The Department of Veterans Affairs (VA) has launched an organization-wide transformation to a Whole Health System of Care that will ideally begin at the time of transition from active duty through the end of a Veteran’s life. A brief history and overview of the Whole Health approach are provided along with selected evaluation results and planned initial actions as a result of the Total Force Fitness–Whole Health Summit held in March 2022. More work is required to strengthen the natural linkages between the Department of Defense’s Total Force Fitness and Veterans Affairs’ Whole Health approach to care. The Total Force Fitness–Whole Health collaboration is a model of whole-person care for the nation.
Search Results
Library (21)
Showing library results for: March 2022
1 - 20 of 21
1 Veterans Affairs’ Whole Health System of Care for transitioning service members and veterans
Veterans Affairs’ Whole Health System of Care for transitioning service members and veterans
APA Citation:
Gantt, C. J., Donovan, N., & Khung, M. (2023). Veterans Affairs’ Whole Health System of Care for transitioning service members and veterans. Military Medicine, 188(Supplement 5), 28–32. https://doi.org/10.1093/milmed/usad047
Focus:
Veterans
Programming
Physical health
Mental health
Branch of Service:
Multiple branches
Military Affiliation:
Veteran
Population:
Adulthood (18 yrs & older)
Young adulthood (18 - 29 yrs)
Thirties (30 - 39 yrs)
Middle age (40 - 64 yrs)
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Research
Gantt, Cynthia J.; Donovan, Nancy; Khung, Maureen
2023
2 Virtual behavioral health for Army soldiers: Soldier perspectives and patterns of treatment
Virtual behavioral health for Army soldiers: Soldier perspectives and patterns of treatment
APA Citation:
Hepner, K. A., Breslau, J., Sousa, J. L., Roth, C. P., Ruder, T., González, I., Montemayor, C. K., & Griffin, B. A. (2023). Virtual behavioral health for Army soldiers: Soldier perspectives and patterns of treatment (Article RR-A2241-1). RAND Corporation. https://www.rand.org/pubs/research_reports/RRA2241-1.html
Focus:
Mental health
Branch of Service:
Army
Military Affiliation:
Active Duty
Population:
Adulthood (18 yrs & older)
Young adulthood (18 - 29 yrs)
Thirties (30 - 39 yrs)
Middle age (40 - 64 yrs)
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Research and Technical Reports
Hepner, Kimberly A.; Breslau, Joshua; Sousa, Jessica L.; Roth, Carol P.; Ruder, Teague; González, Isabelle; Montemayor, Cheryl K.; Griffin, Beth Ann
2023
Delivery of high-quality behavioral health (BH) care is essential to the readiness of the U.S. armed forces and their families. Virtual behavioral health (VBH) care expanded during the COVID-19 pandemic and could support BH care delivery in the future. The authors examined trends in the use of VBH care for U.S. Army soldiers and their spouses from prior to the pandemic through March 2022 and surveyed soldiers about their perceptions of VBH care.
Considering the psychological experience of amputation and rehabilitation for military veterans: A systematic review and metasynthesis of qualitative research
APA Citation:
Murray, C. D., Havlin, H., & Molyneaux, V. (2024). Considering the psychological experience of amputation and rehabilitation for military veterans: A systematic review and metasynthesis of qualitative research. Disability and Rehabilitation, 46(6), 1053-1072. https://doi.org/10.1080/09638288.2023.2182915
Focus:
Physical health
Veterans
Branch of Service:
Multiple branches
Military Affiliation:
Veteran
Population:
Adulthood (18 yrs & older)
Young adulthood (18 - 29 yrs)
Thirties (30 - 39 yrs)
Middle age (40 - 64 yrs)
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Research
Murray, Craig D.; Havlin, Heather; Molyneaux, Victoria
2024
Purpose Research highlights the differences and unique experiences of military veterans experiencing amputation compared to civilians. This review aimed to synthesise qualitative research exploring the experience of amputation and rehabilitation among existing or previous members of the military.Methods A systematic search of six databases (PsycINFO, AMED, MEDLINE, CINAHL, Web of Science and Scopus) was undertaken in March 2022. The results of 17 papers reporting 12 studies published between 2009 and 2022 were synthesised using a meta-ethnographic approach to generate new interpretations reflecting the experiences of members of the military who have experienced limb loss.Results Three themes were developed from the data: (1) Making the physical and psychological transition to life after amputation; (2) The role of the military culture in rehabilitation; and (3) The impact of relationships and the gaze of others during rehabilitation and beyond.Conclusions Military veterans with limb loss experience difficulties in navigating civilian healthcare systems and gaining appropriate support away from the military. Rehabilitation professionals, with psychological training or mentoring, involved in the care of military veterans following amputation could offer psychological support during the transition to civilian life and targeted therapies to veterans experiencing high levels of pain, and facilitate peer support programmes.
