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1.Misguided social support? How Danish veteran families affected by PTSD experience formal and informal social support
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2.Association between social support and mental health conditions in treatment-seeking Veterans and Canadian Armed Forces personnel
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3.Longitudinal change and association between four types of social support and mental health among low-income U.S. veterans
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4.A qualitative descriptive study: Veteran reintegration and their experiences with social support networks
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5.Prevalence of four types of social support and their relation to mental health among low-income U.S. veterans: Implications for community health
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6.Understanding combat veterans and their social supporters’ experiences related to trauma and combat veteran suicide: A qualitative case study
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7.From soldier's wife to widow: Exploring the lived experience of the military widow and the impact of social support networks
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8.Impact of perceived social support on mental health, quality of life, and disability in post–9/11 U.S. military veterans
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9.The role of social support in bridging the digital divide for older veterans
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10.Scoping review of the role of social support in women veterans’ psychosocial and health outcomes
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11.Military lifestyle stressors and social support in the well-being of military families
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12.African American youths with internalizing difficulties: Relation to social support and activity involvement
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13.The effects of stress and social support on externalizing behaviors among children in military families
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14.Social support and treatment utilization for posttraumatic stress disorder: Examining reciprocal relations among active duty service members
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15.Anxiety sensitivity and social support in veterans with emotional disorders
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16.Change in social support while participating in behavioral activation for PTSD
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17.Who supports the troops? Social support domains and sources in active duty Army networks
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18.Facing the fear: Resilience and social support in veterans and civilians with PTSD
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19.The mediating role of social support on the relationship between PTSD and aggression: Examining racial/ethnic differences
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20.Relationship of perceived neighborhood danger with depression and PTSD among veterans: The moderating role of social support and neighborhood cohesion
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Research summaries convey terminology used by the scientists who authored the original research article; some terminology may not align with the federal government's mandated language for certain constructs.
Guiding New Families Through Parenthood: The New Parent Support Program
Guiding New Families Through Parenthood: The New Parent Support Program Written by: Kelly Hallauer Edited by: Kate Abbate In military families, everyday stressors can be heightened by factors like deployment or relocation. Having young children or being pregnant can add to these stressors and uncertainty, especially for first time parents. The New Parent Support Program (NPSP) works to help parents balance these stressors and ensure a successful transition through the journey of parenthood (Military OneSource, 2025). This article shares the services the NPSP offers, the needs they address, and how the services can be accessed. Services Offered by the New Parent Support Program The primary goal of the NPSP is to enhance the lives of children and promote their well-being, while offering services and information to make sure families thrive in their role as new parents along with their military lifestyle (Military OneSource, 2025). To meet their goal, the NPSP offers a variety of services to military families to help them balance family and military life. This includes home visits by professionals, such as nurses and social workers, parenting classes, organizing playgroups, and referrals to other resources. Home visits offer an opportunity for parents to ask questions related to behavior management, sleep schedules, breastfeeding, and more, in the privacy of the family’s home. Parenting classes are an interactive way to focus on topics like child growth, managing the demands of parenting, positive discipline, and self-care. Organizing playgroups can help families build their support system within the military community. The NPSP also offers referrals to other resources through the military health care system to ensure that additional benefits are used as needed. These services are essential to the positive impact that the NPSP can have. Mental Health Needs of New Military Families The transition period of pregnancy and childhood can be stressful for new parents, but the NPSP works to counteract this by offering varying methods of support. Pretorius and colleagues (2024) learned that participating in group prenatal care was shown to have a positive effect on a mother’s mental health by giving mothers an opportunity to talk about their stress and feel comforted by peers. The NPSP works to implement this research by offering parenting classes and home visits to discuss these concerns. Pretorius and colleagues (2024) were also interested in learning more about the effects that social support has on infant-mother attachment. Through a literature review, they learned when women perceived they had more social support (e.g., from their partners, peers, family members), they tended to have better perinatal mental health (i.e., up to 6 months after birth) and infant-mother attachment (Pretorius et al., 2024). Social support is offered by the NPSP through the opportunity to organize playgroups and build a military community. The New Parent Support Program also works to support couples during their parenting journey. Roth and colleagues (2024) investigated the relationship between how couples cope (i.e., dyadic coping) and the mother’s pregnancy and transition to parenthood. Overall, dyadic coping was beneficial to both the individual (e.g., quality of life, wellbeing) and the relationship (e.g., marital adjustment). Parenting classes work to help military couples manage the demands of parenting and feel confident in their ability to parent as a cohesive unit. Accessing the New Parent Support Program A 2023 report indicated that there are over 360,000 active-duty military dependents aged five and younger (DoD, 2023). The NPSP is free for these active-duty service members, as well as reservists, and national guard members. The program is available for military families expecting a baby or those who have a child aged three or younger (Navy, Army, Air Force) or a child aged five or younger (Marine Corps). These families are encouraged to participate in the services offered by the NPSP. The New Parent Support Program strives to support military families through a hands-on approach to mental health and stress related issues to promote child well-being and development. Access to the NPSP is based around individual installations, since in-person home visits and resources are provided. Families can enroll in the program through their installations New Parent Support Program office, Family Advocacy Program, or Military and Family Support Center. Families can locate the office of these programs on individual installations from the Programs and Services database provided by Military OneSource. References Jones, M. N. (2024). Military spouses’ perceptions of family stress and resilience during multiple relocations [Ph.D., Walden University]. https://www.proquest.com/docview/3131065353/abstract/CD7B13A4056342FAPQ/1 Military OneSource. (2023). Chapter 5: Active-duty families, dependents. Military OneSource. Chapter 5: Dependents – 2023 Demographics Dashboards Military OneSource. (2025). New Parent Support Program. Military OneSource. Support Programs for New Military Parents | Military OneSource Pretorius, K., Sposato, M. F., & Trueblood-Miller, W. (2024). Perinatal mental health and active- duty military spouses: A scoping review. BMC Pregnancy and Childbirth, 24(1), Article 557. https://doi.org/10.1186/s12884-024-06727-1 https://aub.ie/MilitaryREACH-Pretorius2024 Roth, M., Weitkamp, K., Landolt, S. A., & Bodenmann, G. (2024). Couples’ dyadic coping in the context of child-related stressors: A systematic review across three decades. Couple and Family Psychology: Research and Practice, 13(3), 202-223. https://doi.org/10.1037/cfp0000237 https://aub.ie/MilitaryREACH-RothM2022 Wu, S., Kaplan, J., Trautwein, M. L., Nelson, D. A., Duong, A., Woolaway-Bickel, K., …Kurina, L. M. (2024). Incidence and predictors of postpartum depression diagnoses among active-duty U.S. Army soldiers. Journal of Women’s Health, 33(12), 1625–1634. https://doi.org/10.1089/jwh.2023.1010 https://aub.ie/MilitaryREACH-Wu2024 RIA categories: Military Families Parents Resources Children Programming Research
Forging Bonds: The Importance of Unit Cohesion
Imagine an efficient, well-oiled machine standing against any challenge with unshakable unity - this is steadfast military unit cohesion in action. Unit cohesion is a type of social support defined by how strongly military members feel connected to and supported by their unit (Armistead-Jehle et al., 2011). The concept of unit cohesion can be broken down into two types, peer-to-peer and peer-to-leadership (i.e., horizontal and vertical cohesion, respectively; Siebold & Kelly, 1988). Though they work together to create unit cohesion, it’s important to understand that horizontal and vertical unit cohesion each impact Service members in different ways. As unit cohesion develops, it can have a great impact on Service members’ overall well-being. Specifically, higher levels of unit cohesion were related to the likelihood of Service members having a supportive network for emotional, informational, tangible, and mental health help-seeking needs (Barr et al., 2023). Essentially, close bonds within the unit help Service members build support systems to cope with various challenges of military life. Furthermore, Rugo and colleagues (2020) found that Soldiers who reported greater unit cohesion tended to indicate decreased likelihood of experiencing depressive symptoms or suicidal ideation. In this article, we will explore the elements of both horizontal and vertical unit cohesion and examine their impact on the well-being of Service members. Horizontal Unit Cohesion Horizontal unit cohesion refers to peer-to-peer support within a military unit (i.e., excluding leadership and higher-ranking officials; Campbell-Sills et al., 2022; Siebold & Kelly, 1988). Horizontal unit cohesion has been identified as a protective factor for Service members exposed to combat, such that unit cohesion protects against the harmful effects of combat exposure on Service members’ PTSD symptoms, depressive symptoms, and