Search Results
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Military REACH Publications
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Military Branch of Service
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Military Affiliation
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Award Winning Publications
1.Quality of life in the U.S. Marine Corps: Executive summary
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2.A needs assessment of Veterans in custody, their families & children: Executive summary
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3.Transition outcomes of armed forces personnel with battlefield injuries: A summary of the literature
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4.MOD health and safety statistics: Annual summary & trends over time 2014/15 – 2018/19
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5.A national study of Veterans with major upper limb amputation: Survey methods, participants, and summary findings
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6.Summary and roadmap of breast cancer research in the Veterans Affairs
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7.Annotated bibliography of Veterans Affairs Canada research directorate publications for 1992-2018: Research evidence to support the well-being of veterans and their families
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8.2013 Synthesis of life after service studies: Executive summary
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9.A thesis of clinical research and practice: Part A: The effectiveness of imagery rescripting interventions for military veterans with nightmares and sleep disturbances: A systematic review and meta-analysis; Part B: Military veterans’ experiences of trust in the therapeutic relationship: An Interpretative Phenomenological Analysis; Part C; Summary of clinical practice and assessments
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10.The Millennium Cohort Study: The first 20 years of research dedicated to understanding the long-term health of US service members and veterans
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11.Heterogeneity in place effects on health: The case of time preferences and adolescent obesity
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12.Servicemembers and veterans with major traumatic limb loss from Vietnam war and OIF/OEF conflicts: Survey methods, participants, and summary findings
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13.Intimate partner violence: Strategies to engage male victims
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14.Differences in quality-of-life scores across injury categories by mental health status among injured U.S. military service members and veterans
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15.Research on fathers in the military context: Current status and future directions
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16.An exploratory analysis of hardiness and health behaviours in Canadian Armed Forces (CAF) recruits
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17.Peer victimization
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18.Engaging veterans, caregivers, and system stakeholders to improve VA home and community-based services
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19.Characterizing mental, behavioural, and physical health among active duty U.S. sailors and Marines
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20.Exploring Canadian veterans’ priorities regarding chronic pain research: A qualitative study
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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.
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
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
MOBILIZING FAMILY RESEARCH: AN OVERVIEW OF MILITARY REACH
The Military REACH team is dedicated to making research practical and accessible for individuals outside of academic settings who are interested in military families. To achieve this goal, our team follows a five-step process: identify, evaluate, translate, archive, and distribute. This process is a systematic approach to making research visible and available. First, we identify and closely examine current research publications related to our project’s focus area (i.e., military families) to determine how the information presented can best serve our target audiences: families, helping professionals, and policy makers. We utilize tools, such as PeerUS, and search engines, such as PsycINFO and Google Scholar, to effectively track new publications. Next, we evaluate the credibility and contribution of identified research studies using an evidence-based appraisal system, which has been modified to tailor the evaluation to the purpose of our project, the content of the research field, and the target audiences. This system assesses research on three aspects: credibility, contribution, and communicativeness. Thus, our evaluation assists readers with determining the degree of trustworthiness each publication possesses. After evaluation, we translate research articles into useful, practical, and high-quality resources. This step primarily involves the creation of Translating Research into Practice (TRIP) Reports, which are focused research summaries written to emphasize the implications for families, helping professionals, and policy makers. We then archive current research and original products into an intuitive, publicly accessible online library where users can find each publication’s detailed information, a link to its original source, and, when appropriate, a summary of the article. Finally, we distribute the research and resources to families, helping professionals, and policy makers through multiple social media platforms, electronic newsletters, and an online library. Our research team also partners with key stakeholders (specifically, the Department of Defense) to distribute these resources directly to those who can inform policy and practice. Military REACH serves as a bridge connecting the gap between academia and military families, helping professionals, and policy makers. The findings of research on military families have real, practical implications for service members, veterans, and their families, so it is imperative that our team work to make this information accessible and understandable to all. Through these processes, the impact of valuable research can be extended into the hands of the individuals who are wellpositioned to apply this information to inform intervention and prevention efforts at various levels.
Why are Credible Resources Important?
