University of South Carolina, 1601 Greene St., Columbia, SC
| | - Diana D Jeffery
- Clinical Support Division, Health Operations Directorate, Defense Health Agency, U.S. Department of Defense, 7700 Arlington Blvd, Suite 5101, Falls Church, VA
| | - K Sue Haddock
- Research Service, WJB Dorn Veterans Administration Medical Center, 6439 Garners Ferry Road, Columbia, SC
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Tupper R, Bureau JF, St-Laurent D. DEPLOYMENT STATUS: A DIRECT OR INDIRECT EFFECT ON MOTHER-CHILD ATTACHMENT WITHIN A CANADIAN MILITARY CONTEXT? Infant Ment Health J 2018; 39:466-477. [PMID: 29920699 DOI: 10.1002/imhj.21720] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Research has suggested that military spouses experience increased depressive symptoms and parenting stress during a military member's deployment. A relationship between maternal depressive symptoms, parenting stress, and child attachment security has been found in the general population, as has an indication that social support may provide a buffering effect. While there appears to be an association between the emotional well-being of military spouses and child emotional well-being during deployment, data are limited regarding the association between maternal emotional well-being and child attachment security. The current study explores the association between deployment status and child attachment to the nonmilitary parent (i.e., the mother in this study) in a sample of 68 Canadian military families. Results revealed a significant impact of deployment status on maternal depressive symptoms and on quality of child attachment. The impact of deployment status on attachment was not mediated through the maternal variables, and despite a main effect of social support on the maternal variables, there was no moderating effect. Thus, our results suggest that deployment may affect child attachment independently of maternal well-being.
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Bauer A, Newbury-Birch D, Robalino S, Ferguson J, Wigham S. Is prevention better than cure? A systematic review of the effectiveness of well-being interventions for military personnel adjusting to civilian life. PLoS One 2018; 13:e0190144. [PMID: 29718969 PMCID: PMC5931793 DOI: 10.1371/journal.pone.0190144] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Accepted: 12/09/2017] [Indexed: 01/07/2023] Open
Abstract
Exposure to stressful and potentially traumatic experiences is a risk for military personnel and for some this may increase susceptibility to reduced well-being. The aim of this systematic review was to examine the effectiveness of interventions to promote the well-being of military personnel adjusting to civilian life. Electronic databases were searched including MEDLINE, Embase, HMIC, PsycINFO, Pilots and CINAHL. Twelve articles, all conducted in the USA, were included in the review. Articles were synthesised narratively and assessed for bias against established criteria. The studies evaluated the effectiveness of interventions for current and former military personnel. The interventions included expressive writing, anger management, cognitive training, psycho-education, and techniques to promote relaxation, connection in relationships and resilience. Interventions had some significant positive effects mostly for veterans adjusting to civilian life and other family members. There was much heterogeneity in the design and the outcome measures used in the studies reviewed. The review highlights the need for future robust trials examining the effectiveness of well-being interventions in military groups with diverse characteristics; in addition qualitative research to explore a conceptualisation of well-being for this group and the acceptability of interventions which may be perceived as treatment. The results of the review will be of interest to a number of stakeholders in military, public health and mental health settings. PROSPERO Registration number: CRD42015026341.
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Affiliation(s)
- Andreas Bauer
- Institute of Neuroscience, Newcastle University, Newcastle, United Kingdom
| | | | - Shannon Robalino
- Institute of Health and Society, Newcastle University, Newcastle, United Kingdom
| | - Jennifer Ferguson
- School of Health and Social Care, Teesside University, Teesside, United Kingdom
| | - Sarah Wigham
- Institute of Neuroscience, Newcastle University, Newcastle, United Kingdom
- * E-mail:
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Richmond RR, Henebry AD. A Maisonneuve Fracture in an Active Duty Sailor: A Case Report. Mil Med 2018; 183:e278-e280. [PMID: 29415223 DOI: 10.1093/milmed/usx080] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Accepted: 11/04/2017] [Indexed: 11/13/2022] Open
Abstract
Maisonneuve fractures are relatively well known in the sports medicine, and orthopedic communities, however, can be commonly missed among primary care providers. The following case outlines an active duty 35-yr-old female patient who presented with acute pain on the left ankle and lower leg after she misjudged a step. The injury is a combination of high fibular and medial malleolar fractures with a disruption of the tibiofibular syndesmosis ligaments. This is a result of extreme external rotation and pronation of a fixed foot. The proper diagnosis is reliant on ankle and tibiofibular films, to include orthogonal views. This case serves as a reminder to always examine joints above and below the injury site, obtain orthogonal views of a fracture, as well as the unstable nature of syndesmosis injuries. This fracture is commonly a sports-related injury; thus, it is particularly important for military providers to be aware of Maisonneuve fractures and the common pitfalls in diagnosis and treatment.