suicidal thoughts (Campbell-Sills et al., 2022). These findings mean that having a close, supportive group of peers within a unit can reduce the impact of mental health challenges for Service members at home and abroad. Support networks for Service members highlight the impact of peer connections on mental health, emphasizing how camaraderie and mutual understanding within a unit can alleviate challenges faced by Service members both during and after deployment. The concept of horizontal unit cohesion becomes apparent when thinking about real-life scenarios. Take a look at the fictional Service member, Specialist Davis, who seems to be struggling while on deployment. Specialist Davis finds herself face-to-face with the stress and pressure of combat. Sitting alone, Davis feels reality weighing on her. Noticing Davis’s isolation, Specialist Bradley and a few unit members approach her, not to give orders, but to offer something far more impactful—genuine, peer-to-peer support. They start up a card game at Davis’s table and begin to share their own struggles and vulnerabilities, recounting battle stories and cracking jokes to help ease the emotional tension. This informal, yet earnest conversation provides Davis with a sense of understanding and comfort, lifting some of that heavy emotional burden. Vertical Unit Cohesion Vertical unit cohesion refers to peer-to-leadership support within a military unit, encompassing both leadership and subordinate roles (Campbell-Sills et al., 2022; Siebold & Kelly, 1988). Vertical unit cohesion is invaluable as it fosters a deep sense of trust and mutual respect, both essential for units performing complex and high-pressure assignments. Charbonneau & Wood (2018) found that perceptions of fairness within the unit and the quality of unit leaders serve as important contributors to Service members’ perceptions of unit cohesion. Similar to horizontal unit cohesion, vertical unit cohesion has been shown to buffer the harmful effects of combat exposure on psychological symptoms for Service members (Campbell-Sills, et al., 2022). Beyond mental health, leadership quality in vertical relationships (i.e. peer-to-leadership) is associated with Service members’ overall emotional attachment to the military, which may have consequences for their decision to stay in the military (Charbonneau & Wood, 2018). This concept can be vividly illustrated in the fictional scenario where Sergeant Martinez’s leadership significantly impacts her squad’s morale and cohesion. Sergeant Martinez, leading her squad through a grueling training exercise, notices Private Lee struggling and falls behind. Sensing his exhaustion, she pauses the exercise and gathers the squad for a break and begins to share her own challenging experiences. She encourages the squad to share their worst training exercise and how they survived. As they open up, Lee feels a renewed sense of connection. This informal exchange uplifts his spirits and strengthens his bond with the squad, helping him complete the exercise with renewed determination. Horizontal and vertical unit cohesion work together to create a supportive and resilient military environment. Horizontal cohesion, peer-to-peer support, helps Service members address the psychological challenges of combat and deployment. Vertical cohesion, peer-to-leadership support, builds essential trust and collaboration for success as well as emotional well-being. Together, these forms of cohesion create a strong foundation for military units ensuring that Service members are not only equipped to handle their responsibilities but also receive the support needed to navigate their challenges. References Armistead‐Jehle, P., Johnston, S. L., Wade, N. G., & Ecklund, C. J. (2011). Posttraumatic stress in U.S. marines: The role of unit cohesion and combat exposure. Journal of Counseling & Development, 89(1), 81–88. https://doi.org/10.1002/j.1556-6678.2011.tb00063.x 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 Campbell-Sills, L., Flynn, P. J., Choi, K. W., Ng, T. H. H., Aliaga, P. A., Broshek, C., Jain, S., Kessler, R. C., Stein, M. B., & Bliese, P. D. (2022). Unit cohesion during deployment and post-deployment mental health: Is cohesion an individual- or unit-level buffer for combat-exposed soldiers? Psychological Medicine, 52(1), 121-131. https://doi.org/10.1017/S0033291720001786 Charbonneau, D., & Wood, V. M. (2018). Antecedents and outcomes of unit cohesion and affective commitment to the army. Military Psychology, 30(1), 43–53. https://doi.org/10.1080/08995605.2017.1420974 Rugo, K.F., Leifker, F. R., Drake-Brooks, M. M., Snell, M. B., Bryan, C. J., & Bryan, A. O. (2020). Unit cohesion and social support as protective factors against suicide risk and depression among National Guard service members. Journal of Social and Clinical Psychology, 39(3), 214-228. https://doi.org/10.1521/jscp.2020.39.3.214 Siebold, G. L., & Kelly, D. R. (1988). Development of the Combat Platoon Cohesion Questionnaire (Report No. 817). Army Research Institute for the Behavioral and Social Sciences. https://apps.dtic.mil/sti/pdfs/ADA204917.pdf
A HIDDEN CRISIS: WOMEN'S POSTPARTUM MENTAL HEALTH
(334) 844-3299 MilitaryREACH@auburn.edu HOME ABOUT MILITARY REACH LIBRARY UPDATES RESOURCES SEARCH 12 DEC 2023 A HIDDEN CRISIS: WOMEN'S POSTPARTUM MENTAL HEALTH By Haley Sherman & Sheila SjolsethEditors Emily Hanson Although many people might consider sleep deprivation and changing dirty diapers to be the greatest struggles during the first year of having a baby, statistics show that women's postpartum mental health is of greatest concern. In fact, in the first year after a baby is born, "suicide is one of the top five leading causes of maternal death in the United States, accounting for approximately 20% of all maternal deaths" (Pratt et al., 2023, p. 1-2). This statistic does not account for all the mental and physical challenges that arise during pregnancy and before birth. Other perinatal (i.e., the time period before and immediately after childbirth) and postnatal (i.e., a year after the birth otherwise known as 'postpartum') mental health disorders, including postpartum depression, postpartum anxiety, obsessive-compulsive disorder, posttraumatic stress disorder, bipolar disorder, and postpartum psychosis (Nguyen et al., 2023; Pratt et al., 2023), are rampant - affecting approximately 1 in 7 mothers in the United States (Nguyen et al., 2023). In addition to this severity and the serious nature of perinatal/postpartum mental health concerns, women are not often "treated to remission" meaning that treatment did not last long enough to fully address the mental health concern (Nguyen et al., 2023, p. 78). Further, these statistics may not capture the full extent of postpartum mental health challenges, as many women may have undiagnosed perinatal and postpartum disorders. While the aforementioned statistics are at the national level, mental health challenges among postpartum military women are even more prevalent. Military mothers (i.e., active-duty, dependents, reservists, and retirees) experience mental health conditions almost 3 times more often than civilian mothers (United States Government Accountability Office, 2022; Maternal Mental Health Leadership Alliance, 2023). Statistics on pregnant women from 2017-2019 suggest that approximately 36% of TRICARE active-duty Service members and their dependents received a perinatal (i.e., prenatal and postnatal) mental health diagnosis (United States Government Accountability Office, 2022). Receiving a postpartum depression (PPD) diagnosis increased drastically from 2001 to 2018 such that in 2001 for every 1,000 Servicewomen, 1.96 were diagnosed with PPD whereas in 2018 29.95 Servicewomen were diagnosed with PPD (Nicholson et al., 2020). Additionally, other research has found that although some Veteran mothers experience elevated symptoms of postnatal mental health disorders such as depressive disorder, PTSD, or pregnancy-related anxiety (Goger et al., 2022), they do not meet the established threshold to receive an official diagnosis, potentially limiting their access to resources and treatments needed to thrive during their postnatal period. Further, research suggests that compounding military-specific stressors such as combat deployment experiences, lack of access to maternity care through the Office of Veterans Affairs (VA), stigma around accessing mental health services, and the prevalence of military sexual assault may exacerbate perinatal and postpartum mental health challenges for military-connected women (Nguyen et al., 2023). Although the reality of the hidden crisis of women's perinatal and postpartum health is alarming, it is time to start bringing concerns about postpartum mental health to light, and so, we invite you to join us in a call to action. Call To Action One of the first steps in creating change is by spreading awareness that a crisis exists – we must talk about it! In addition to spreading awareness by talking about maternal mental health challenges, we need to: Normalize that some changes in mood will occur during postpartum, but that major mental health challenges are abnormal and may need to be professionally addressed. Stress the importance of new mothers asking for help, especially helping them understand what mental health symptoms or experiences may require professional support (see the WIC Works Resource System: Resources website as a place to start). Share resources with parents (i.e., both the mother and her partner) to support their parenting journey. Ideas to Take Action All efforts that promote awareness of the maternal health crisis, no matter what size, are needed. Share this article with a friend to start a conversation. Learn how to talk to a new mother experiencing depression and listen to military moms share their birth stories to better understand their experiences. When talking with others about the mental health needs of postpartum women, emphasize the severity of the need and how rates of postpartum difficulties are increasing. Advocate for increased support for military families at your place of employment and in your community with this key fact sheet on Military Maternal Health. Contact your U.S. Representative and Senator and ask for more support for military mothers like increasing paid leave for military parents and to support bills like the Federal Moms Matter Act. Find your U.S. Representative Find your U.S. Senator Support and Resources for Postpartum Servicewomen and Military Families Thankfully there are supports and resources available to help Servicewomen and their families if postpartum difficulties arise (Herrick & Chai, 2023), but we need to do our part to make sure these resources get into the hands of those who need them the most. Postpartum Support International: Help for Military Families The National Maternal Mental Health Hotline can help. Call or text 1-833-TLC-MAMA (1-833-852-6262). This hotline is for mothers as well as healthcare providers and those calling on behalf of someone. Veterans Crisis Line: 1-800-273-TALK (8255), PRESS 1. To chat, use their Crisis Chat. To text, send a text to 838255. Potential Signs of Postpartum Depression Depression in Pregnant Service Members: Three Things Providers Can Do to Help Postpartum depression and anxiety: How to start the conversation USDA Maternal Mental Health Resources NIH Moms' Mental Health Matters USDA Maternal Depression: Everyone can play a role to Help Families Thrive RECENT STORIES Related Stories in References Goger, P., Szpunar, M. J., Baca, S. A., Garstein, 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/s10995-012-03241-0 Herrick, M. S. R., & Chai, W. (2023). Incidence of postpartum depression decreases