4 How does the American public interact with chaplains? Evidence from a national survey
How does the American public interact with chaplains? Evidence from a national survey
APA Citation:
Lawton, A., Cadge, W., & Hamar Martinez, J. (2024). How does the American public interact with chaplains? Evidence from a national survey. Journal of Health Care Chaplaincy, 30(2), 137-151. https://doi.org/10.1080/08854726.2023.2239109
Focus:
Other
Branch of Service:
Multiple branches
Military Affiliation:
Active Duty
Veteran
Population:
Adulthood (18 yrs & older)
Thirties (30 - 39 yrs)
Middle age (40 - 64 yrs)
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Research
Lawton, Amy; Cadge, Wendy; Hamar Martinez, Jessica
2024
How does the American public understand the term chaplain? What fraction interact with chaplains and in what settings? What is the content of those interactions and do care recipients find them valuable? We answer these questions with data from a nationally representative survey (N = 1096) conducted in March 2022 and interviews with a subset (N = 50) of survey recipients who interacted with chaplains. We find that people in the United States do not have a consistent understanding of the term chaplain. Based on our definition, at least 18% of Americans have interacted with a chaplain. Among those who interacted with a chaplain as defined in the survey, the majority did so through healthcare organizations. Care recipients include people who were ill and their visitors/caregivers. The most common types of support received were prayer, listening and comfort. Overall, survey respondents found chaplains to be moderately or very valuable.
Depression and mental health service use among 12–17 Year old U.S. adolescents: Associations with current parental and sibling military service
APA Citation:
London, A. S. (2021). Depression and mental health service use among 12-17 year old U.S. adolescents: Associations with current parental and sibling military service. SSM – Population Health, 16, 100920. https://doi.org/10.1016/j.ssmph.2021.100920
Focus:
Mental health
Youth
Branch of Service:
Multiple branches
Military Affiliation:
Active Duty
Population:
Childhood (birth - 12 yrs)
School age (6 - 12 yrs)
Adolescence (13 - 17 yrs)
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Research & Summary
London, Andrew S.
2021
Objective To examine whether having a parent and/or a sibling currently serving in the military is associated with major depression and use of mental health services among 12–17 year old adolescents in the United States. Method Descriptive and multivariate logistic regression analyses are conducted using pooled data from the 2016–2019 National Survey of Drug Use and Health (NSDUH). Analyses are weighted and standard errors are adjusted for the complex sampling design. Results Adolescents are more likely to have a sibling than a parent currently serving in the military. Having a sibling currently in the military increases the likelihood of having a lifetime and a past-year major depressive episode (MDE), but not a past-year MDE with severe role impairment or use of mental health services. Having a parent in the military is not associated with any measure of MDE, but increases use of specialty outpatient, specialty inpatient/residential, and non-specialty mental health services net of MDE and sociodemographic controls. Conclusion Considerable attention has focused on risk and resilience among the dependent children of current service members. A better understanding of how the current military service experiences of siblings, as well as parents, influences related adolescents’ mental health, mental health care service use, substance use, and health behaviors has the potential to contribute to programs and interventions that can enhance the well-being of youth with intra-generational as well as inter-generational connections to the military. Adolescents who have a sibling currently serving in the military are an at-risk population for MDE and potentially other mental and behavioral health problems.
6 Predictors of early postpartum maternal functioning among women veterans
Predictors of early postpartum maternal functioning among women veterans
APA Citation:
Goger, P., Szpunar, M. J., Baca, S. A., Gartstein, M. A., & Lang, A. J. (2022). Predictors of early postpartum maternal functioning among women veterans. Maternal and Child Health Journal, 26, 149 – 155. https://doi.org/10.1007/s10995-021-03241-0
Focus:
Parents
Mental health
Veterans
Branch of Service:
Multiple branches
Military Affiliation:
Veteran
Population:
Adulthood (18 yrs & older)
Young adulthood (18 - 29 yrs)
Thirties (30 - 39 yrs)
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Research & Summary
Goger, Pauline; Szpunar, Mercedes J.; Baca, Selena A.; Gartstein, Masha A.; Lang, Ariel J.
2021
Introduction The perinatal period constitutes an important window of opportunity for optimizing healthy development of offspring but is heavily influenced by maternal mental health. Maternal pregnancy-related anxiety (PrA), depression, and post-traumatic stress disorder (PTSD) have been implicated in adverse outcomes for both mother and child. The current study examined whether psychopathology during pregnancy and postpartum was associated with greater experienced parenting stress and bonding difficulties in women veterans, who may be predisposed to develop psychopathology due to heightened risk of exposure to traumatic events. Methods Pregnant veterans (N = 28) completed self-report questionnaires regarding their PrA, depression and PTSD symptoms during pregnancy and postpartum, as well as on their experience of parenting stress and bonding with their infant. Results PrA was a more robust predictor of postpartum depression (PPD) than depression during pregnancy. PPD, in turn, was significantly associated with bonding and parenting stress, such that more depressed mothers were more likely to experience greater general bonding difficulties, increased rejections and pathological anger towards their infants, greater anxiety towards their infants, and more parenting stress. Conclusions PrA might be a high-yield modifiable risk factor in the prevention of PPD for women veterans and their subsequent experiences with high parenting stress and bonding difficulties.
