Partners' experiences of their loved ones' trauma and PTSD: An ongoing journey of loss and gain

BACKGROUND

Traumatic life events can have a profound impact on the physical and psychological wellbeing of not only those who directly experience them, but others who are indirectly affected, such as victims' partners.

AIMS

This study aimed to explore the experiences and views of partners of individuals who have a history of trauma and diagnosis of posttraumatic stress disorder (PTSD).

METHODS

In-depth semi-structured interviews were conducted with six partners of people who had experienced trauma and were diagnosed with PTSD and awaiting or receiving treatment at a specialist Trauma Service. The data was analysed using Interpretative Phenomenological Analysis.

RESULTS

One overarching theme resulted from the data: partners experienced trauma and PTSD as an ongoing journey of loss and gain. This was supported by three superordinate themes: making sense of the trauma and ensuing consequences, shifting identities, and accessing and experiencing outside resources. Partners' journeys were characterised by striving and struggling to make sense of the trauma and its ensuing consequences, whilst grappling with the identities of themselves, their partners and relationships shifting over time. Participants navigated their journeys in the context of external resources and support from friends, family, colleagues and professionals.

CONCLUSIONS

The results of this study highlight the need for greater information and support for partners of people with PTSD.

Study protocol for a sequential multiple assignment randomized trial to reduce risky drinking among service members and their partners

BACKGROUND

Military spouses and partners in relationships with a heavy drinking service member report high levels of mental health concerns and consequences, which are compounded when both partners drink heavily. Military spouses and partners -termed "concerned partners" (CPs)-may be an important gateway for motivating service members (SMs) to seek care. However, CPs may first need to reduce their own drinking and improve their communication to effectively support and encourage changes for their service member partner. Partners Connect is a web-based intervention aimed at improving communication and relationship quality and increasing SM help-seeking.

METHODS

The current study design is a two-stage Sequential Multiple Assignment Randomized Trial (SMART) to develop an adaptive CP intervention to decrease CP drinking and increase SM help-seeking. CPs aged 18 and older (n = 408) will be recruited via social media and followed for six months. In stage one, we will randomize CPs to either a 4-session web-based intervention (Partners Connect) or to receive communication resources from the Gottman Institute website. The goal is to have CPs invite their SM to complete an online personalized normative feedback (PNF) session. If their SM completes the PNF at stage one, CPs will be considered "responders," if the SM does not complete, CPs who are "non-responders" will be re-randomized during stage two to receive either (1) a CRAFT workbook or (2) phone-based CRAFT if in Partners Connect; or (1) Partners Connect or (2) a CRAFT workbook if in Gottman.

DISCUSSION

By first intervening with the service member's CP, we aim to better equip them to engage their service member partner in treatment services. In doing so, we develop a model that increases treatment accessibility and appeal among a group that may not otherwise seek care.

CLINICALTRIALS

gov Identifier: NCT05619185.

I AM FAMILY: Understanding the adapted sport experiences of family members of military personnel with physical and psychological illnesses and injuries through the lens of the Invictus Games

Family are influential actors in adapted sport participation. However, little is known about their experiences with adapted sport. The current study sought to explore the experiences of families in adapted sport through the context of the Invictus Games, an international adapted sport competition for military personnel with physical and psychological illnesses and injuries that is unique in its inclusion of family programming. Family members (n = 21; partners, parents, siblings, and children) of Invictus Games Toronto 2017 competitors participated in semi-structured interviews. Data were analyzed using reflexive thematic analysis. Three themes were identified: recognition of family experiences during service and after onset of disability; creating a sense of belonging; and improving family knowledge and perceptions. This study provides insight regarding how adapted sport events can support the well-being of both individuals with illnesses and injuries and their families.