after initial expansion of military maternity leave. Military Medicine. Article usad354. https://doi.org/10.1093/milmed/usad354 Maternal Mental Health Leadership Alliance. (2023, May 17). Military Mothers Experience Maternal Mental Health Conditions Almost 3 Times More than Civilians. MMHLA Takes Steps to Solve this Issue. Maternal Mental Health Leadership Alliance: MMHLA. https://www.mmhla.org/articles/military-mothers-experience-maternal-mental-health-conditions-almost-3-times-more-than-civilians-mmhla-takes-steps-to-solve-this-issue Nguyen, M. H. (Theresa), Semino-Asaro, S., Reminick, A. M., Rukaj, A. T., & Connelly, C. D. (2023). Barriers to and facilitators of military spouses' recovery from perinatal mental health disorders: A qualitative study. Journal of Military, Veteran and Family Health. Advance online publication. https://doi.org/10.3138/jmvfh-2022-0067 Nicholson, J. H., Moore, B. A., Dondanville, K., Wheeler, B., & DeVoe, E. R. (2020). Examining the rates of postpartum depression in active duty US military servicewomen. Journal of Women's Health, 29(12), 1530-1539. https://doi.org/10.1089/jwh.2019.8172 Pratt, Alessandra A., Anne G. Sadler, Emily B. K. Thomas, Craig H. Syrop, Ginny L. Ryan, and Michelle A. Mengeling. “Incidence and Risk Factors for Postpartum Mood and Anxiety Disorders among Women Veterans.” General Hospital Psychiatry 84 (2023): 112–24. https://doi.org/10.1016/j.genhosppsych.2023.06.013 United States Government Accountability Office. (2022). Defense health care: Prevalence of and efforts to screen and treat mental health conditions in prenatal and postpartum TRICARE beneficiaries (Report to Congressional Committees GAO-22-105136; pp. 1–54). United States Government Accountability Office. https://www.gao.gov/assets/gao-22-105136.pdf MOBILIZING RESEARCH, PROMOTING FAMILY READINESS. Our Partners Auburn University University of Georgia Department of Defense US Department of Agriculture 203 Spidle Hall, Auburn University, Auburn, Alabama 36849 Military REACH Department of Human Development and Family Sciences (334) 844-3299 MilitaryREACH@auburn.edu Contact Us Website Feedback Stay Connected with Military REACH These materials were developed as a result of a partnership funded by the Department of Defense (DoD) between the DoD's Office of Military Community and Family Policy and the U.S. Department of Agriculture/National Institute of Food and Agriculture (USDA/NIFA) through a grant/cooperative agreement with Auburn University. USDA/NIFA Award No. 2021-48710-35671. Last Update: 02/23/2022 2017 - 2024 All Right Reserved - Military REACHPrivacy Statement| Accessibility Plan This website uses cookies to improve the browsing experience of our users. Please review Auburn University's Privacy Statement for more information. Accept & Close
Theory Series: Social Organization Theory of Action and Change
Theory Series: Social Organization Theory of Action and Change By: Emily Hanson This month, Military REACH continues the Theory Series, by diving into the social organization theory of action and change (Mancini & Bowen, 2013). We will provide an overview of the model and provide context for how military families and communities can benefit from its implementation. Overview: Social Organization Theory of Action and Change The social organization theory of action and change (Mancini & Bowen, 2009, 2013; Mancini et al., 2018) is a framework used to identify the processes (i.e., creating shared responsibility and trust to support communities) and antecedents (i.e., networks and resources that are available and currently established in the community) required to promote community capacity. Community capacity is the extent to which community resources are leveraged to solve problems, maintain well-being, and foster resilience, and is composed of two essential elements: collective competence and shared responsibility. When a community is collectively competent, it demonstrates the ability to mobilize resources and embrace opportunities to address families’ needs. Likewise, communities must also exhibit a shared responsibility; that is, a genuine care for one another and willingness to offer help. To achieve collective competence and shared responsibility, certain structures must be in place to facilitate social connection and achieve resilience. Social Organization and Change Model (Mancini & Bowen, 2009) Community conditions and characteristics, or the physical and social infrastructure are important antecedents to adequately address community needs. It is not simply the existence of these structures, though, that build community capacity; ideally, these structures are created intentionally with the community in mind. The physical infrastructure (e.g., safe roads for travel, places to gather) should serve to facilitate social processes which, in turn, create support networks (e.g., relationships with friends, social service programs) for individuals and families. Implications for Military Families and Communities Approximately 70% of military families live in civilian communities (Sonethavilay, 2019) and move, on average, every 2-3 years (Office of People Analytics, 2023). This transitional nature can disrupt social connection (O’Neal et al., 2016; O’Neal et al., 2020); however, when families can establish a sense of community in both a military and civilian context, there are greater opportunities for support. Communities can best support military families when they are collectively competent; that is, communities have infrastructure and resources that are sensitive to military family needs. This means creating partnerships and programs with military families in mind. Communities: Building culturally sensitive resources Establish multidisciplinary partnerships. Military families can benefit from connections with both the military and civilian community (Akin et al., 2020). Multidisciplinary and collaborative partnerships are beneficial to community capacity because they combine respective strengths to achieve a shared vision. For example, • The Department of Defense Military Spouse Employment Partnership connects military spouses with corporate and non-profit organizations that have committed to hire, promote, and retain military spouses. • The 4-H Military Partnership is a collaboration between the military and land grant universities to provide military families with learning opportunities, mentorship, and other activities. Incorporate military cultural competence into service delivery. While not all families are the same, military families do have common shared experiences such as deployment, spouse unemployment, and school transitions after relocation. Helping professionals may not know they are serving military families, so it is important to identify them in order to provide tailored solutions and in turn, develop more trust and participation. For example, • The Star Behavioral Health Providers program connects military families with therapists who have completed training on military culture. • The Military Child Education Coalition provides a two-day professional development course for individuals working with military-connected children (e.g., guidance counselors, school nurses, social workers). This course teaches participants how to best support military-connected children and bolster resilience in response to military-specific stressors. Military Families: Achieving a sense of community Take advantage of community resources to cultivate social support, connection, and integration. Military families should feel like they can turn to civilian social networks, programs, and organizations for support. When these resources are made with military families in mind, social connections are more easily developed and can help bolster families’ resilience. By building a sense of community, Service members and their families can achieve not only a sense of meaning and purpose (Jetten et al., 2017), but also long-term psychological well-being (O’Neal et al., 2016). • Seek out events that connect military families to one another as well as the larger community. Help new families navigate community resources once you’re settled. When military families can fully participate in their community, they develop a sense of community and shared responsibility, which can lead to a reciprocal relationship in which they help to further these support networks and help future families. Although it is important to integrate into the civilian community, the shared culture among military families is powerful and can help protect against stressors and challenges (Conforte et al., 2017). • Apply to be a sponsor for incoming families to help them adjust to the community. The social organization theory of action and change serves as a useful guide to identifying community strengths as well as gaps in services. Communities can use this framework to create or enhance partnerships that address military families’ needs and establish opportunities for social connection. When opportunities for connection exist, families can take advantage of them, feel a sense of belonging within the community, and reciprocate this benefit to others. References Conforte, A. M., Bakalar, J. L., Shank, L. M., Quinlan, J., Stephens, M. B., Sbrocco, T., & Tanofsky-Kraff, M. (2017). Assessing military community support: Relations among perceived military community support, child psychosocial adjustment, and parent psychosocial adjustment. Military Medicine, 182(9–10), 1871–1878. https://doi.org/10.7205/MILMED-D-17-00016 Jetten, J., Haslam, S. A., Cruwys, T., Greenaway, K. H., Haslam, C., & Steffens, N. K. (2017). Advancing the social identity approach to health and well-being: Progressing the social cure research agenda. European Journal of Social Psychology, 47(7), 789–802. https://doi.org/10.1002/ejsp.2333 Mancini, J. A. & Bowen, G. L. (2009). Community resilience: A social organization theory of action and change. In J. A. Mancini & K. A. Roberto (Eds.), Pathways of human development: Explorations of change (pp. 245–265). Lexington Books. Mancini, J. A., & Bowen, G. L. (2013). Families and communities: A social organization theory of action and change. In G. W. Peterson & K. R. Bush (Eds.), Handbook of marriage and the family (pp. 781–813). Springer. https://doi.org/10.1007/978-1-4614-3987-5_32 Mancini, J. A., O’Neal, C. W., Martin, J. A., & Bowen, G. L. (2018). Community social organization and military families: Theoretical perspectives on transitions, contexts, and resilience. Journal of Family Theory & Review, 10(3), 550–565. https://doi.org/10.1111/jftr.12271 Office of People Analytics. (2023). Results from the 2021 Active Duty Spouse Survey (ADSS). Department of Defense. https://download.militaryonesource.mil/12038/MOS/Presentations/2021-active-duty-spouse-overview-briefing.pdf O’Neal, C. W., Mancini, J. A., & DeGraff, A. (2016). Contextualizing the psychosocial well-being of military members and their partners: The importance of community and relationship provisions. American Journal of Community Psychology, 58(3–4), 477–487. https://doi.org/10.1002/ajcp.12097 O’Neal, C. W., Richardson, E. W., & Mancini, J. A. (2020). Community, context, and coping: How social connections influence coping and well-being for military members and their spouses. Family Process, 59(1), 158–172. https://doi.org/10.1111/famp.12395 Sonethavilay, H., Akin, J. L., Strong, J. D., Maury, R. V., Linsner Uveges, R., Hunt, K., Preston Page, A., & Pierce, L. (2019). Blue Star Families 2019 military family lifestyle survey: Comprehensive report. Blue Star Families. https://bluestarfam.org/wp-content/uploads/2020/03/BSF-2019-Survey-Comprehensive-Report-Digital-rev200305.pdf
Moral Injury: What Is It and How Can Professionals Assist?