7 Predictors of adolescent resilience during the COVID-19 pandemic: Cognitive reappraisal and humor
Predictors of adolescent resilience during the COVID-19 pandemic: Cognitive reappraisal and humor
APA Citation:
Kuhlman, K. R., Straka, K., Mousavi, Z., Tran, M. L., & Rodgers, E. (2021). Predictors of adolescent resilience during the COVID-19 pandemic: Cognitive reappraisal and humor. Journal of Adolescent Health, 69, 729-736. https://doi.org/10.1016/j.jadohealth.2021.07.006
Focus:
Mental health
Youth
Population:
School age (6 - 12 yrs)
Adolescence (13 - 17 yrs)
Adulthood (18 yrs & older)
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Research & Summary
Kuhlman, Kate R.; Straka, Kelci; Mousavi, Zahra; Tran, Mai-Lan; Rodgers, Emma
2021
Purpose The COVID-19 pandemic and efforts to slow the spread of disease have particularly affected the lives of adolescents. Many studies have recently identified the risks to adolescent mental health posed by the COVID-19 pandemic, yet few have identified the markers of resilience to the events and concerns associated with the pandemic's lived experience. This study examined the moderating role of psychosocial resources in the association between the tangible and emotional experiences of the COVID-19 pandemic and symptoms of common psychiatric problems during adolescence (depression, anxiety, proactive and reactive aggression, and sleep problems).
The lived experiences of highly mobile military adolescents in search of their identity: An interpretive phenomenological study
APA Citation:
Thomas, J. S., Smart, D., Severtsen, B., & Haberman, M. R. (2021). The lived experiences of highly mobile military adolescents in search of their identity: An interpretive phenomenological study. Journal of Adolescent Research. Advance online publication. https://doi.org/10.1177/07435584211006469
Focus:
Youth
Mental health
Branch of Service:
Army
Military Affiliation:
Active Duty
Population:
Adolescence (13 - 17 yrs)
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Research & Summary
Thomas, Jennifer S.; Smart, Denise; Severtsen, Billie; Haberman, Mel R.
2021
The challenges that military adolescents face, including frequent relocations, pose potential risks to their identity development. The central aim of this study is to understand the impact that frequent relocations have on the identity development of highly mobile military adolescents. Military adolescents between the ages of 16 and 18 years were interviewed. An interpretive phenomenological design was employed to inform the interview and analytic approach. An inductive approach using humanistic interpretation through Hermeneutic circles was conducted. Four overarching themes were identified, including self-perception in the world, building relationships, overwhelming emotions, and fostering healthy transitions. Several subthemes developed and gave rise to common adolescent experiences. Military adolescents facing frequent relocations experience a series of identity crises that are often masked in daily life and kept secret from peers and family. Healthy transitions require the adolescent and family to openly and repeatedly explore the impact of relocations on the inner and social life of adolescents. This study calls for future research on the military adolescent-provider relationship to explore how to better help meet the needs of this population from a health care standpoint.
Peer-to–Patient-Aligned Care Team (Peer-to-PACT; P2P), a peer-led home visit intervention program for targeting and improving long-term care services and support for veterans with high needs and high risk: Protocol for a mixed methods feasibility study
APA Citation:
Garcia-Davis, S., Palacio, A., Bast, E., Penney, L. S., Finley, E., Kinosian, B., Intrator, O., & Dang, S. (2023). Peer-to–Patient-Aligned Care Team (Peer-to-PACT; P2P), a peer-led home visit intervention program for targeting and improving long-term care services and support for veterans with high needs and high risk: Protocol for a mixed methods feasibility study. JMIR Research Protocols, 12(1), Article e46156. https://doi.org/10.2196/46156
Focus:
Veterans
Programming
Branch of Service:
Multiple branches
Military Affiliation:
Veteran
Population:
Adulthood (18 yrs & older)
Aged (65 yrs & older)
Very old (85 yrs & older)
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Research
Garcia-Davis, Sandra; Palacio, Ana; Bast, Elizabeth; Penney, Lauren S.; Finley, Erin; Kinosian, Bruce; Intrator, Orna; Dang, Stuti
2023
Background: Keeping older veterans with high needs and high risk (HNHR) who are at risk of long-term institutional care safely in their homes for as long as possible is a Department of Veterans Affairs priority. Older veterans with HNHR face disproportionate barriers and disparities to engaging in their care, including accessing care and services. Veterans with HNHR often have poor ability to maintain health owing to complicated unmet health and social needs. The use of peer support specialists (peers) is a promising approach to improving patient engagement and addressing unmet needs. The Peer-to–Patient-Aligned Care Team (Peer-to-PACT; P2P) intervention is a multicomponential home visit intervention designed to support older veterans with HNHR to age in place. Participants receive a peer-led home visit to identify unmet needs and home safety risks aligned with the age-friendly health system model; care coordination, health care system navigation, and linking to needed services and resources in collaboration with their PACT; and patient empowerment and coaching using Department of Veterans Affairs whole health principles. Objective: The primary aim of this study is to evaluate the preliminary effect of the P2P intervention on patient health care engagement. The second aim is to identify the number and types of needs and unmet needs as well as needs addressed using the P2P needs identification tool. The third aim is to evaluate the feasibility and acceptability of the P2P intervention delivered over 6 months. Methods: We will use a quantitative-qualitative convergent mixed methods approach to evaluate the P2P intervention outcomes. For our primary outcome, we will conduct an independent, 2-tailed, 2-sample t test to compare the means of the 6-month pre-post differences in the number of outpatient PACT encounters between the intervention and matched comparison groups. Qualitative data analysis will follow a structured rapid approach using deductive coding as well as the Consolidated Framework for Implementation Research. Results: Study enrollment began in July 2020 and was completed in March 2022. Our sample size consists of 114 veterans: 38 (33.3%) P2P intervention participants and 76 (66.7%) matched comparison group participants. Study findings are expected to be published in late 2023. Conclusions: Peers may help bridge the gap between PACT providers and veterans with HNHR by evaluating veterans’ needs outside of the clinic, summarizing identified unmet needs, and developing team-based solutions in partnership with the PACT. The home visit component of the intervention provides eyes in the home and may be a promising and innovative tool to improve patient engagement.