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Affiliation(s)
- Ryan R Richmond
- Naval Health Branch Clinic Naval Air Technical Training Command, Naval Hospital Pensacola, 6000 West Highway 98, Pensacola, FL 32512
| | - Andrew D Henebry
- Department of Orthopedics, Naval Hospital Pensacola, 6000 West Highway 98, Pensacola, FL 32512
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Vest BM, Heavey SC, Homish DL, Homish GG. Alcohol Misuse in Reserve Soldiers and their Partners: Cross-Spouse Effects of Deployment and Combat Exposure. Subst Use Misuse 2018; 53:800-807. [PMID: 29161165 PMCID: PMC5951303 DOI: 10.1080/10826084.2017.1385632] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Military deployment and combat are associated with worse outcomes, including alcohol misuse. Less is known about how these experiences affect soldiers' spouses. OBJECTIVE The study objective was to explore relationships between deployment, combat exposure, and alcohol misuse; especially cross-spouse effects (effect of one partner's experiences/behavior on the other partner), which has been under-examined in military samples. METHODS U.S. Army Reserve/National Guard soldiers and their partners completed a questionnaire covering physical and mental health, military service and substance use. Negative binomial regression models examined number of deployments and combat exposure individually for alcohol misuse and frequent heavy drinking (FHD). In additional models, we examined combat exposure's role on alcohol outcomes, controlling for the soldiers' number of deployments, PTSD symptoms, age, and in cross-spouse models, alcohol use and FHD. We considered individuals' deployment experiences related to their alcohol outcomes and to their spouses' alcohol outcomes. RESULTS The study sample included male soldiers with current/lifetime military service (n = 248) and their female partners. Combat exposure was related to FHD (RR: 1.01, p < .05, 95% CI: 1.01, 1.01) among male soldiers while controlling for PTSD symptoms, number of deployments, and age. Female partners of male soldiers were more likely to engage in FHD (RR: 1.01, p < .05, 95% CI: 1.01, 1.01) if their spouse experienced combat. CONCLUSIONS Our results demonstrate that male soldiers and their spouses are at increased risk of FHD if the soldier experienced combat. This points to the need for better screening, particularly of spouses of soldiers, whose alcohol misuse may be overlooked.
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Affiliation(s)
- Bonnie M. Vest
- Department of Family Medicine, University at Buffalo, Buffalo NY
| | - Sarah Cercone Heavey
- Department of Community Health & Health Behavior, University at Buffalo, Buffalo NY
| | - D. Lynn Homish
- Department of Community Health & Health Behavior, University at Buffalo, Buffalo NY
| | - Gregory G. Homish
- Department of Family Medicine, University at Buffalo, Buffalo NY
- Department of Community Health & Health Behavior, University at Buffalo, Buffalo NY
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Rodriguez LM, Osilla KC, Trail T, Gore K, Pedersen E. Alcohol Use Among Concerned Partners of Heavy Drinking Service Members and Veterans. JOURNAL OF MARITAL AND FAMILY THERAPY 2018; 44:277-291. [PMID: 28782116 PMCID: PMC5803486 DOI: 10.1111/jmft.12261] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Heavy drinking in relationships is complex and we focus on an understudied sample of concerned partners (CPs) worried about their U.S. service member/veteran partner's drinking. We evaluated the link between CP drinking and their own mental health, and how CP drinking moderated the efficacy of a web-based intervention designed to address CPs' mental health and communication. CPs (N = 234) were randomly assigned to intervention or control and completed assessments at baseline and 5 months later. CP drinking was associated with greater CP depression, anxiety, and anger independent of partner drinking. Moreover, the intervention was more efficacious in reducing depression for heavy drinking CPs. CPs are often an overlooked population and resources to help support them are needed.