Moral Injury: What Is It and How Can Professionals Assist? Lily Annino, Undergraduate Research Assistant Imagine you’re a Service member. Your commanding officer has reason to believe that certain civilians are making bombs at home and will use them against the public. Your unit is tasked with breaking in and finding the bombs. Entering the home is necessary to the mission – but you’ve been told your entire life that breaking into a person’s home is wrong and a violation of their privacy (not to mention against the law). However, you have a mission to fulfill. So, you break in, regardless of your inhibitions. The above scenario is one example of an event that could lead to moral injury. Moral injury is any act, whether perpetrated or witnessed, that may conflict with personal morals or beliefs (Douglas, 2022). While we often think of this conflict in the context of war, other examples of potential moral injury include abuse, rape, and violence (Moral Injury Project, n.d.). And although moral injury may have lasting effects on someone’s life (Litz et al., 2009), it’s still a concept of which many people aren’t fully aware. This article will explain moral injury and discuss some ways that mental health professionals can help Service members and Veterans work through issues related to it. Moral injury is more common than we realize among Service members and Veterans, and it can lead to negative outcomes, such as co-occurring PTSD (Maguen et al., 2022). In one study, 41.8% of veterans reported experiencing at least one form of moral injury; the majority had been betrayed by others or suffered a transgression (Wisco et al., 2017). Dealing with extreme levels of guilt and regret without understanding what you’re going through can be confusing. At the same time, being able to talk to your provider about what you’re dealing with and learning that it’s not abnormal are helpful for Service members (Douglas, 2022). Professionals familiar with the concept of moral injury and with therapeutic approaches that focus on acceptance and self-forgiveness can be beneficial for people working through the effects of moral injury (Maguen & Norman, 2022). Find the best therapist for you. Finding a therapist is like test-driving a car – it’s okay to take your time finding the best fit. It’s important for you to express your experiences freely without having to constantly explain details (e.g., defining acronyms, describing job-specific duties) that are well-known to those in the service (Douglas, 2022). Seek out a therapist who understands military culture and your unique experience as a Service member or Veteran. Connect with your chaplain. Therapists and counselors are trained to help Service members work through moral injury. In addition, military chaplains (i.e., U.S. military’s educated, religious leaders who provide services to Service members and their families) will talk with you regardless of your faith or beliefs. Chaplains combine their knowledge of military culture with their own resource awareness to help those in need. Connecting with a chaplain could benefit you during your healing process. Surround yourself with your support system. According to Chesnut and colleagues, moral injury can lead to the potential impairment of social well-being, social support, and social relationships (Chesnut et al., 2020). Re-engaging with your communities, friends, and family, and increasing your social support may help you in your struggle with moral injury. Moral injury is difficult to deal with due to its negative psychological effects. Nonetheless, there are ways to work through the challenges – such as receiving mental health services – and continue moving forward. If you feel you may be struggling with decisions your service requires of you, surround yourself with your support system and know that there are trained professionals who can help you work through these emotions. To continue learning about moral injury, check out the Military REACH library and access current research summaries, reports, and other educational resources, released monthly. References Chesnut, R. P., Richardson, C. B., Morgan, N. R., Bleser, J. A., Perkins, D. F., Vogt, D., …. Finley, E. (2020). Moral injury and social well-being: A growth curve analysis. Journal of Traumatic Stress, 33(4), 587-597. https://doi.org/10.1002/jts.22567 Douglas, C. V. (2022). A phenological study and investigation of moral Injury with veterans. [Doctoral dissertation, Liberty University]. Digital Commons. https://digitalcommons.liberty.edu/doctoral/3722 Litz, B. T., Stein, N., Delaney, E., Lebowitz, L., Nash, W. P., Silva, C., & Maguen, S. (2009). Moral injury and moral repair in war veterans: A preliminary model and intervention strategy. Clinical Psychology Review, 29(8), 695–706. https://doi.org/10.1016/j.cpr.2009.07.003 Maguen, S., Griffin, B., Copeland, L., Perkins, D., Richardson, C., Finley, E., & Vogt, D. (2022). Trajectories of functioning in a population-based sample of veterans: Contributions of moral injury, PTSD, and depression. Psychological Medicine, 52(12), 2332-2341. https://doi.org/10.1017/S0033291720004249 Maguen, S., & Norman, S. B. (2022). Moral Injury. National Center for PTSD. 33(1), 1-9. https://www.ptsd.va.gov/publications/rq_docs/V33N1.pdf The Moral Injury Project. (n.d.). What is moral injury? Syracuse University. https://moralinjuryproject.syr.edu/about-moral-injury/the-moral-injury-project/ Wisco, B. E., Marx, B. P., May, C. L., Martini, B., Krystal, J. H., Southwick, S. M., & Pietrzak, R. H. (2017). Moral injury in U.S. combat veterans: Results from the National Health and Resilience in Veterans Study. Depression and Anxiety, 34, 340–347. https://doi.org/10.1002/da.22614
REFLECTIONS AND PREVENTIONS FOR CHILD ABUSE AWARENESS MONTH
Being a parent is hard and comes with many challenges. Children misbehave because they often have difficulty following directions, and they may push their parents’ buttons to get what they want. It’s important for parents and caretakers to put support in place (e.g., a go-to person who can help when needed) to ensure they can raise their children in a healthy, effective way regardless of the challenges they face. When parents’ actions harm their child emotionally or physically, they are committing child abuse (U.S. Department of Health and Human Services, n.d.). And while child abuse is on the decline, it’s still a pervasive problem in the United States today (Children’s Bureau, 2020). This article will discuss a few contexts in which child abuse can occur, stress management suggestions for parents, and available resources for child abuse prevention, specifically within the military. Understanding Child Abuse Children who experience abuse can suffer long-term effects on their physical and mental health, such as depression, anxiety, and chronic health conditions (Maschi et al., 2013). Research and social learning theory (i.e., modeling behaviors observed in one’s environment; McMillen & Rideout, 1996) show that child abuse often occurs within a family cycle: if you have experienced abuse yourself, you are more likely to abuse as a parent (Morgan et al., 2022). Similarly, children who see fewer examples of emotional regulation from their parents or caregivers will have fewer opportunities to learn such skills and become more likely to perpetuate the cycle (Osborne et al., 2021). In addition to the role of generational abuse, the challenges that new parents face also can also contribute. Parenthood is stressful enough, but the COVID-19 pandemic demonstrated how compounding stress affects families. The pandemic heightened stressors for parents, but their typical resources (e.g., daycare, school), perceptions (e.g., thoughts about how a stressful event may affect their family), and coping strategies (e.g., creating positive meaning, social support) were less effective, which, in turn, increased child maltreatment (Wu & Xu, 2020). When parents have reduced coping skills and a decreased ability to regulate their own emotions, their children can be less likely to develop the same skills (Osborne et al., 2021). Additionally, parents with maltreatment histories themselves often struggled with regulating their emotions then passed the struggles to their children (Osborne et al., 2021), in turn hindering an effective coping skill these children might use when experiencing stress as an adult. How to Cope Identifying healthier coping skills and means of emotional regulation (e.g., not holding onto anger) can be one way for parents to improve their well-being and limit opportunities for abuse. Some potential coping skills are: Creating a community for social support Talking with other parents about their coping skills Taking relaxation