Design of the CHARGE study: A randomized control trial evaluating a novel treatment for veterans with binge eating disorder and overweight and obesity
APA Citation:
Boutelle, K. N., Afari, N., Obayashi, S., Eichen, D. M., Strong, D. R., & Peterson, C. B. (2023). Design of the CHARGE study: A randomized control trial evaluating a novel treatment for veterans with binge eating disorder and overweight and obesity. Contemporary Clinical Trials, 130, Article 107234. https://doi.org/10.1016/j.cct.2023.107234
Focus:
Physical health
Programming
Veterans
Branch of Service:
Multiple branches
Military Affiliation:
Veteran
Population:
Adulthood (18 yrs & older)
Young adulthood (18 - 29 yrs)
Thirties (30 - 39 yrs)
Middle age (40 - 64 yrs)
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Research
Boutelle, Kerri N.; Afari, Niloofar; Obayashi, Saori; Eichen, Dawn M.; Strong, David R.; Peterson, Carol B.
2023
A large number of Veterans experience binge eating and overweight or obesity, which are associated with significant health and psychological consequences. The gold-standard program for the treatment of binge eating, Cognitive Behavioral Therapy (CBT), results in decreases in binge eating frequency but does not result in significant weight loss. We developed the Regulation of Cues (ROC) program to reduce overeating and binge eating through improvement in sensitivity to appetitive cues and decreased responsivity to external cues, an approach that has never been tested among Veterans. In this study, we combined ROC with energy restriction recommendations from behavioral weight loss (ROC+). This study is a 2-arm randomized controlled trial designed to evaluate the feasibility and acceptability of ROC+, and to compare the efficacy of ROC+ and CBT on reduction of binge eating, weight, and energy intake over 5-months of treatment and 6-month follow-up. Study recruitment completed in March 2022. One hundred and twenty-nine Veterans were randomized (mean age = 47.10 (sd = 11.3) years; 41% female, mean BMI = 34.8 (sd = 4.7); 33% Hispanic) and assessments were conducted at baseline, during treatment and at post-treatment. The final 6-month follow-ups will be completed in April 2023. Targeting novel mechanisms including sensitivity to internal cures and responsivity to external cues is critically important to improve binge eating and weight-loss programs among Veterans.
A comparison of end-of-life care quality for Veterans receiving hospice in VA nursing homes and community nursing homes
APA Citation:
Wachterman, M. W., Smith, D., Carpenter, J. G., Griffin, H. L., Thorpe, J., Feder, S. L., Hoelter, J., Ersek, M., Shreve, S., & Kutney-Lee, A. (2024). A comparison of end-of-life care quality for Veterans receiving hospice in VA nursing homes and community nursing homes. Journal of the American Geriatrics Society, 72(1), 59-68. https://doi.org/10.1111/jgs.18606
Focus:
Veterans
Programming
Branch of Service:
Multiple branches
Military Affiliation:
Veteran
Population:
Adulthood (18 yrs & older)
Very old (85 yrs & older)
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Research
Wachterman, Melissa W.; Smith, Dawn; Carpenter, Joan G.; Griffin, Hillary L.; Thorpe, Joshua; Feder, Shelli L.; Hoelter, Jillian; Ersek, Mary; Shreve, Scott; Kutney-Lee, Ann
2024
Background While the Veterans Health Administration (VA) has long provided hospice care within VA community living centers (CLCs, i.e., VA nursing homes), an increasing number of Veterans are receiving hospice in VA-contracted community nursing homes (CNHs). However, little data exist about the quality of end-of-life (EOL) care provided in CNHs. The aim of this study was to compare family ratings of the quality of EOL care provided to Veterans receiving hospice in VA CLCs and VA-contracted CNHs. Methods We conducted a retrospective analysis of national data from VA's electronic medical record and Bereaved Family Survey (BFS) for Veterans who received hospice in VA CLCs or VA-contracted CNHs between October 2021 and March 2022. The final sample included 1238 Veterans who died in either a CLC (n = 1012) or a CNH (n = 226) and whose next-of-kin completed the BFS. Our primary outcome was the BFS global rating of care received in the last 30 days of life. Secondary outcomes included BFS items related to symptom management, communication, emotional and spiritual support, and information about burial and survivor benefits. We compared unadjusted and adjusted proportions for all BFS outcomes between those who received hospice in CLCs and CNHs. Results The adjusted proportion of family members who gave the best possible rating (a score of 9 or 10 out of a possible 10) for the overall care received near EOL was more than 13 percentage points higher for Veterans who received hospice in VA CLCs compared to VA-contracted CNHs. Our findings also revealed quality gaps of even greater magnitude in specific EOL care-focused domains. Conclusions Our findings document inadequacies in the quality of multiple aspects of EOL care provided to Veterans in CNH-based hospice and illuminate the urgent need for policy and practice interventions to improve this care.