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Osilla KC, Trail TE, Pedersen ER, Gore KL, Tolpadi A, Rodriguez LM. Efficacy of a Web-based Intervention for Concerned Spouses of Service Members and Veterans with Alcohol Misuse. JOURNAL OF MARITAL AND FAMILY THERAPY 2018; 44:292-306. [PMID: 28972265 PMCID: PMC5882610 DOI: 10.1111/jmft.12279] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
Concerned partners (CPs) of service members and veterans who misuse alcohol face help-seeking barriers and mental health problems. We used multiple regression to evaluate the efficacy of Partners Connect, a four-session web-based intervention (WBI) to address military CPs' mental health and communication. We randomized 312 CPs to the WBI or a control group. Five months later, WBI CPs reported significant reductions in their anxiety and increases in their social support compared to control CPs. Intervention dose was also associated with improved WBI CP outcomes. Partners Connect appears to fill a need for families who face help-seeking barriers and provides an alternative to traditional care for those who may not otherwise seek help.
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Bakhurst M, McGuire A, Halford WK. Trauma Symptoms, Communication, and Relationship Satisfaction in Military Couples. FAMILY PROCESS 2018; 57:241-252. [PMID: 28271505 DOI: 10.1111/famp.12285] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
Trauma symptoms are negatively correlated with couple relationship satisfaction, which is of particular importance in the relationships of military personnel who are often exposed to trauma whilst on overseas deployment. This study tested a model in which communication mediated an association between trauma symptoms and low relationship satisfaction. Thirty-one Australian military couples were observationally assessed during a communication task, and assessed on their relationship satisfaction and individual functioning. As expected, trauma symptoms in the male military spouse were associated with low satisfaction in both spouses. Females' low positive communication fully mediated the relationship between males' trauma symptoms and low female satisfaction, but not male relationship satisfaction. Unexpectedly, males' negative communication behaviors were associated with high male relationship satisfaction, and partially mediated the association between trauma symptoms and male satisfaction. Discussion focused on how some communication usually thought of as negative might be associated with relationship satisfaction in military couples.
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Affiliation(s)
| | | | - W Kim Halford
- The University of Queensland, Brisbane, Qld, Australia
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Trone DW, Powell TM, Bauer LM, Seelig AD, Peterson AV, Littman AJ, Williams EC, Maynard CC, Bricker JB, Boyko EJ. Smoking and drinking behaviors of military spouses: Findings from the Millennium Cohort Family Study. Addict Behav 2018; 77:121-130. [PMID: 28992577 DOI: 10.1016/j.addbeh.2017.09.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Revised: 09/12/2017] [Accepted: 09/25/2017] [Indexed: 10/18/2022]
Abstract
INTRODUCTION The associations between stressful military experiences and tobacco use and alcohol misuse among Service members are well documented. However, little is known about whether stressful military experiences are associated with tobacco use and alcohol misuse among military spouses. METHODS Using 9872 Service member-spouse dyads enrolled in the Millennium Cohort Family Study, we employed logistic regression to estimate the odds of self-reported cigarette smoking, risky drinking, and problem drinking among spouses by Service member deployment status, communication regarding deployment, and stress associated with military-related experiences, while adjusting for demographic, mental health, military experiences, and Service member military characteristics. RESULTS Current cigarette smoking, risky drinking, and problem drinking were reported by 17.2%, 36.3%, and 7.3% of military spouses, respectively. Current deployment was not found to be associated with spousal smoking or drinking behaviors. Communication about deployment experiences with spouses was associated with lower odds of smoking, but not with risky or problem drinking. Spouses bothered by communicated deployment experiences and those who reported feeling very stressed by a combat-related deployment or duty assignment had consistently higher odds of both risky and problem drinking. CONCLUSIONS Our findings suggest that contextual characteristics about the deployment experience, as well as the perceived stress of those experiences, may be more impactful than the simple fact of Service member deployment itself. These results suggest that considering the impact of deployment experiences on military spouses reveals important dimensions of military community adaptation and risk.
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Fisher JE, Mauro C, Cozza SJ, Wall M, Simon NM, Ortiz CD, Harrington‐LaMorie J, Wang Y, Fullerton CS, Ursano RJ, Katherine Shear M. Examination of factor structure of the inventory of complicated grief (ICG) in a sample of bereaved military family members with persistent and elevated grief. Int J Methods Psychiatr Res 2017; 26:e1571. [PMID: 28664618 PMCID: PMC5614803 DOI: 10.1002/mpr.1571] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Revised: 04/17/2017] [Accepted: 04/21/2017] [Indexed: 11/09/2022] Open
Abstract
Knowledge about the effect of a US service member's death on surviving family members is limited. In order to identify their grief-related health care needs, a first step is to identify the characteristics of persistent and elevated grief in a military family sample. The present study identified military family members (n = 232) bereaved more than six months who endorsed an elevated level of grief. A confirmatory factor analysis and test of measurement invariance of factor structure were used to compare the factor structure of their Inventory of Complicated Grief (ICG) responses to that of a bereaved non-military-related clinical research sample with similar grief levels. Results confirmed an equivalent five-factor structure of the ICG in both the military family sample and the clinical research sample. The similarity in factor structure was present despite differences in demographic characteristics and bereavement experiences between samples. Thus, the ICG reliably measures persistent and elevated grief in military family samples and provides grief symptom profiles that facilitates better understanding of their grief-related needs.