breaks (e.g., deep breathing, listening to music), even if only for 5 minutes Asking for help (e.g., with errands, babysitting) from community and friends Finding and using professional support when stress begins to pile up or when parents can no longer manage their stressors alone (APA, 2011). Prevention Efforts and Resources for Military Communities Just like civilian populations, military families can experience child abuse, and may even perpetrate it. Thankfully, the military has developed programs to support families and children experiencing abuse. One such program is the Family Advocacy Program (FAP), which works to prevent abuse and provide treatment for those affected by abuse. FAP also supports military families and connects them to local resources. Another program for Service members and their families is the After Deployment Adaptive Parenting Tools (ADAPT) program. At-risk families can use this program to build resilience, strengthen emotional regulation, and improve overall family well-being. The ADAPT program (which has been researched extensively) seeks to improve family functioning by teaching core parenting skills, such as teaching through encouragement, problem-solving, and emotional socialization. The New Parent Support Program assists military parents and expecting parents with transitioning into parenthood and developing a nurturing home. The program’s goal is to help parents build strong, healthy bonds with their children and manage the demands of parenting within the context of the military and its already-stressful job demands (e.g., deployment). Support and Resources for Those Who Have Experienced Abuse Having community support is essential to creating a buffer between oneself and the negative outcomes of child abuse. We know that experiencing abuse can lead to repeating the cycle with a child’s future family; however, there are also protective factors predictive of greater long-term psychological well-being for children (Siddiqui, 2015). Examples of such factors include receiving love from siblings or people outside of the family and participating in activities outside the home (e.g., school sports). These experiences can heighten a child’s sense of social support (Fasihi Harandi et al., 2017) and self-esteem (Liu et al., 2021). If you or your loved one experienced childhood abuse and still struggle with its effects, know that you are not alone. Below is a list of resources to help improve your well-being. Suicide & Crisis Line – 988 (https://988lifeline.org/) Child Help (https://childhelphotline.org/) MilParent Power ToolKit (https://www.militaryonesource.mil/parenting/children-youth-teens/milparent-power-toolkit/) Child Abuse Report Line for Military Families (877-790-1197 + 571-372-5348) It is important that we find healthy ways of coping with our stress so we can be positive role models for our children and families. If you need help coping, look within your community for mental health support programs or parenting classes (APA, 2008). Helping professionals should stay on top of reporting requirements and help their families create safe, loving environments for their children (APA, 2008). We still have a long way to go in preventing and limiting child abuse cases – ultimately, though, prevention starts with us.
WHAT ARE ADVERSE CHILDHOOD EXPERIENCES (ACES)?
Trauma is a word that you have probably heard before – but what about adverse childhood experiences (ACEs)? A growing area of research is distinguishing ACEs from the more general term trauma and examines why this type of trauma may be particularly important to examine. This article will outline what ACEs are and why they matter for military families. A landmark study was published in 1998 that described ACEs as exposure to seven types of abuse and household dysfunction (i.e., physical, sexual, and psychological abuse, parental substance misuse, parental mental illness, mother treated violently, and parental incarceration) prior to age 18 (Felitti et al., 1998). Since then, others have called for the expansion of ACEs to include experiences such as neglect, socioeconomic status challenges, parental absence or separation, and removal from the family home (Bruskas & Tessin, 2013; Tyler & Schmitz, 2013; Wade et al., 2014). Unfortunately, ACEs are quite prevalent. When using the originally defined ACE categories, around half of the adults in the U.S. report at least one ACE (Bethel et al., 2014; Campbell et al., 2016; Felitti et al., 1998). This number is likely higher when you start to consider more expanded definitions of ACEs. The researchers who originally introduced ACEs also demonstrated that experiencing four or more ACEs puts individuals at risk for several leading causes of death (Felitti et al., 1998). ACEs have also been linked to myriad negative outcomes across the lifespan that are more common among military members, such as substance misuse, depression, and posttraumatic stress disorder (PTSD) (Campbell et al., 2016; Felitti et al., 1998; Hovens et al., 2017; Huges et al., 2017). What does this mean for military families? There is evidence that ACEs are more prevalent among military service members (Blonich et al., 2014; Kanton et al., 2015). Further, emerging research demonstrates approximately one in five service members have experienced moderate to high levels of ACEs (Reed-Fitzke et al., 2022; Reed-Fitzke et al., under review). Some suggest these higher levels exist because volunteering for military service may be seen as an opportunity to leave an adverse childhood environment and improve one’s circumstances (Blosnich et al., 2014; Kanton et al., 2015). Although that may be true, those who enter service with a history of ACEs may be at-risk for health concerns if exposed to military-related trauma. There is a growing body of evidence indicating that service members who report ACEs are more likely to report postdeployment mental health concerns compared to service members with similar military-related trauma without childhood adversity (LeardMann et al., 2010; Morgan et al., 2022; Sareen et al., 2013; Reed-Fitzke et al., under review). As you might expect, ACEs have been connected to various difficulties within interpersonal relationships, although much of this research has been conducted within the broader population. Most notably, ACEs have been connected to both intimate partner violence victimization and perpetration, relationship distress and instability, and lower relationship satisfaction (Friesen et al., 2010; Hughes et al., 2017; Wheeler et al., 2019). Among military couples, there is some evidence to suggest a similar pattern of ACEs and relationship challenges exists, as well as a possible connection between service member ACEs history and partner mental health (Khalifian et al., 2022; Miller et al., 2013). Additionally, active-duty service members with higher ACEs have been found to be more likely to report family characteristics that are indicative of problematic functioning (Oshri et al., 2015). Unfortunately, the majority of what we know regarding the impact of ACEs on military families is limited to how ACEs impact the service member, particularly in regard to their mental health. Since this area of study is relatively new, that means there is still a lot we do not know. Given what we do know about ACEs, there may be a connection between ACEs and challenges in separation and reintegration, as well as relocation. Despite the challenges that ACEs may cause, individuals and families can be adaptive. It may be that certain individuals and families have learned to be flexible and face challenges head-on due to their past experiences of adversity and may handle military related stressors with ease. We still have much to learn about how ACEs might impact the nature of military family life. So is it all bad news? Fortunately, the answer to that question is no! Although there is certainly an impact of childhood adversity that persists into adulthood, service members with ACEs and their families can be resilient – and resilience is something that can be fostered (Lamson et al., 2020; Oshri et al., 2015; Reed-Fitzke et al., 2022. Service members with ACEs may benefit from engaging in resilience training, such as the Master Resilience Training Course offered by the Army. Additionally, bolstering social support may be a way to protect individuals and families against the negative impact of future military trauma, as strong support systems have been shown to help buffer against military stressors (Han et al., 2014; Reed-Fitzke & Lucier-Greer, 2020; Zalta et al., 2020). Families with a history of ACEs, just like all military families, may benefit from getting connected to their local Family Readiness Systems.