12 Alcohol use patterns during and after the COVID-19 pandemic among veterans in the United States
Alcohol use patterns during and after the COVID-19 pandemic among veterans in the United States
APA Citation:
Wong, R. J., Yang, Z., Ostacher, M., Zhang, W., Satre, D., Monto, A., Khalili, M., Singal, A. K., & Cheung, R. (2024). Alcohol use patterns during and after the COVID-19 pandemic among veterans in the United States. The American Journal of Medicine, 137(3), 236-239.e2. https://doi.org/10.1016/j.amjmed.2023.11.013
Focus:
Veterans
Substance use
Branch of Service:
Multiple branches
Military Affiliation:
Veteran
Population:
Adulthood (18 yrs & older)
Young adulthood (18 - 29 yrs)
Thirties (30 - 39 yrs)
Middle age (40 - 64 yrs)
Aged (65 yrs & older)
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Research
Wong, Robert J.; Yang, Zeyuan; Ostacher, Michael; Zhang, Wei; Satre, Derek; Monto, Alexander; Khalili, Mandana; Singal, Ashwani K.; Cheung, Ramsey
2024
Background Veterans may be especially susceptible to increased alcohol consumption following the COVID-19 pandemic. We aim to evaluate trends in alcohol use among U.S. Veterans before, during, and following the onset of the COVID-19 pandemic. Methods All U.S. Veterans utilizing Veterans Affairs healthcare facilities in the U.S. from March 1, 2018 to February 28, 2023 with ≥1 AUDIT-C score were categorized into 1) No alcohol use (AUDIT-C = 0), 2) Low-risk alcohol use (AUDIT-C 1-2 for women, 1-3 for men), and 3) High-risk alcohol use (AUDIT-C ≥ 3 for women, ≥ 4 for men). Trends in the proportion of Veterans reporting high-risk alcohol use, stratified by sex, age, race/ethnicity, and urbanicity were evaluated. Results Among a cohort of 2.15 to 2.60 million Veterans, 15.5% reported high-risk alcohol use during March 2018-February 2019, which declined to 14.6% during the first year of the pandemic, increased to 15.2% in the second year, and then decreased to 14.9% from March 2022-February 2023. Among non-Hispanic whites, African Americans, Asians, and Hispanics, the proportion of women reporting high-risk alcohol use surpassed that of men during the onset of the pandemic and beyond. The greatest proportion of high-risk alcohol use was observed among young Veterans aged 18-39 years (17-27%), which was consistent across all race/ethnic groups. Conclusions High-risk alcohol use among U.S. Veterans has increased since the COVID-19 pandemic onset, and in the third year following pandemic onset, 15% of Veterans overall and over 20% of young Veterans aged 18-39 years reported high -risk alcohol use.
Feasibility of a combined neuromodulation and yoga intervention for mild traumatic brain injury and chronic pain: Protocol for an open-label pilot trial
APA Citation:
Krese, K. A., Donnelly, K. Z., Etingen, B., Bender Paper, T. L., Chaudhuri, S., Aaronson, A. L., Shah, R. P., Bhaumik, D. K., Billups, A., Bedo, S., Wanicek-Squeo, M. T., Bobra, S., & Herrold, A. A. (2022). Feasibility of a combined neuromodulation and yoga intervention for mild traumatic brain injury and chronic pain: Protocol for an open-label pilot trial. JMIR Research Protocols., 11(6). https://doi.org/10.2196/37836
Focus:
Trauma
Physical health
Veterans
Branch of Service:
Multiple branches
Military Affiliation:
Veteran
Population:
Young adulthood (18 - 29 yrs)
Adulthood (18 yrs & older)
Thirties (30 - 39 yrs)
Middle age (40 - 64 yrs)
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Research
Krese, Kelly A.; Donnelly, Kyla Z.; Etingen, Bella; Pape, Theresa L. Bender; Chaudhuri, Sarmistha; Aaronson, Alexandra L.; Shah, Rachana P.; Bhaumik, Dulal K.; Billups, Andrea; Bedo, Sabrina; Wanicek-Squeo, Mary Terese; Bobra, Sonia; Herrold, Amy A.