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Affiliation(s)
- Joscelyn E. Fisher
- Center for the Study of Traumatic Stress, Department of PsychiatryUniformed Services University of the Health SciencesBethesdaMarylandUSA
| | - Christine Mauro
- Department of Biostatistics, Mailman School of Public HealthColumbia UniversityNew YorkNew YorkUSA
| | - Stephen J. Cozza
- Center for the Study of Traumatic Stress, Department of PsychiatryUniformed Services University of the Health SciencesBethesdaMarylandUSA
| | - Melanie Wall
- Department of Biostatistics, Mailman School of Public HealthColumbia UniversityNew YorkNew YorkUSA
- Department of PsychiatryColumbia UniversityNew YorkNew YorkUSA
| | - Naomi M. Simon
- Department of PsychiatryMGH and Harvard Medical SchoolBostonMassachusettsUSA
| | - Claudio D. Ortiz
- Center for the Study of Traumatic Stress, Department of PsychiatryUniformed Services University of the Health SciencesBethesdaMarylandUSA
| | - Jill Harrington‐LaMorie
- Center for the Study of Traumatic Stress, Department of PsychiatryUniformed Services University of the Health SciencesBethesdaMarylandUSA
| | - Yuanjia Wang
- Department of Biostatistics, Mailman School of Public HealthColumbia UniversityNew YorkNew YorkUSA
| | - Carol S. Fullerton
- Center for the Study of Traumatic Stress, Department of PsychiatryUniformed Services University of the Health SciencesBethesdaMarylandUSA
| | - Robert J. Ursano
- Center for the Study of Traumatic Stress, Department of PsychiatryUniformed Services University of the Health SciencesBethesdaMarylandUSA
| | - M. Katherine Shear
- School of Social WorkColumbia UniversityNew YorkNew YorkUSA
- University College of Physicians and SurgeonsColumbia UniversityNew YorkNew YorkUSA
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McNulty Y, Vance CM, Fisher K. Beyond corporate expatriation - global mobility in the sports, religious, education and non-profit sectors. JOURNAL OF GLOBAL MOBILITY: THE HOME OF EXPATRIATE MANAGEMENT RESEARCH 2017. [DOI: 10.1108/jgm-04-2017-0014] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Bakhurst MG, Loew B, McGuire ACL, Halford WK, Markman HJ. Relationship Education for Military Couples: Recommendations for Best Practice. FAMILY PROCESS 2017; 56:302-316. [PMID: 26932356 DOI: 10.1111/famp.12211] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Military couples have a number of distinctive strengths and challenges that are likely to influence their relationship adjustment. Military couples' strengths include stable employment, financial security, and subsidized health and counseling services. At the same time, military couples often experience long periods of separation and associated difficulties with emotional disconnect, trauma symptoms, and reintegrating the family. This paper describes best practice recommendations for working with military couples, including: addressing the distinctive challenges of the military lifestyle, ensuring program delivery is seen as relevant by military couples, and providing relationship education in formats that enhance the accessibility of programs.