IN SICKNESS & IN HEALTH: PROMOTING HEALTHY LIFESTYLES FOR MILITARY SPOUSES
Along with everyday stressors, military spouses are exposed to unique stressors that may compromise their health (e.g., deployment stress, injury stress, family stress, and relocation stress). Because of these unique stressors, it’s important to find ways to minimize stress to live a healthier lifestyle. Many people’s first thought when it comes to living a healthy lifestyle is to increase exercise or improve their diet. Although diet and exercise are both important aspects of health, a person’s health can be improved in a multitude of other ways (e.g., reducing stressors when possible, practicing healthy sleep habits, maintaining social support). In this article, common health-related struggles of military spouses are identified, and we provide suggestions on ways to incorporate healthier activities into your daily life. According to recent research conducted by Corry and colleagues (2019), many military spouses may struggle to meet their health-related goals, such as reaching a certain body mass index (BMI) and getting enough exercise or sleep. More specifically, findings from this study showed: • Fewer than half of military spouses met the healthy weight/BMI (body mass index) goal or strength training goals; • The proportion of military spouses who met their sleep goal was lower compared to the national target for the U.S. adult population (i.e., 7 hours a day for those younger than 21 years old and 8 hours for those older than 21 years old); • Military spouses reported smoking more than the national target for the U.S. adult population (i.e., fewer than 100 cigarettes in their lifetime and no smoking in the past year); and • Military spouses who were also parents were less likely to meet weight, exercise, and sleep goals. Based on these findings, it’s clear that military spouses may benefit from additional support to ensure a healthy lifestyle. So, to help military spouses achieve their health goals, we’ve compiled several tips for incorporating healthier activities into their lives (e.g., healthy eating behaviors, sleep habits, stress management). Healthy Eating • Understand food labels. Food labels give helpful information for understanding what you’re eating, as well as portion sizes. Many people do not understand the unknowns of processed foods, and while all processed foods are not unhealthy, many contain high levels of sugar, salt, and fat that are unhealthy when eaten in large amounts. • Plan for your meals. This can help limit stress and reduce spending on foods high in sugar and sodium. • Be mindful while eating. Did a parent ever tell you that you need to chew 20 times before taking another bite? When you do this, you’re being mindful of your eating. Being mindful allows you to slow down, really enjoy your meal, and you allow your body time to feel full (it takes your body about 20 minutes to feel full after you begin eating). • Drink water. Men need to drink around 13 8-ounce cups of water a day (104 ounces) while women need to drink about nine (72 ounces). Drinking water quenches your thirst and can keep you from binge eating when you’re bored. • Limit alcohol consumption. Drinking alcohol is associated with short- and long-term health risks (e.g., high blood pressure, various cancers, engaging in sexually risky behaviors), and these risks increase with each drink consumed. Therefore, it’s recommended that men drink fewer than 14 alcoholic beverages in a week (2 or fewer in a day), and women drink fewer than 7 alcoholic beverages in a week (1 or less in a day). Exercise • Any activity is better than no activity. The recommended physical activity for adults is 150 minutes per week – about 20 minutes per day – of moderate-intensity activity, such as taking a brisk walk or playing pickleball with friends, or 75 minutes per week – about 10 minutes per day – of vigorous aerobic activity, such as swimming and aerobic dancing. The most important things to keep in mind here is that you listen to your body, don’t push yourself too hard too quickly, and you don’t need to be an all-star athlete when trying something new (you’ll get there soon enough!). • Change your mindset – working out isn’t just about losing weight. It’s also a great tool to help with alleviating the stresses of day-to-day life, and it can help improve your mood, boost your energy, promote better sleep, and more. Healthy Sleep Habits • Keep a consistent sleep schedule and get up at the same time every morning. When you get good sleep, your body relieves stress. • Turn off electronics 30 – 60 minutes before going to sleep because they have shown to have adverse effects on your sleep (i.e., increased time it takes to fall asleep, reduced sleep quality, affected attentiveness the following day). • Get adequate sleep. Because adults should sleep 7+ hours a night and teenagers should sleep 8 – 10, make sure that you go to bed early enough to sleep the recommended amount. Managing Stress • Declutter. Decluttering has been found to be one of the best places to start when you feel stressed or overwhelmed. Decluttering can be beneficial in managing stress because when you have a clean and organized space, you can focus on other areas of your life. It can also help make your space a place to decompress from daily stress. • Find your calm. Finding a way to calm down and relax amidst all the stress can sometimes be difficult to do on your own, but it’s important that you find ways to alleviate stress when possible. You might take just 5 minutes to engage in mindful activities, such as meditating or journaling. If you’re interested in mindfulness programs, MoodHacker, available through Military OneSource, can help track your mood and help you better understand your feelings. • Hold yourself accountable to stay motivated and achieve your goals. One way to do so is by finding an accountability partner to send daily or weekly texts to of some of your workouts and healthy meals. Another way to stay motivated is by writing down your daily, weekly, and long-term goals and checking in to assess your progress. A daily app may also be helpful in tracking yourself and maintaining accountability. • Limit or quit smoking because it’s linked to cardiovascular, respiratory, and reproductive health issues, along with cancers. Do it for yourself and only when you’re ready. It may be difficult to just quit cold turkey, but there is no harm in trying to quit. Social Support • Use support systems. Friends and family can provide excellent support when you need it. Turning to them for encouragement might help on the days when making a lifestyle change proves difficult. • Find a community. Find friends and build a strong network of people who are looking to lead a healthier lifestyle. Having someone else who is working toward the same goal can help keep you accountable and can also be a good workout buddy! • Try a group exercise class. Exercising with a group can eliminate the pressure of planning workouts and is a wonderful way to meet people who also enjoy exercise! Additional Resources Accessing resources can be difficult or intimidating for people who are looking to kickstart their health. The resources below make it easy to start your healthy lifestyle: • Military OneSource provides a multitude of health and well-being resources for military families. One resource, MyPlate.gov, is a website that provides nutrition tips and recipes as well as information about nutrition during different life stages (e.g., pregnancy and breast feeding, preschoolers, and older adults). Another helpful resource is health.gov, which highlights the importance of a healthy diet and physical activity and provides the Dietary Guidelines for Americans and Physical Activity Guidelines for Americans. • Military Families Magazine offers information on assorted topics pertaining to military families. For example, “The First Step in Staying Healthy as A Military Spouse” is an article specifically for military spouses looking to work on their physical health. This article highlights the specific importance for military wives of prioritizing health and suggests some ways of accomplishing this.
SEE THE CHANGE, BE THE CHANGE
Every February, the eating disorder community gathers to celebrate National Eating Disorder Awareness Week. This year’s theme is “See the Change, Be the Change.” Anyone, no matter their age, shape, or gender, can suffer from an eating disorder, and it’s the community’s goal to help society address that. One specific community goal is to draw attention to the fact that military families often suffer from eating disorders at a higher rate than the civilian population. One study of 46,219 Service members (72.6% male) evaluated disordered eating behaviors and weight changes over 2.7 years. When evaluating the onset of new disordered eating behaviors, about 415 women (3.3%) and 886 men (2.6%) reported an onset of disordered eating during that span. To analyze how these disordered eating behaviors affected weight changes, the researchers calculated the percentage of weight that subjects gained or lost over the course of the study. Researchers placed participants in one of five categories, depending on their percentage: Extreme weight loss (weight loss of 10% or more); Moderate weight loss (weight loss between 3-10%); Stable weight (remained with 3% gain or loss); Moderate weight gain (weight gain between 3-10%); or Extreme weight gain (a gain of 10% or more). Although 33.2% of women and 47.4% of men’s weight remained stable, 21.3% of women and 11% of men experienced either extreme weight loss or weight gain as a result of their disordered eating patterns. The authors did not further classify whether these Service members met the criteria for an eating disorder, but they did highlight how disordered eating behaviors are precursors to a diagnosable eating disorder. Children in military families are also at a higher risk of developing an eating disorder. In an additional study of 340 pairs of adolescent females and a military-affiliated parent (i.e., an active duty, deployed, or retired military family member), 21% of adolescents and 26% of parents met the criteria for an eating disorder. The study’s findings reflect the substantial overlap among children and military-affiliated parents who both have an eating disorder. The overlap was smaller in a civilian sample. One stressor comes from the constant changes required by military culture. Because active-duty Service members move roughly every four years, military children are required to change schools and make new friend groups. Sudden changes, such as a parent’s deployment or a permanent change of station, are also common. Children who lack control over their external surroundings may resort to either restricting food intake or overeating to cope with their emotions. With that being said, there are treatment options and resources for military families who may suffer from an eating disorder, like the National Eating Disorder Association (NEDA). Through NEDA, families can quickly be connected with a trained professional who can provide support through an online chat, phone call, or text. While not a diagnostic service, NEDA is a great way to learn about treatment options within the United States. And NEDA does offer guidance on specific questions to ask treatment providers, the different levels of care, and expectations for treatment. Additionally, TRICARE offers treatment at most inpatient and outpatient levels of care. Although recovering from an eating disorder is challenging, having the support of others makes a difference. Just knowing that someone supports you on your journey to recovery can increase the likelihood that you’ll seek and remain in treatment. And it’s always important to point out the prevalence of eating disorders within military families. If we want to see the change and be the change, we need to discuss the military community’s unique risk factors and make sure we’re offering the best treatment possible.