Caring for carers: Understanding the physical and psychological well-being of carers of veterans in Australia

Carers of veterans tend to put their own physical and psychological well-being needs behind the needs of the person they are caring for and often do not seek assistance for their own physical and psychological well-being. Combined, these factors lead to increased risk of acute and chronic illness and mental health issues. It is acknowledged that physical activity independently contributes to improved physical and mental health and may be a driver for mental well-being in carers. The aim of this pilot research was to understand how movement behaviour and health behaviours of carers of veterans in Australia relate to carers' physical and psychological well-being. Assessment occurred between February and July 2019 and included objective, validated measures to examine physical and psychological well-being. To assess the association between physical and psychological factors, correlational analyses were performed. Twenty-eight carers participated in the pilot study (96% female, mean age 61.6 years). Exercise capacity varied, and 84% of carers met the recommended 150 min of physical activity per week, with carers spending 8.6% of their time in moderate-to-vigorous physical activity; and 37.9% of the day sedentary. Psychological health outcomes reflect a population with high distress levels and lower than average mental well-being, but with normal resilience scores. Carers with higher levels of resilience had greater exercise capacity, covering further distance in the 6-min walk test, and as resilience increased, number of sedentary bouts decreased. This research demonstrates that there is a relationship between health behaviours and psychological well-being in carers of veterans and serving personnel. Based on the findings of this pilot study, programmes to support family carers should include information about physical activity, reducing sedentary time, and increasing resilience. Interventions designed to improve physical and psychological well-being should be trialled and evaluated for effectiveness.

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

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

Experience of children growing up with a parent who has military-related post-traumatic stress disorder: a qualitative systematic review

OBJECTIVE

The objective of this review is to describe the experiences of children growing up in military families whose parents have military-related post-traumatic stress disorder.

INTRODUCTION

Whether serving as a peacekeeper or warrior, military service is both physically and psychologically demanding, increasing exposures to potentially traumatic and morally injurious events and threats to personal safety. Those who have served in the military are at increased risk for developing post-traumatic stress disorder, which includes symptoms such as emotional numbing, withdrawal, and hyperarousal. Research has focused on the experiences of and impacts on spouses and partners of military veterans with post-traumatic stress disorder, with quantitative and synthesis studies reporting on measurable impacts on children growing up in military families where a parent is diagnosed with post-traumatic stress disorder.

INCLUSION CRITERIA

This review included children who are or have grown up in military families in domestically peaceful nations that deploy their armed forces to global locations of political instability, armed civil conflict, and/or natural disasters for the purposes of peacekeeping, humanitarian aid, or war, as well as parents living with post-traumatic stress disorder who speak specifically about the experience of their children. Situations of homeland conflict were excluded. The military families of interest are those with one or more parent having a diagnosis of post-traumatic stress disorder associated with military service. Traumatic experiences leading to post-traumatic stress disorder can be acquired prior to military service or through unrelated experiences, so it cannot be presumed that military service or even combat deployment, in and of itself, causes post-traumatic stress disorder. This review includes the experiences of children currently in childhood as well as adult children of a parent with current or previous military service.

METHODS

The following databases were first searched in August 2016 and updated in January 9, 2020: MEDLINE, Embase, Web of Science Core Collection, CINAHL, PsycINFO, AMED, ERIC, and ProQuest Dissertations and Theses Global. This review was conducted in accordance with JBI methodology for systematic reviews of qualitative evidence and with an a priori protocol published in 2018.

RESULTS

Twelve studies were included. The majority of the studies were published after 2006. The review represents the experiences of 139 children (n = 66) and adult children (n = 73) participants from military families in the United States, Canada, and Australia. There were four synthesized findings: i) Parental post-traumatic stress disorder creates a volatile and distressing climate within the family, eliciting a range of responses from children (86 findings across three categories); ii) Parental post-traumatic stress disorder ripples through the family system, disrupting interpersonal communication and relationships during childhood (57 findings over four categories); iii) Children can experience emotional and psychological difficulties well into adulthood (84 findings across five categories); and iv) Making sense of it all and moving beyond parental post-traumatic stress disorder can take significant time, energy, and support (74 findings across four categories).

CONCLUSIONS

The quality of the included studies proved to be high, giving strength to this review. Effective ways of communicating with children about the nature of both the traumatic exposure and the post-traumatic stress disorder itself must be developed. While individuals with post-traumatic stress disorder deserve appropriate interventions to alleviate symptoms and improve functioning, it is not sufficient for recovery from post-traumatic stress disorder either for the individual or for the family who has been deeply affected themselves. Prospective and longitudinal research is needed, ensuring that both the voice of the child and multiple perspectives within family systems are included and compared.

Supporting the Mental Health Needs of Military Partners Through the Together Webinar Program: Pilot Randomized Controlled Trial

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.

Exploring the Acceptability of The Together Webinar Programme for Military Partners: A Qualitative Study

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.