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Affiliation(s)
- Melissa G Bakhurst
- School of Psychology, The University of Queensland, Brisbane, QLD, Australia
| | - Benjamin Loew
- Department of Psychology, University of Denver, Denver, CO
| | | | - W Kim Halford
- School of Psychology, The University of Queensland, Brisbane, QLD, Australia
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Bakhurst MG, McGuire ACL, Halford WK. Relationship Education for Military Couples: A Pilot Randomized Controlled Trial of the Effects of Couple CARE in Uniform. JOURNAL OF COUPLE & RELATIONSHIP THERAPY 2016. [DOI: 10.1080/15332691.2016.1238797] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
| | - Annabel C. L. McGuire
- Centre for Australian Military and Veterans' Health, The University of Queensland, Brisbane, Australia
| | - W. Kim Halford
- School of Psychology, The University of Queensland, Brisbane, Australia
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Kahn JR, Collinge W, Soltysik R. Post-9/11 Veterans and Their Partners Improve Mental Health Outcomes with a Self-directed Mobile and Web-based Wellness Training Program: A Randomized Controlled Trial. J Med Internet Res 2016; 18:e255. [PMID: 27678169 PMCID: PMC5059485 DOI: 10.2196/jmir.5800] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2016] [Revised: 05/19/2016] [Accepted: 07/20/2016] [Indexed: 11/13/2022] Open
Abstract
Background Veterans with history of deployment in the Global War on Terror face significant and ongoing challenges with high prevalences of adverse psychological, physical, spiritual, and family impacts. Together, these challenges contribute to an emerging public health crisis likely to extend well into the future. Innovative approaches are needed that reach veterans and their family members with strategies they can employ over time in their daily lives to promote improved adjustment and well-being. Objective The objective of this study was to evaluate effects of use of a Web-based, self-directed program of instruction in mind- and body-based wellness skills to be employed by Global War on Terror veterans and their significant relationship partners on mental health and wellness outcomes associated with postdeployment readjustment. Methods We recruited 160 veteran-partner dyads in 4 regions of the United States (San Diego, CA; Dallas, TX; Fayetteville, NC; and New York, NY) through publicity by the Iraq and Afghanistan Veterans of America to its membership. Dyads were randomly allocated to 1 of 4 study arms: Mission Reconnect (MR) program alone, MR plus the Prevention and Relationship Enhancement Program (PREP) for Strong Bonds weekend program for military couples, PREP alone, and waitlist control. We administered a battery of standardized and investigator-generated instruments assessing mental health outcomes at baseline, 8 weeks, and 16 weeks. Dyads in the MR arms were provided Web-based and mobile app video and audio instruction in a set of mindfulness-related stress reduction and contemplative practices, as well as partner massage for reciprocal use. All participants provided weekly reports on frequency and duration of self-care practices for the first 8 weeks, and at 16 weeks. Results During the first 8-week reporting period, veterans and partners assigned to MR arms used some aspect of the program a mean of 20 times per week, totaling nearly 2.5 hours per week, with only modest declines in use at 16 weeks. Significant improvements were seen at 8 and 16 weeks in measures of posttraumatic stress disorder, depression, sleep quality, perceived stress, resilience, self-compassion, and pain for participants assigned to MR arms. In addition, significant reductions in self-reported levels of pain, tension, irritability, anxiety, and depression were associated with use of partner massage. Conclusions Both veterans and partners were able to learn and make sustained use of a range of wellness practices taught in the MR program. Home-based, self-directed interventions may be of particular service to veterans who are distant from, averse to, or prohibited by schedule from using professional services. Leveraging the partner relationship may enhance sustained use of self-directed interventions for this population. Use of the MR program appears to be an accessible, low-cost approach that supports well-being and reduces multiple symptoms among post-9/11 veterans and their partners. Trial Registration Clinicaltrials.gov NCT01680419; https://clinicaltrials.gov/ct2/show/NCT01680419 (Archived by WebCite at http://www.webcitation.org/6jJuadfzj)
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Affiliation(s)
- Janet R Kahn
- College of Medicine, Department of Psychiatry, University of Vermont, Burlington, VT, United States.
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Abstract
Military cultural competence has recently gained national attention. Experts have posited that limited outcomes in the treatment of posttraumatic stress disorder and depression in the military may be related to limited familiarity with the military. National surveys have indicated low military cultural competence among providers and limited educational efforts on military culture or pertinent military pathology in medical schools and residency training programs. Military families, with their own unique military cultural identity, have been identified as a population with increased risks associated with deployment. In response to these findings, several curricula regarding military culture have been established and widely distributed. Assessments of military cultural competence have also been developed. The clinical impact of enhanced cultural competence in general has thus far been limited. The military, however, with its highly prescribed cultural identity, may be a model culture for further study.
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Affiliation(s)
- Eric G Meyer
- Department of Psychiatry, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD, 20814, USA.
| | - Brian W Writer
- Department of Psychiatry, Audie Murphy VA Hospital, 7400 Merton Minter Blvd, MC 116 A, San Antonio, TX, 78229, USA. .,Department of Psychiatry, University of Texas Health Science Center in San Antonio, 7703 Floyd Curl Drive, Mail Code 7792, San Antonio, TX, 78229, USA.
| | - William Brim
- Center for Deployment Psychology, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD, 20814, USA.
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