Social support is a critical determinant of military service members’ mental and behavioral health outcomes, but few studies have investigated social support types and sources in the mixed family and military social networks in which service members are embedded. We applied multilevel logistic regression modeling to investigate links between active-duty Army Soldiers’ individual demographic and military characteristics, relational characteristics, and social support outcomes, in sample of 241 active-duty U.S. Army personnel. Results showed that participants who rated unit cohesion higher were more likely to report receiving informational, emotional, and mental health help-seeking support. Participants were more likely to receive informational, emotional, and help-seeking support from a romantic partner or deployment buddy than a relative and less likely to receive help-seeking support from males than females. Findings highlight the critical importance of both unit level and external relationships in meeting Soldiers’ social support needs.
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Showing library results for: November 2023
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1 - 12 of 121 Who supports the troops? Social support domains and sources in active duty Army networks
Who supports the troops? Social support domains and sources in active duty Army networks
APA Citation:
Barr, N., Petry, L., Fulginiti, A., Arora, A., Cederbaum, J., Castro, C., & Rice, E. (2023). Who supports the troops? Social support domains and sources in active duty Army networks. Armed Forces & Society. Advance online publication. https://doi.org/10.1177/0095327X231182907
Focus:
Physical health
Mental health
Other
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 & Summary
Barr, Nicholas; Petry, Laura; Fulginiti, Anthony; Arora, Anil; Cederbaum, Julie; Castro, Carl; Rice, Eric
2023
2 Biracial identity in adult military children
Biracial identity in adult military children
APA Citation:
Williams, C., Guillaume, R. O., & Zamora, R. C. (2023). Biracial identity in adult military children. Identity, 23(4), 361-378. https://doi.org/10.1080/15283488.2023.2238208
Focus:
Other
Branch of Service:
Army
Air Force
Navy
Marine Corps
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 & Summary
Williams, Charlotte; Guillaume, Rene O.; Zamora, Richard C.
2023
This study sought to explore adult biracial individuals and their perceived racial identities and their own military dependent identities in military communities. Utilizing a social constructivist grounded theory methodology, the study participants consisted of 21 Black/White self-identifying biracial former military dependent children. Results show a core category, and two key categories were discovered from the analysis. The core category indicated that biopsychosocial and ecological factors across time influence biracial military identity development. These individuals have an intersecting and outsider identity that influences their community identity. The participants used different coping behaviors to ecological stressors they experienced that shaped their identity. The implications and recommendations for practice, training, and future research are discussed for this study.
The military spouse experience of living alongside their serving/veteran partner with a mental health issue: A systematic review and narrative synthesis
APA Citation:
Senior, E., Clarke, A., & Wilson-Menzfeld, G. (2023). The military spouse experience of living alongside their serving/veteran partner with a mental health issue: A systematic review and narrative synthesis. PLOS ONE, 18(5), Article e0285714. https://doi.org/10.1371/journal.pone.0285714
Focus:
Couples
Veterans
Mental health
Branch of Service:
Multiple branches
International Military
Military Affiliation:
Active Duty
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 & Summary
Senior, Emma; Clarke, Amanda; Wilson-Menzfeld, Gemma
2023
Introduction Military healthcare studies have reported a wide range of mental health issues amongst military personnel. Globally, mental health issues are one of the main causes of ill health. Military personnel have a greater prevalence of mental health issues than that of the general population. The impact of mental health issues can be wide and far reaching for family and carers. This systematic narrative review explores the military spouse experience of living alongside their serving or veteran partner with a mental health issue. Methods The systematic review performed was based on the PRISMA guide for searching, screening, selecting papers for data extraction and evaluation. Studies were identified from CINHAL, ASSIA, Proquest Psychology, Proquest Nursing & Allied Health source, Proquest Dissertations & Theses, ETHOS, PsychArticles, Hospital collection, Medline, Science Direct Freedom Collection and hand searching of citations and reference lists. Results Twenty-seven studies were included in the narrative synthesis. Five overarching themes from the experiences of military spouses’ living alongside their serving/veteran partners mental health issue were identified: caregiver burden, intimate relationships, psychological/psychosocial effects on the spouse, mental health service provision and spouse’s knowledge and management of symptoms. Conclusions The systematic review and narrative synthesis identified that the majority of studies focused on spouses of veterans, very few were specific to serving military personnel, but similarities were noted. Findings suggest that care burden and a negative impact on the intimate relationship is evident, therefore highlight a need to support and protect the military spouse and their serving partner. Likewise, there is a need for greater knowledge, access and inclusion of the military spouse, in the care and treatment provision of their serving partner’s mental health issue.