MILITARY SPOUSES: DON’T FORGET TO TAKE CARE OF YOURSELF
MILITARY SPOUSES: DON’T FORGET TO TAKE CARE OF YOURSELF By: Meredith Farnsworth Military Spouse Appreciation Day is a nationally-recognized day that was established in 1999 and is acknowledged each year on the Friday before Mother’s Day. Military Spouse Appreciation Day recognizes the essential role military spouses have in supporting the military through strengthening their Service member partners. This crucial role can be difficult at times, so it is key to make sure military spouses develop the support they need to take on this role, such as benefit-finding, keeping in touch, and using available military resources. Benefit-finding When we get caught up in the stress and challenges of circumstances, such as parenting children, taking care of a home, or meeting deadlines at work, we often forget about all the things we like about it, and military life is no exception. Benefit-finding, or identifying the positive aspects of a circumstance, can help balance out the negative aspects of whatever we are dealing with. Some studies have found that people who engage in benefit-finding also report greater well-being. This research can be applied to all the military spouses out there. For instance, take time to identify some of the benefits of being a military spouse. Some benefits might include the unique cultivation of community and friendships that military life offers or the personal strength you’ve developed from overcoming challenges. Find a relevant place to write these benefits (like in a planner, journal, mirror, or on a note on an end table where you sit often) as a reminder to yourself when life becomes stressful and challenges present themselves again. Tip: Identifying benefits can be an individual or group activity with your spouse and/or family. They might have some ideas to share! Keep in Touch The hectic tasks of life can keep us isolated. Running errands, going to work, taking care of children, and completing various projects leaves limited time to connect with family and friends. It seems that when we need family and friends most, we don’t always reach out. However, keeping in touch with others is important. One study found that when military spouses experienced higher levels of anxiety or depression, they didn’t connect as frequently with their family and friends. So consider being more proactive in connecting with family and friends, especially when facing difficulties. Importantly, continue adding to the list of ways that you build your support system, as support figures can provide a variety of options for mitigating stressful circumstances! Tip: Instead of feeling the pressure to schedule hours of time with friends/family, pick up the phone for a quick check-in. Weekly check-ins with family and friends can keep us connected, even when life feels hectic. Use Available Military Resources As a military spouse, you’re busy keeping your family running smoothly, and that’s a tall order! Knowing what resources are available to military families and using available military resources can make your life a little easier. The number of various supports and services available to military families can be overwhelming. However, Military OneSource provides a great starting point for military spouses to compile a list of resources and services, as well as online tools. Tip: Download the free Military OneSource app to more efficiently find benefits tailored to you as a military spouse and chat with a MilLife expert at any time from within the app! Military spouses, remember to take care of yourself! Taking care of yourself is a critical component to ensure you and your Service member are ready to take the stressors of military life. So, don’t feel that spending time and effort on yourself is unproductive and invaluable. Even spending as little as 10 minutes at a time (such as listening to music, meditating, reading a few pages from a book, or benefit-finding) can help manage stress. Lastly, continue adding to the list of ways that you build your support system to provide lots of options for mitigating stressful circumstances!
DEAR FAMILIES WITH A CHILD ON THE AUTISM SPECTRUM, APRIL IS FOR YOU!
April is National Autism Awareness and Acceptance month! In honor of this, we want to share some good news coming out of the research world about military families with a child on the Autism spectrum, offer some additional tips and resources that might benefit these families, and suggest different ways you can celebrate National Autism Awareness and Acceptance month. Let’s start with some validation. Amidst the common experiences that military families share, sometimes their unique challenges are talked about less often. If you are a parent of a child on the Autism spectrum, your experiences of military life are probably different than families with neurotypical children. All the transitions that come with saying goodbye to deploying Service members and welcoming them back home - they’re challenging for any family and can be particularly stressful if your child has a strong need for consistency and routine. Helping a child get adjusted to a new school or neighborhood is a lot of work for any parent and can be even more demanding if your child requires additional services. We see you and appreciate the hard work you put into keeping your family moving along through life! Now let us share some good news from the research! Military Spouse Online Autism Relocation Readiness (MilSOARR) is a program designed to help military families with a child on the Autism spectrum provide long distance mentorship to their peers in similar circumstances. Research has showed that a short 1-2 hour training can help families increase their knowledge of how to use supportive communication when mentoring. Takeaways: - If you have the capacity, consider completing this type of training through a program like MilSOARR to support fellow military families with a child on the Autism spectrum. - If you are a parent looking for support from peers, check out suggestions from Operation Autism, which places an emphasis on accessing local support or distance mentoring programs as they become more widespread, like MilSOARR. Project SEARCH and ASD Supports recently partnered to execute a program that helps young adults in military families who are on the Autism spectrum find community internships and on-the-job training. This specialized program is novel because it utilizes the tools from applied behavior analysis to prepare participants for future work environments and to be successful in their positions. In a pilot study of this specialized program, five out of the six young adults with an Autism Spectrum Disorder (ASD) who completed the program obtained employment offers! Of these, four were offered competitive employment (where they were paid minimum wage or higher) in an integrated environment (where they interacted with other employees regularly, rather than being isolated). Of the individuals who did not complete the program, who were part of a comparison group, only one out of eight obtained employment. Takeaways: - If you have a child on the Autism spectrum approaching working age, consider researching if Project SEARCH is offering any employment preparation and support programs near you, especially services for those on the Autism spectrum. - You may also consider contacting your local Vocational Rehabilitation (VR) office. This federal and state funded agency helps those with disabilities obtain employment. Depending on the size of the agency in your local area, your VR office may offer programs that are focused on the school-to-work transition for youth, including internships or job training. Keep in mind that the application to join VR can take more than a month, so you’ll need to plan ahead accordingly. Helpful resources for you If you are a parent of a child on the Autism spectrum, here are some resources that are specifically helpful for those navigating military life: - The Exceptional Family Member Program can help you ensure that your family is able to access appropriate local services, wherever you are stationed. - The Resource Guide provided by Operation Autism has information about first steps to take after your child has been diagnosed, and the types of medical and educational services available, and how they interact with military structures, such as Tricare. - This resource list from Operation We are Here has some great ideas about recreational opportunities (e.g., adventure or fishing camps) and services (e.g., sensory vests, equine therapies) that might be a good fit for your child. Celebrate National Autism Awareness and Acceptance month! If you have a family member on the Autism spectrum, April is a unique opportunity to celebrate differences and spread awareness. Here are some suggestions about how to be involved in National Autism Awareness and Acceptance month: 1) spreading awareness, 2) building community & connections, 3) financially supporting Autism-focused organizations, and 4) advocating for the needs of families with a member on the Autism spectrum. - Spread awareness to help build communities that truly celebrate diversity. Remember, “Knowledge is power, and understanding leads to inclusion.” - Use the FREE digital resources from the American Autism Society to share high quality information about Autism on your social media accounts or in other physical spaces (classrooms, offices). Remember to use #celebratedifferences in your social media posts! - On April 2nd, wear blue or light up the exterior of a building with blue light to show support for members of the Autism community and spread awareness. - Build a community with other families who have a child on the Autism spectrum so you and others can mutually benefit from social support! Try getting involved with local chapters of organizations (e.g., American Autism Society, Autism Speaks) by attending events. Note that some events may be temporarily digital due to COVID safety precautions. - Support Autism-focused organizations that provide information and resources (e.g., services, funding) to help individuals on the Autism spectrum reach their full potential. - Fundraise in your community, on your social media, or in your place of employment to both raise awareness and finances to keep Autism-focused organizations working toward their vital missions. - Purchase apparel and accessories from Autism Speaks to both spread awareness and support the organization. - Advocate for the needs of families with a member on the Autism spectrum by being aware of news and policies that affect individuals with disabilities or becoming a formal Advocacy Ambassador. Being both a member of a military family and a parent of a child on the Autism spectrum are demanding jobs, but with some helpful resources and moments of celebration, we hope you continue to find the strength to overcome your challenges each day. References: Kremkow, J. M. D., & Finke, E. H. (2020). The effectiveness of a distance peer mentor training program with military spouses with children with autism. Journal of Autism and Developmental Disorders, 50, 1097-1110. https://doi.org/10.1007/s10803-019-04334-0 Whittenburg, H. N., Schall, C. M., Wehman, P., McDonough, J., & DuBois, T. (2020). Helping high school-aged military dependents with autism gain employment through Project SEARCH+ ASD Supports. Military Medicine, 185, 663–668. https://doi.org/10.1093/milmed/usz224
SUICIDE PREVENTION