Over the course of their service, military families may experience events that can disrupt family functioning. For example, it is common for military families to experience long separations due to deployments or military training, as well as moving, on average, every two to three years (U.S. Government Accountability Office, 2022). Frequently finding themselves in new, fast-changing situations, military families can rely on resources, such as a parenting program, to help them successfully adjust to their surroundings. This piece will discuss the importance of using credible resources and identify some common barriers to resource utilization. \n\n #### THE IMPORTANCE OF EVIDENCE-BASED RESOURCES \n\n A study on community resource adequacy explained that having *access to resources* and *feeling satisfied after using them* can help Service members and spouses maintain emotional and physical wellbeing (Hobfoll & Lilly, 1993). In another study, the wellbeing of spouses and their satisfaction with resources was found to be the most important factor for staying in the military (Segal & Harris, 1993). Knowing that resource availability can influence family wellbeing and retention, it is important to figure out which resources are best. It is useful to know if resources are evidence-based or not, because this is a reliable way to understand causality. \n\n Resources created by institutions, like the U.S. Military or universities, are typically created based on need and supported by empirical research. Let’s dive into an example: *The Department of Defense (DoD) recently learned from a survey that many Service members feel disconnected from their units, so they decide to implement a program to improve unit cohesion. After reviewing many programs, or developing a new one, the DOD decides to implement a relationship-building program to increase unit cohesion among the members. Finally, after the program has been implemented, it is studied to determine if it is achieving its goal.* \n\n The example involves a lengthy, but essential, process! Resource evaluation can exist in different forms and is done at different time points in a program’s creation or implementation. But what makes empirically-based resources any different from those that aren’t? Well, they are supported by research. One way that evidence-based programs are differentiated from those that aren’t is through the methodology used for evaluation. For example, the [Clearinghouse for Family Readiness](https://www.continuum.militaryfamilies.psu.edu/search) categorizes programs by their use of a [randomized control trial](https://militaryreach.auburn.edu/DictionaryResult?term=Randomized%20Controlled%20Trial) or [quasi-experimental design](https://militaryreach.auburn.edu/FamilyStoryDetails?resourceid=063db49a-c73b-4148-a997-0dbb81126fdf#:~:text=quasi%2Dexperimental%20design), two methods that test the efficacy of interventions. Without these methods, it is difficult to determine the causality of an intervention. That is, how can we determine what caused the outcome of increased unit cohesion? Using the example above, an evidence-based method to test the efficacy of the relationship-building program will be able to determine if the program itself increased unit cohesion among members, rather than another variable such as leadership support. \n\n #### BARRIERS TO USING RESOURCES \n\n Navigating resources and deciphering which to use can be a balancing act, as there are so many. Knowing what to look for can make choosing one a little easier. As previously mentioned, using empirically-based resources can help military communities understand which programs have been proven to address a specific outcome. Creating a valid resource is only the first step, though. The program should address a need as well as be accessible. I had the opportunity to discuss this complex issue with Auburn University’s Extension Veterans Outreach Coordinator, Curtis Pippin. Though Curtis didn’t have the final answer, he did have some words of wisdom. “Bridging the gap [between resources and people using them] starts with giving [people] a voice. \n\n Trying to untangle the issue of why some people don’t use available resources is difficult. There may be several reasons – some may be environmental (e.g., not having reliable transportation), psychological (e.g., viewing getting help as a weakness), or simply because they do not address the need of the individual. The multi-layered reasons can make it difficult to determine the best solution because an approach may address one barrier but not another. \n\n For example, in the case of accessing mental health services after deployment, some of the barriers Service members may experience include stigma, military culture, general attitudes about treatment, and logistical concerns (e.g., long wait times, far distances to medical facilities) (Institute of Medicine of The National Academies, 2013). When resources are set up to target singular problems (e.g., housing) then all the person’s other needs end up not being met (Trail et al., 2017). Therefore, looking for a holistic resource that offers multiple types of assistance (e.g., housing, mental health services, childcare assistance) may be a better option for Service members who are experiencing a multi-faceted circumstance, such as deployment and reintegration (Trail et al., 2017). \n\n While resources are not one-size-fits-all, it is important for researchers to consider the needs being met, the efficacy of the intervention, and the accessibility of the final product. Creating accessible, useful, and evidence-based resources for military families can go a long way in terms of wellbeing, family functioning, and retention. To learn more about epirically-based, military-focused programs, visit [Clearing House for Military Family Readiness](https://militaryfamilies.psu.edu/), a research team that evaluates program effectiveness. Additionally, our team at [Military REACH](https://militaryreach.auburn.edu/) also helps identify and evaluate research, including that on empirically-based programs, and we even developed a [study](https://militaryreach.auburn.edu/dr?id=2337eb95-bfd8-48a8-a288-8d137882e259) to evaluate the effectiveness of our research summaries!