4 Unmet needs and coping strategies of older underserved veterans during the COVID-19 pandemic
Unmet needs and coping strategies of older underserved veterans during the COVID-19 pandemic
APA Citation:
Haltom, T. M., Tiong, J., Evans, T. L., Kamdar, N., True, G., & Kunik, M. E. (2023). Unmet needs and coping strategies of older underserved veterans during the COVID-19 pandemic. Journal of Primary Care & Community Health, 14. https://doi.org/10.1177/21501319231184368
Focus:
Veterans
Physical health
Branch of Service:
Multiple branches
Military Affiliation:
Veteran
Population:
Adulthood (18 yrs & older)
Middle age (40 - 64 yrs)
Aged (65 yrs & older)
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Research & Summary
Haltom, Trenton M.; Tiong, Joyce; Evans, Tracy L.; Kamdar, Nipa; True, Gala; Kunik, Mark E.
2023
Introduction: The COVID-19 pandemic has had profound impacts on people with diabetes, a group with high morbidity and mortality. Factors like race, age, income, Veteran-status, and limited or interrupted resources early in the COVID-19 pandemic compounded risks for negative health outcomes. Our objective was to characterize the experiences and needs of under-resourced Veterans with type 2 diabetes during the COVID-19 pandemic. Methods: We conducted semi-structured qualitative interviews (March through September 2021) with U.S. military Veterans with diabetes. Transcripts were analyzed using a team-based, iterative process of summarizing and coding to identify key themes. Participants included Veterans (n = 25) who were mostly men (84%), Black or African American (76%), older (mean age = 62.6), and low-income (<$20 000/year; 56%). Most participants self-reported moderate (36%) or severe (56%) diabetes-related distress. Results: Shutdowns and social distancing negatively impacted Veterans’ social, mental, and physical health. Veterans reported feeling increased isolation, depression, stress, and unmet mental health needs. Their physical health was also negatively affected. Despite pandemic-related challenges, Veterans adapted with new technological skills, appreciating their families, staying active, and relying on their religious faith. Conclusions: Veterans’ experiences during the pandemic revealed the importance of social support and access to technology. For those without social support, peer support could protect against negative health outcomes. Emergency-preparedness efforts for vulnerable patients with type 2 diabetes should include raising awareness about and increasing access to technological resources (eg, Zoom or telehealth platforms). Findings from this study will help tailor support programs for specific populations’ needs in future health crises.
Exploring the role of moral injury outcomes in intimate relationship functioning among U.S. combat veterans
APA Citation:
Fernandez, P. E., & Currier, J. M. (2023). Exploring the role of moral injury outcomes in intimate relationship functioning among U.S. combat veterans. Psychological Trauma: Theory, Research, Practice, and Policy. Advance online publication. https://doi.org/10.1037/tra0001553
Focus:
Veterans
Mental health
Couples
Branch of Service:
Army
Marine Corps
Navy
Air Force
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 & Summary
Fernandez, Paola Estefania; Currier, Joseph M.
2023
Objective: Moral injury entails psychological, social, and possible spiritual issues that might interfere with veterans’ functioning in romantic or intimate relationships. To date, research has not examined the contribution of moral injury outcomes in this core functional domain in many veterans’ lives. Method: In total, 65 combat veterans who were engaging in a peer-led intervention for moral injury in a Veteran Service Organization completed the Expressions of Moral Injury Scale, posttraumatic stress disorder (PTSD) checklist for DSM-5, and the romantic relationship subscale of the Inventory of Psychosocial Functioning Scale. Results: Bivariate analyses revealed that moral injury and PTSD symptoms were each associated with worse relationship functioning among the veterans. When including moral injury and PTSD symptoms as predictors in a multivariate analysis, only moral injury was uniquely linked with poorer relationship functioning. Conclusions: Overall, these findings suggest that moral injury could play a pernicious role in many veterans’ issues in relationship problems with their spouses or partners. Future research needs to examine the potential utility of addressing moral injury among veterans who are struggling to meet demands for intimacy and connection in their intimate or romantic relationships. (PsycInfo Database Record (c) 2023 APA, all rights reserved)
Replication and extension of the military family stress model: The after deployment adaptive parenting tools ADAPT4U study
APA Citation:
Cheng, C. H., Darawshy, N. A. S., Lee, S., Brigman, H., DeGarmo, D., & Gewirtz, A. (2023). Replication and extension of the military family stress model: The after deployment adaptive parenting tools ADAPT4U study. Family Process. Advance online publication. https://doi.org/10.1111/famp.12918
Focus:
Programming
Mental health
Deployment
Couples
Parents
Children
Branch of Service:
Army