2022
Background: Mild traumatic brain injury (mTBI) and chronic pain often co-occur and worsen rehabilitation outcomes. There is a need for improved multimodal nonpharmacologic treatments that could improve outcomes for both conditions. Yoga is a promising activity-based intervention for mTBI and chronic pain, and neuromodulation through transcranial magnetic stimulation is a promising noninvasive, nonpharmacological treatment for mTBI and chronic pain. Intermittent theta burst stimulation (iTBS) is a type of patterned, excitatory transcranial magnetic stimulation. iTBS can induce a window of neuroplasticity, making it ideally suited to boost the effects of treatments provided after it. Thus, iTBS may magnify the impacts of subsequently delivered interventions as compared to delivering those interventions alone and accordingly boost their impact on outcomes. Objective: The aim of this study is to (1) develop a combined iTBS+yoga intervention for mTBI and chronic pain, (2) assess the intervention’s feasibility and acceptability, and (3) gather preliminary clinical outcome data on quality of life, function, and pain that will guide future studies. Methods: This is a mixed methods, pilot, open-labeled, within-subject intervention study. We will enroll 20 US military veteran participants. The combined iTBS+yoga intervention will be provided in small group settings once a week for 6 weeks. The yoga intervention will follow the LoveYourBrain yoga protocol—specifically developed for individuals with TBI. iTBS will be administered immediately prior to the LoveYourBrain yoga session. We will collect preliminary quantitative outcome data before and after the intervention related to quality of life (TBI-quality of life), function (Mayo-Portland Adaptability Index), and pain (Brief Pain Inventory) to inform larger studies. We will collect qualitative data via semistructured interviews focused on intervention acceptability after completion of the intervention. Results: This study protocol was approved by Edward Hines Jr Veterans Administration Hospital Institutional Review Board (Hines IRB 1573116-4) and was prospectively registered on ClinicalTrials.gov (NCT04517604). This study includes a Food and Drug Administration Investigational Device Exemption (IDE: G200195). A 2-year research plan timeline was developed. As of March 2022, a total of 6 veterans have enrolled in the study. Data collection is ongoing and will be completed by November 2022. We expect the results of this study to be available by October 2024. Conclusions: We will be able to provide preliminary evidence of safety, feasibility, and acceptability of a novel combined iTBS and yoga intervention for mTBI and chronic pain—conditions with unmet treatment needs.
14 Risk and protective factors predictive of marital instability in U.S. military couples
Risk and protective factors predictive of marital instability in U.S. military couples
APA Citation:
Pflieger, J. C., Richardson, S. M., Stander, V. A., & Allen, E. S. (2022). Risk and protective factors predictive of marital instability in U.S. military couples. Journal of Family Psychology, 36(5), 791–802. http://dx.doi.org/10.1037/fam0000949
Focus:
Couples
Branch of Service:
Air Force
Army
Coast Guard
Marine Corps
Navy
Multiple branches
Military Affiliation:
Active Duty
Population:
Adulthood (18 yrs & older)
Young adulthood (18 - 29 yrs)
Thirties (30 - 39 yrs)
Middle age (40 - 64 yrs)
Aged (65 yrs & older)
Very old (85 yrs & older)
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Research & Summary
Pflieger, Jacqueline C.; Richardson, Sabrina M.; Stander, Valerie A.; Allen, Elizabeth S.
2022
The objective of this study was to predict marital instability from a range of risk and protective factors in a large, representative cohort of military couples participating in the Millennium Cohort Family Study. Online and paper surveys were administered to service members and their spouses in 2011–2013, which captured couples’ demographic and background characteristics, family stressors, military experiences, and mental health risk factors as well as protective factors including family communication, and military support and satisfaction. Approximately 3 years later, change in marital status was examined among participants who completed a follow-up survey (n = 6,494 couples). Hierarchical logistic regression models indicated that couples’ younger age, lower education, childhood trauma, spouse employment status, mental health, and lower levels of communication contributed significant unique risk for marital instability. Moderation analyses by service member gender and spouse military status revealed that social isolation increased odds of marital instability for couples in which the service member was male but was not evidenced for couples in which the service member was female. Further, combat experience increased odds of marital instability for couples in which the service member was married to a veteran spouse but not for service members married to a dual-military or civilian spouse. Findings from this study can be used to target specific couple risk factors for marital instability and to tailor programs to at-risk subgroups. (PsycInfo Database Record (c) 2021 APA, all rights reserved)
Effects of social network characteristics on mental health outcomes among United States Army Reserve and National Guard soldiers
APA Citation:
Vest, B. M., Goodell, E. M. A., Homish, D. L., & Homish, G. G. (2022). Effects of social network characteristics on mental health outcomes among United States Army Reserve and National Guard soldiers. Community Mental Health Journal, 58, 1268–1278. https://doi.org/10.1007/s10597-021-00935-1
Focus:
Mental health
Substance use
Branch of Service:
Army
Military Affiliation:
Guard
Reserve
Population:
Adulthood (18 yrs & older)
Young adulthood (18 - 29 yrs)
Thirties (30 - 39 yrs)
Middle age (40 - 64 yrs)
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Research & Summary
Vest, Bonnie M.; Goodell, Erin M. Anderson; Homish, D. Lynn; Homish, Gregory G.
2022
We sought to examine the relative salience of multiple social network structural characteristics (e.g., size, composition, quality, substance use) for understanding soldiers’ mental health symptoms (anger, anxiety, depression, PTSD). Data are drawn from soldiers (N = 421) participating in the Operation: SAFETY study. Negative binomial regression models examined the relationship between ten social network characteristics and mental health outcomes, controlling for age, sex, years of military service, and deployment history. Greater number of close network ties was associated with fewer symptoms of anger, anxiety, and depression (ps < 0.05), but not PTSD. Having more illicit drug-using network ties was associated with greater severity of anxiety symptoms (p < 0.05). Finally, more days spent drinking with network members was related to higher levels of anger (p < 0.05). Interpersonal relationships that entail substance use are associated with greater anxiety and anger while a greater number of close ties is associated with fewer anger, anxiety, and depression symptoms.