This article is about suicide. If you or someone you know is having thoughts about ending their life, you can call 911 or access the resources in the table below. Each resource will connect you with confidential, qualified crisis counseling 24/7. Organization Phone Text Live Web Chat Military/Veteran Crisis Line Call 1-800-273-8255, Press 1 Text 838255 https://www.veteranscrisisline.net/get-help/chat National Suicide Hotline Call 1-800-273-TALK (8255) - https://suicidepreventionlifeline.org/chat/ National Alliance on Mental Health Call 1-800-950-NAMI (6264) Text NAMI to 741741 - Crisis Text Line - Text HOME to 741741 - September has been named National Suicide Prevention month because suicide is sadly a pervasive issue throughout the country. Below you will find guidance about language, risk factors, and warning signs related to suicide. Next, and more importantly, you will find actions you can take in response to a crisis suicide situation, as well as steps you can take in your everyday life to prevent this growing problem. Use Words Carefully Be thoughtful about the language you use when discussing suicide. A common, problematic term that is used is “commit.” People commit crimes and sins, and these describe actions that are willful acts against society and religious beliefs. If we use the same word to describe the actions of a person who feels they have no viable alternatives, it will only be more difficult for that person to seek help. To learn more about this idea, read the thoughtful article on Dictionary.com, “Why the phrase “commit suicide” isn’t the right way to talk about suicide” or the reader-friendly research summary from the National Elf Service, “Language matters: How should we talk about suicide”, which notes alternate wording you can try out, such as “died by suicide.” Understand the Facts In the United States (according to the CDC and the National Alliance on Mental Illness or NAMI): ● The rate of deaths by suicide has increased by 31% in the past two decades. ● Suicide is relevant across ages. “It is the 2nd leading cause of death for people ages 10-34 and the 4th leading cause of death for people 35-54.” (NAMI) ● Suicide is relevant across genders. Women attempt suicide more than men. However, men are around four times more likely to die by suicide (75% of people who die by suicide are men). ● 54% of people who die by suicide do not have a diagnosed mental health condition. However, about 90% of these people still show identifiable symptoms prior to their death (see “Recognize Warning Signs” section below). Specifically in the US military (according to the Department of Defense or DOD suicide event report): ● The most common mechanism for death by suicide among Service members is a personally owned firearm (not a military-issued firearm), accounting for 66% of suicide deaths in this population. ● The most common mechanism for suicide attempts among Service members is alcohol or drug use, accounting for 56% of suicide attempts in this population. ● Similar to the larger US population, 51% of Service members who die by suicide did not have a documented mental health diagnosis (e.g., depression). To truly understand facts, remember to stay abreast of research that continues to examine evolving trends in suicide among Service members and effective treatments. Know the Risk Factors “Risk factors are characteristics that make it more likely that someone will consider, attempt, or die by suicide. They can't cause or predict a suicide attempt, but they're important to be aware of.” (NAMI) Some important risk factors, according to Military One Source and NAMI, include: ● Demographic: being a young and unmarried male ● Military: having recently returned from deployment, or having combat-related injuries (mental & physical) ● Career: job loss, lack of advancement, a sense of a loss or honor, or disciplinary actions ● Social: feeling isolated, lacking social support, relationship problems or ending of a significant relationship, grief from loss of a loved one ● Psychological: lack of access to mental health services, ongoing mental health difficulties (even without an official diagnosis), enduring prolonged stressful experiences, impulsive and/or aggressive tendencies, negative attitudes toward asking for help ● Health: lack of healthcare access, ongoing medical issues, heavy drinking, or other substance use problems ● History: previous suicide attempt(s) or family history of suicide, experiences of trauma or abuse Recognize Warning Signs According to Military One Source, NAMI, and the Suicide Prevention Lifeline, the behaviors, expressions, and emotions below are all possible indicators that a person may be having suicidal thoughts or planning to attempt suicide. ● Behaviors: ○ Isolation: distancing themselves from their loved ones, community, or unit ○ Risk taking: seeking or obtaining means of self-harm (e.g., guns, pills), increasing alcohol or drug use, unusual spending ○ Preparing: drafting a will, giving away possessions, making arrangements for pets ○ Sudden changes in sleep (too little or too much) ● Expression & Emotions: ○ Talking about wanting to die/hurt themselves, having no reason to live or being a burden on others ○ Intense mood swings (e.g., from being more anxious or agitated to being in an extremely good mood) ○ Feeling hopeless, trapped, or like a burden, experiencing unbearable pain, having intense rage or a desire for revenge Plan How You Will React in a Crisis If you suspect that someone you care about is experiencing ongoing thoughts about suicide (aligning with warning signs above, or your own intuition), here are steps you can take. See Suicide Prevention Lifeline for more info. 1. Ask: Directly inquire with the person if they are thinking about suicide. * You may want to remind them that you are a trustworthy person that cares about them and wants to help and is not here to judge them. Asking this question will not increase the chances they will attempt suicide or “give them any ideas.” It will help you detect how risky the situation is and direct the person to appropriate resources. 2. Be There: Respond in a way that clearly shows your support, whether verbally or physically. Don’t shy away from the topic or shame the person for having these thoughts. Listen to what the person believes will be helpful or help them brainstorm here if they are having difficulty. 3. Help Them Connect: You are valuable as a social support, but chances are that you are not a professional. Direct the person to relevant resources that can help them manage these thoughts long term. Resources such as Real Strength, Project R.E.D. Team (through Hope for the Day), and In Transition may also be particularly relevant, as they are designed for Service members and families. *You may want to remind them that you are not recommending services because they are broken or crazy. Rather, they deserve an opportunity to process their experiences in an environment that is safe, productive, and focused on their unique needs. If someone you care about intends to cause themselves immediate harm (according to Military One Source): ● If you’re on the phone, try to keep him or her on the line while you or someone else calls 911 or one of the crisis resources mentioned at the top of the article. Keep talking until help arrives. ● If you are with the person, stay until help arrives. (Never leave a person experiencing suicidal thoughts alone.) Remove any means of self-injury (e.g., weapons, drugs) from the area. ● If the person is unwilling to accept help in either situation, contact emergency services or command, if they are a Service member. If you are interested in additional information on how to be most helpful in a crisis situation surrounding suicide, consider the trainings listed on the Speak Up Reach Out website. Remember that Suicide Doesn’t Just Affect the Person Who Passed Away If someone you care about dies by suicide, there are resources available to help you. Taking active steps in caring for yourself is important, and healing is very much possible. The Tragedy Assistance Program for Survivors (TAPS) provides support services for military-linked survivors of suicide. Read TAPS article “10 things we know to be true” to learn about facts for survivors of suicide loss. Be Preventative! Remember that suicide affects all kinds of people across ages, genders, ethnicities, jobs/ranks, and education levels. What is common across most people when they begin to contemplate suicide is that they are undergoing stressors in their life that deplete their ability to feel hopeful about their own futures. The best way to prevent suicide is to help people address those stressors and maintain their wellbeing far in advance of any suicidal thoughts. Think about the examples below when trying to prevent suicide among people in military families: ● Not being able to access physical and mental health care are significant risk factors for suicide. In addition, finances, housing, and food insecurity are major life stressors. ○ Take note of the needs in your community and find small ways to support those facing challenges. ■ Volunteer your skills as a medical or mental health professional in military communities. ■ Connect with other military families to create a network of social support. ■ Offer to help a fellow military family with transportation to and from healthcare services. ■ Patron businesses that hire veterans and military spouses. ■ Start a community garden in your area to help those who are food insecure to access nutritious fruits and vegetables more easily. ■ Pick up extra supplies on your shopping trip and share them with a fellow military family in a tight financial spot. ○ Be aware of organizations that target these problems, refer families to them, and support them! ■ Donate goods to charities or food banks that serve military communities. Refer military families to Military One Source and Operation We Are Here for financial resources. ■ Encourage engagement with organizations that provide free or low-cost, easily accessible mental health services and resources to military families. Consider supporting these organizations with financial contributions if you are able. Some examples include: ● Treatment Works for Vets ● The Psychological Health Center for Excellence ● In Transition ● Project R.E.D. Team ● Real Strength ○ Support legislation that addresses the financial stability of military families and makes healthcare more accessible to them. Talk with your local representatives about these initiatives and vote in favor of them when the time comes. See our article about voting in the military for more information. ● Loneliness and isolation are highly relevant risk factors. ○ Connect with other military families on a regular basis. Schedule monthly dinners together or participate in mutual activities that can support mental health, such as a group exercise class. ○ Encourage your fellow military families to attend local events. Invite them personally, give them a reminder when the event is approaching, and, if they come, be enthusiastic about them joining! ● Big family transitions are normal sources of significant life stress. ○ Check in with families undergoing transitions such as welcoming a new baby or having a Service member return from deployment. Help them with small everyday stresses by mowing the lawn a few times or making dinner and sending it over. Sometimes it is better to come ready to help, even before it is requested. This article is about suicide. But it is also about the many ways we can create communities that nurture members and provide safety nets for those who may struggle. Together, we can all make small efforts to address suicide in a way that is informed, empathetic, and likely to change our nation for the better. References: Military OneSource. (2019, December 21). Suicide Awareness. Military OneSource. https://www.militaryonesource.mil/health-wellness/mental-health/suicide/suicide-awareness?utm_campaign=mos-enews-sept2020&utm_content=html&utm_medium=email&utm_source=govdelivery&fbclid=IwAR05ph5sngElTInbRHxXAjs1JtGVkRrcg8vshAK2csCOw7u_S24Lmf5DHzI National Alliance on Mental Illness. (n.d.). Risk of Suicide. National Alliance on Mental Illness.https://www.nami.org/About-Mental-Illness/Common-with-Mental-Illness/Risk-of-Suicide National Alliance on Mental Illness. (n.d.). Suicide Prevention Awareness Month. National Alliance on Mental Illness.https://www.nami.org/Get-Involved/Awareness-Events/Suicide-Prevention-Awareness-Month Stayton, L. E., Martin, C. E., Pease, J. L., & Chard, K. M. (2019). Changes in suicidal ideation following cognitive processing therapy in a VA residential treatment program. Military Psychology, 31(4), 326-334. https://doi.org/10.1080/08995605.2019.1630230 Tucker, Jennifer. (2019, July 17) 2017 DoD suicide event report: Key findings about suicidal behaviors among Service members. Psychological Health Center of Excellence. https://www.pdhealth.mil/news/blog/2017-dod-suicide-event-report-key-findings-about-suicidal-behaviors-among-service-members