Air Force
Navy
Marine Corps
Multiple branches
Military Affiliation:
Active Duty
Guard
Reserve
Population:
Childhood (birth - 12 yrs)
Adolescence (13 - 17 yrs)
Young adulthood (18 - 29 yrs)
Adulthood (18 yrs & older)
Thirties (30 - 39 yrs)
Middle age (40 - 64 yrs)
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Research & Summary
Cheng, Cheuk H.; Ali-Saleh Darawshy, Neveen; Lee, Susanne; Brigman, Hayley; DeGarmo, Dave; Gewirtz, Abigail
2023
The military family stress (MFS) model conceptualizes that wartime deployments and post-traumatic stress disorder (PTSD) symptoms are associated with couple, parenting, and child adjustment difficulties. The aim of this study was to replicate and extend the military family stress model by examining the associations among deployment length, PTSD symptoms, marital functioning, parenting practices, and child adjustment in a replication sample of both National Guard and Reserve (NG/R) as well as active-duty service member families. The MFS model is extended to test whether these relationships vary between mothers and fathers. The sample included 208 families enrolled in a randomized controlled trial of a parenting program for military families (94.4% of fathers and 21.6% of mothers were deployed). Replicating the MFS model, we specified parenting, marital quality, and child adjustment as latent variables and conducted multi-group structural equation models. Parenting practices were positively associated with marital quality and child adjustment. PTSD symptoms were negatively associated with marital quality. The indirect effect from PTSD symptoms to parenting practices through marital quality was marginally significant. The indirect effect from marital quality to child adjustment through parenting practices was significant. There were no significant gender differences between the two structural models. This study provides empirical support for the MFS model. Results demonstrate that deployment-related stressors are significantly associated with parent and family functioning. Parenting programs for military families might effectively target similar risk processes among both mothers and fathers.
7 Incidence and risk factors for postpartum mood and anxiety disorders among women veterans
Incidence and risk factors for postpartum mood and anxiety disorders among women veterans
APA Citation:
Pratt, A. A., Sadler, A. G., Thomas, E. B. K., Syrop, C. H., Ryan, G. L., & Mengeling, M. A. (2023). Incidence and risk factors for postpartum mood and anxiety disorders among women veterans. General Hospital Psychiatry, 84, 112–124. https://doi.org/10.1016/j.genhosppsych.2023.06.013
Focus:
Veterans
Mental health
Parents
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
Pratt, Alessandra A.; Sadler, Anne G.; Thomas, Emily B. K.; Syrop, Craig H.; Ryan, Ginny L.; Mengeling, Michelle A.
2023
Background Our aim was to determine rates of postpartum mood and anxiety disorders (PMADs) among U.S. women Veterans and the overlap among PMADs. We further sought to identify PMAD risk factors, including those unique to military service. Methods A national sample of women Veterans completed a computer-assisted telephone interview (N = 1414). Eligible participants were aged 20–45 and had separated from service within the last 10 years. Self-report measures included demographics, general health, reproductive health, military exposures, sexual assault, childhood trauma, and posttraumatic stress disorder (PTSD). The PMADs of interest were postpartum depression (PPD), postpartum anxiety (PPA) and postpartum PTSD (PPPTSD). This analysis included 1039 women Veterans who had ever been pregnant and who answered questions about PPMDs related to their most recent pregnancy. Results A third (340/1039, 32.7%) of participants were diagnosed with at least one PMAD and one-fifth (215/1039, 20.7%) with two or more. Risk factors common for developing a PMAD included: a mental health diagnosis prior to pregnancy, a self-report of ever having had a traumatic birth experience, and most recent pregnancy occurring during military service. Additional risk factors were found for PPD and PPPTSD. Conclusion Women Veterans may be at an increased risk for developing PMADs due to high rates of lifetime sexual assault, mental health disorders, and military-specific factors including giving birth during military service and military combat deployment exposures.
Early and recent military and nonmilitary stressors associated with posttraumatic stress symptoms among military service members and their spouses
APA Citation:
Sullivan, K. S., Park, Y., Richardson, S., Cederbaum, J., Stander, V., & Jaccard, J. (2023). Early and recent military and nonmilitary stressors associated with posttraumatic stress symptoms among military service members and their spouses. Journal of Traumatic Stress, 36(5), 943-954. https://doi.org/10.1002/jts.22958
Focus:
Mental health
Couples
Branch of Service:
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)
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Research & Summary
Sullivan, Kathrine S.; Park, Yangjin; Richardson, Sabrina; Cederbaum, Julie; Stander, Valerie; Jaccard, James
2023
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.