PTSD and parental functioning: The protective role of neighborhood cohesion among black and white veterans
APA Citation:
Franz, M. R., Sanders, W., Nillni, Y. I., Vogt, D., Matteo, R., & Galovski, T. (2022). PTSD and parental functioning: The protective role of neighborhood cohesion among Black and White veterans. Psychological Trauma: Theory, Research, Practice, and Policy, 14(S1), S4-S12. https://doi.org/10.1037/tra0001123
Focus:
Parents
Trauma
Veterans
Branch of Service:
Multiple branches
Military Affiliation:
Veteran
Population:
Adulthood (18 yrs & older)
Young adulthood (18 - 29 yrs)
Thirties (30 - 39 yrs)
Middle age (40 - 64 yrs)
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Research & Summary
Franz, Molly R.; Sanders, Wesley; Nillni, Yael I.; Vogt, Dawne; Matteo, Rebecca; Galovski, Tara
2022
Objective: Caregivers with a history of trauma exposure may struggle to parent effectively, particularly when symptoms of PTSD are prominent. Consequently, identifying factors that buffer associations between PTSD and poor parental functioning is critical to help trauma-exposed families thrive. One important source of resilience may spring from being part of a socially cohesive neighborhood that offers positive social connections and resources. The purpose of this study was to examine whether greater neighborhood cohesion buffers associations between PTSD and perceived parental functioning. Method: A diverse national sample of 563 Black and White veterans raising children in single or dual parent households completed questionnaires assessing PTSD symptoms and neighborhood cohesion at baseline, as well as parental functioning four months later. Results: Multigroup moderation analyses that controlled for crime index, income, and sex revealed that among single Black veterans, but not other groups, the relationship between higher PTSD and poorer parental functioning was weakened for veterans who reported higher neighborhood cohesion. Conclusions: Findings suggest that PTSD symptoms and neighborhood cohesion affect parenting differently across racial and family makeup configurations, and that higher neighborhood cohesion might be particularly useful in buffering the association between PTSD and parenting among single Black veterans. (PsycInfo Database Record (c) 2021 APA, all rights reserved)
Training needs among nonmental health professionals working with service members: A qualitative investigation
APA Citation:
Baier, A. L., Marques, L., Borba, C. P. C., Kelly, H., Clair-Hayes, K., Dixon De Silva, L., Chow, L. K., & Simon, N. M. (2019). Training needs among nonmental health professionals working with service members: A qualitative investigation. Military Psychology, 31(1), 71–80. https://doi.org/10.1080/08995605.2018.1541392
Focus:
Veterans
Mental health
Programming
Branch of Service:
Air Force
Army
Coast Guard
Marine Corps
Navy
Multiple branches
Military Affiliation:
Veteran
Population:
Adulthood (18 yrs & older)
Young adulthood (18 - 29 yrs)
Thirties (30 - 39 yrs)
Middle age (40 - 64 yrs)
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Research & Summary
Baier, Allison L.; Marques, Luana; Borba, Christina P. C.; Kelly, Hope; Clair-Hayes, Katherine; Dixon De Silva, Louise; Chow, Louis K.; Simon, Naomi M.
2019
Though many service members will not directly seek mental health care due to stigma and other factors, they may interact with the healthcare system in other ways including contact with first responders, nurses, and allied health care professionals. However, little attention has been spent in this regard on the educational needs of these professionals whose contact with service members and Veterans may provide the opportunity to assist Veterans in need with overcoming barriers to accessing mental health care. This qualitative study investigates the educational training needs of first responders and health care professionals in contact with military families and trauma survivors to determine whether, and what type, of additional training is needed. A sample of 42 first responders and health care professionals including emergency medical technicians, police officers, fire fighters, speech language pathologists, occupational therapists, physical therapists, and nurses were recruited to participate in 1 of 6 focus groups. Sessions were audiotaped and transcribed verbatim. Data analysis was guided by a thematic analysis approach. Thematic analyses suggest there is a significant knowledge gap with unmet educational needs of these professionals such as information on the invisible wounds of war, military culture, and screening and referring patients who present symptoms falling outside professionals' scope of practice. Findings point to a need and desire for more robust education for first responders and health care providers around mental health concerns of military populations, including topics such as trauma, military culture, and screening tools. Efforts to develop curricula addressing these concerns are warranted.
Evidence-based social work outreach to military leaders to facilitate intimate partner violence and child maltreatment identification and referral: An evaluation
APA Citation:
Mitnick, D. M., Heyman, R. E., Slep, A. M. S., Lorber, M. L., & Dills, A. L. (2021). Evidence-based social work outreach to military leaders to facilitate intimate partner violence and child maltreatment identification and referral: An evaluation. Journal of Family Social Work, 24(4), 320–338. https://doi.org/10.1080/10522158.2021.1974141
Focus:
Couples
Child maltreatment
Children
Physical health
Parents
Programming
Branch of Service:
Air Force
Military Affiliation:
Active Duty
Population:
Young adulthood (18 - 29 yrs)
Adulthood (18 yrs & older)
Thirties (30 - 39 yrs)
Middle age (40 - 64 yrs)
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Research & Summary
Mitnick, Danielle M.; Heyman, Richard E.; Slep, Amy M. Smith; Lorber, Michael L.; Dills, Ashley L.