9 A qualitative examination of the reintegration experiences of Australian Defense Force families
A qualitative examination of the reintegration experiences of Australian Defense Force families
APA Citation:
Risi, A., Bird, A. L., Jackson, J., & Pickard, J. A. (2023). A qualitative examination of the reintegration experiences of Australian Defense Force families. Military Psychology. Advance online publication. https://doi.org/10.1080/08995605.2023.2192637
Focus:
Children
Parents
Deployment
Branch of Service:
Army
Air Force
Multiple branches
International Military
Military Affiliation:
Active Duty
Population:
Adulthood (18 yrs & older)
Thirties (30 - 39 yrs)
Middle age (40 - 64 yrs)
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Research & Summary
Risi, Alixandra; Bird, Amy L.; Jackson, Jocelyn; Pickard, Judy A.
2023
The profound development that occurs during the first five years of a child’s life may contribute to military families with young children facing unique challenges during reintegration. Yet, little is known about the reintegration experiences of military families with young children, and less so from the perspectives of non-deployed parents and families outside of the US. In this qualitative study, we explored the reintegration experiences of Australian Defense Force (ADF) families with young children (five years and younger). Through written responses to open-ended prompts, ADF service members (n = 9) and their non-deployed spouses (n = 38) reflected on periods of reintegration and discussed their family’s adaption during this time. Using thematic analysis, six themes representing the reintegration experiences of these families were generated from the data. Four themes were generated from the combined experiences of service members and non-deployed parents, while a further two themes were generated from the experiences of non-deployed parents only. Relational and parenting challenges were at the forefront of reintegration experiences. These findings offer meaningful implications for practice and research to improve the quality of parent-child relationships and enhance outcomes for military families with young children during reintegration.
10 Emotion socialization profiles in military parents: Associations with post-traumatic stress disorder
Emotion socialization profiles in military parents: Associations with post-traumatic stress disorder
APA Citation:
Giff, S. T., Renshaw, K. D., Denham, S. A., Martin, L. N., & Gewirtz, A. H. (2023). Emotion socialization profiles in military parents: Associations with post-traumatic stress disorder. Family Process. Advance online publication. https://doi.org/10.1111/famp.12931
Focus:
Parents
Mental health
Children
Deployment
Branch of Service:
Multiple branches
Army
Air Force
Navy
Military Affiliation:
Guard
Reserve
Population:
School age (6 - 12 yrs)
Adolescence (13 - 17 yrs)
Adulthood (18 yrs & older)
Thirties (30 - 39 yrs)
Middle age (40 - 64 yrs)
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Research & Summary
Giff, Sarah T.; Renshaw, Keith D.; Denham, Susanne A.; Martin, Laura N.; Gewirtz, Abigail H.
2023
Military families face many difficulties, including a parent deploying to a warzone and the subsequent risk of returning with symptoms of posttraumatic stress disorder (PTSD). Symptoms of PTSD are associated with parenting difficulties; however, little is known about how PTSD symptoms may be associated with emotion socialization (ES), a set of processes crucial to children's emotional well-being. This project investigated observed ES behaviors in deployed and non-deployed parents in a sample of 224 predominantly White, non-Hispanic National Guard/Reserve (NG/R) families with deployed fathers, non-deployed mothers, and a child between the ages of 4 and 13. Parents completed self-report questionnaires and families engaged in videotaped parent–child discussions, which were coded for three types of ES behaviors. Latent profile analyses of the coded behaviors identified five profiles of parental ES: Balanced/Supportive, Balanced/Limited Expression, Unsupportive/Distressed, Unsupportive/Positive, and Involved/Emotive/Angry. Multinomial logistic regressions of each parent's profile membership on fathers' PTSD symptoms revealed no significant associations, while additional analyses including additional family factors revealed that greater father PTSD symptoms were associated with a greater likelihood of mothers being in the Balanced/Supportive profile compared to the Balanced/Limited Expression profile, particularly when children displayed average to low levels of emotion during discussion tasks. No other significant associations with PTSD symptoms were detected. Overall, in contrast to the hypotheses, the majority of these findings indicated that PTSD symptoms did not play a significant role in parental ES behaviors.
Incidence and prevalence of eating disorders among active duty US military-dependent youth from 2016 to 2021
APA Citation:
Thompson, K. A., Bauman, V., Sunderland, K. W., Thornton, J. A., Schvey, N. A., Moyer, R., Sekyere, N. A., Funk, W., Pav, V., Brydum, R., Klein, D. A., Lavender, J. M., & Tanofsky-Kraff, M. (2023). Incidence and prevalence of eating disorders among active duty US military-dependent youth from 2016 to 2021. International Journal of Eating Disorders, 56(10), 1973-1982. https://doi.org/10.1002/eat.24025
Focus:
Physical health
Mental health
Youth
Branch of Service:
Air Force
Army
Coast Guard
Marine Corps
Navy
Multiple branches
Military Affiliation:
Active Duty
Guard
Population:
School age (6 - 12 yrs)
Adolescence (13 - 17 yrs)
Share the article
Research & Summary
Thompson, Katherine A.; Bauman, Vivian; Sunderland, Kevin W.; Thornton, Jennifer A.; Schvey, Natasha A.; Moyer, Rachel; Sekyere, Nana Amma; Funk, Wendy; Pav, Veronika; Brydum, Rick; Klein, David A.; Lavender, Jason M.; Tanofsky-Kraff, Marian
2023
Objective The offspring of US military service members may be at increased risk for eating disorders. However, no epidemiological studies to date have evaluated eating disorder incidence rates and prevalence estimates among military-dependent youth. Method This retrospective cohort study examined eating disorder diagnoses in the military healthcare system (MHS) from 2016 through 2021. Active duty and national guard military-dependent youth, aged 10–17 years, who received care in the MHS via TRICARE Prime insurance, were identified by one or more ICD-10 codes indicative of an eating disorder diagnosis (anorexia nervosa, bulimia nervosa, binge-eating disorder, and other-specified eating disorders). Results During the 6-year surveillance period, 2534 dependents received incident diagnoses of eating disorders, with a crude overall incidence rate of 1.75 cases per 10,000 person-years. The most common diagnosis was other-specified eating disorder, followed by anorexia nervosa, bulimia nervosa, and binge-eating disorder. The crude annual incidence rate of all eating disorder diagnoses increased by nearly 65% from 2016 to 2021. Rates for all diagnoses were highest in 2020 and 2021. Period prevalence estimates were .08% for any eating disorder diagnosis, .01% for anorexia nervosa, .004% for bulimia nervosa, .004% for binge-eating disorder, and .06% for other-specified eating disorders. Discussion The observed increase in eating disorder diagnoses during the surveillance period appeared to be driven by female dependents. More military dependents experienced a new-onset diagnosis during the COVID-19 pandemic compared to previous years. These findings highlight the need for eating disorder screening, identification, and treatment for dependents within the MHS. Public Significance Statement Children of US military service members may be at increased risk for eating disorders. Results indicate new-onset eating disorder cases increased 65% from 2016 to 2021, primarily among girls compared to boys. The most diagnosed and fastest growing diagnosis was other-specified eating disorder. Rates of anorexia nervosa increased following the COVID-19 pandemic. Findings highlight the need for eating disorder screening, identification, and treatment within the military healthcare system.
Women veterans’ experiences discussing household firearms with their intimate partners: Collaborative, devalued, and deferential relational types
APA Citation:
Polzer, E. R., Rohs, C. M., Thomas, S. M., Holliday, R., Miller, C. N., Simonetti, J. A., Iverson, K. M., Brenner, L. A., & Monteith, L. L. (2023). Women veterans’ experiences discussing household firearms with their intimate partners: Collaborative, devalued, and deferential relational types. Injury Epidemiology, 10(1), Article 39. https://doi.org/10.1186/s40621-023-00452-7
Focus:
Veterans
Couples
Branch of Service:
Army
Air Force
Navy
Marine Corps
Multiple branches
Military Affiliation:
Veteran
Population:
Young adulthood (18 - 29 yrs)
Adulthood (18 yrs & older)
Thirties (30 - 39 yrs)
Middle age (40 - 64 yrs)
Aged (65 yrs & older)
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Research & Summary
Polzer, Evan R.; Rohs, Carly M.; Thomas, Suzanne M.; Holliday, Ryan; Miller, Christin N.; Simonetti, Joseph A.; Iverson, Katherine M.; Brenner, Lisa A.; Monteith, Lindsey L.
2023
Rates of firearm suicide have increased among women Veterans. Discussing firearm access and reducing access to lethal means of suicide when suicide risk is heightened are central tenets of suicide prevention, as is tailoring suicide prevention strategies to specific populations. While research has begun to explore how to optimize firearm lethal means safety counseling with women Veterans, there is limited knowledge of women Veterans' perspectives on including their intimate partners in such efforts. This gap is notable since many women Veterans have access to firearms owned by other household members. Understanding women Veterans’ experiences and perspectives regarding including their partners in firearm lethal means safety conversations can provide important information for tailoring firearm lethal means safety counseling for women Veterans.