2021
The effects of family maltreatment on the military are far-reaching and well documented, with implications that include the deterioration of mission readiness and an increase in distractibility for all involved. Congress has mandated each service agency to take steps in preventing partner and child maltreatment, including outreach – enlisting military leaders to identify, respond to, and mitigate risk factors for maltreatment in their active duty (AD) members – but the success and impact of these efforts have gone mostly unexamined. This article explores the implementation and evaluation of a new Air Force (AF) family maltreatment training based on empirical and military-specific evidence of prevalence, risk and protective factors, and the impact on military families. This project sought to optimize and standardize such trainings across bases in an interactive manner. As expected, the training led to significantly greater knowledge about family maltreatment, significantly lower belief in the justification of both IPV and parent–child aggression, significantly lower belief in the effectiveness of parent–child aggression to solve problems, significantly increased self-efficacy to help prevent and address family maltreatment on the base, and marginally significantly more positive beliefs about Family Advocacy Program (FAP). Additionally, satisfaction with the training was very high.
19 Spiritual care for combat trauma: A qualitative evaluation of REBOOT Combat Recovery
Spiritual care for combat trauma: A qualitative evaluation of REBOOT Combat Recovery
APA Citation:
Knobloch, L. K., Owens, J. L., & Gobin, R. L. (2021). Spiritual care for combat trauma: A qualitative evaluation of REBOOT Combat Recovery. Military Psychology, 33, 392–402. https://doi.org/10.1080/08995605.2021.1962183
Focus:
Trauma
Mental health
Programming
Children
Deployment
Parents
Veterans
Branch of Service:
Army
Navy
Air Force
Marine Corps
Coast Guard
Multiple branches
Military Affiliation:
Active Duty
Veteran
Guard
Population:
Adulthood (18 yrs & older)
Young adulthood (18 - 29 yrs)
Thirties (30 - 39 yrs)
Middle age (40 - 64 yrs)
Aged (65 yrs & older)
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Research & Summary
Knobloch, Leanne K.; Owens, Jenny L.; Gobin, Robyn L.
2021
Combat trauma experienced in a warzone can hamper the physical, mental, and spiritual health of military service members and Veterans for years afterward. Spiritual care for combat trauma is designed to help service members and Veterans find meaning and purpose in their experiences. One such spiritual care program is REBOOT Combat Recovery, a 12-week, Christian-based course led by trained volunteers across the country. An in-depth investigation of the REBOOT program is needed to advance knowledge of spiritual care for combat trauma and to assess the course in attendees’ own words. Semi-structured interviews were conducted with 40 course graduates. Experiences of the course were positive. Interviewees identified the program’s emphasis on peer fellowship, spirituality, and the roots of distress as reasons for its effectiveness (RQ1). The most helpful aspects of the program involved the hospitality and family focus; targets for improvement included maintaining fidelity to the curriculum and offering opportunities for continuity upon graduation (RQ2). Interviewees described a variety of ways the course affected their view of self, their relationship with God and others, and their perceptions of combat trauma (RQ3). These findings are valuable for enriching spiritual care, in general, and enhancing the REBOOT Combat Recovery program, in particular.
Predicting marital health from adverse childhood experiences among United States Air Force active-duty personnel
APA Citation:
Cigrang, J., Balderrama-Durbin, C., Snyder, D. K., Parsons, A. M., Lorko, K., Gupta, A., Smith Slep, A. M., Heyman, R. E., Mitnick, D. M., Wijdenes, K. L., & Yahle, C. (2023). Predicting marital health from adverse childhood experiences among United States air force active-duty personnel. Couple and Family Psychology: Research and Practice, 12(4), 218–232. https://doi.org/10.1037/cfp0000207
Focus:
Couples
Trauma
Branch of Service:
Air Force
Military Affiliation:
Active Duty
Population:
Adulthood (18 yrs & older)
Young adulthood (18 - 29 yrs)
Thirties (30 - 39 yrs)
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Research & Summary
Cigrang, Jeff; Balderrama-Durbin, Christina; Snyder, Douglas K.; Parsons, Aleja M.; Lorko, Kelsey; Gupta, Avantika; Smith Slep, Amy M.; Heyman, Richard E.; Mitnick, Danielle M.; Wijdenes, Kati L.; Yahle, Courtney
2023
Marital dysfunction in military samples demands special scrutiny because of its concurrent and prospective linkages with a broad spectrum of mental and physical health disorders, as well as its demonstrated adverse impact on military readiness. Although previous research has shown higher risk for marital distress and divorce among female service members (SMs), particularly at the enlisted ranks, contributing factors to this elevated risk remain largely undetermined. The present study examined the antecedent contributing influence of exposure to adverse childhood experiences (ACEs) on current marital health in a sample of 373 early-career active-duty Airmen, as well as the potential moderating effect of sex on the magnitude of adverse impact. Results indicated higher prevalence of ACEs for this military sample compared with a community sample and higher prevalence of ACEs for female SMs compared with their male counterparts. Moreover, findings revealed the relatively greater adverse impact of childhood abuse or neglect for female SMs in increasing their likelihood of both IPV perpetration and victimization. Overall, these findings indicate the importance of screening for both antecedent and concurrent indicators of marital health in military settings and developing brief intervention protocols targeting relationship distress and its comorbid conditions in this population. (PsycInfo Database Record (c) 2021 APA, all rights reserved)
