Intensive outpatient treatment of PTSD and complicated grief in suicide-bereaved military widows.

We report on a novel 2-week intensive outpatient treatment program (IOP) for 24 widows bereaved by the suicide death of their veteran spouse. We targeted symptoms of posttraumatic stress disorder (PTSD) and complicated grief (CG) concurrently in three separate cohorts. All patients either witnessed the death or discovered the body of their deceased partner, who was a veteran of the United States military. PTSD, CG, and depression symptom severity decreased significantly from pre- to post-treatment, with effect sizes of 0.85, 1.21, and 1.35, respectively. These outcomes provide preliminary support for an IOP to treat co-occurring PTSD and CG among widowed survivors of veteran suicide.

The effect of intimate partner violence on treatment response in an intensive outpatient program for suicide-bereaved military widows.

Suicide-bereaved military widows can struggle with posttraumatic stress disorder (PTSD) and prolonged grief. Intimate partner violence survivors (IPV) are particularly at risk. We examined whether IPV impacts outcomes in a two-week intensive outpatient program for N = 50 suicide-bereaved military widows. Mixed-model regressions were employed to examine the effects of IPV, time, and their interaction on symptoms. Thirty-four percent experienced IPV perpetrated by their deceased veteran. Symptoms improved at post-treatment (ps < .001), one-month (ps < .01), and three-month follow-up (ps< .001). There was no significant effect of IPV or significant interaction (ps > .05), indicating that IPV survivors also benefitted from treatment.

Staying Strong with Schools: Testing an Elementary School-Based Intervention for Military-Connected Children.

To address the unique behavioral health challenges facing military-connected children (MCC) during parental deployment and reintegration, we developed a low-cost, low-burden school-based intervention, Staying Strong With Schools (SSWS). SSWS builds upon best educational practice by formalizing relationships between administrators, guidance staff, teachers, and parents to enhance social connection to support psychosocial functioning of MCC. We previously evaluated the feasibility and acceptability of the intervention in an open pilot with 2 elementary schools, finding high feasibility and high acceptability. A randomized controlled trial of 10 civilian elementary schools was conducted to examine the efficacy of SSWS. Ten schools were randomly assigned to SSWS versus an educational pamphlet waitlist control condition. Participants included 56 MCC, assessed on measures of behavioral and emotional functioning, perceived social support, and mental health symptoms at the beginning, middle, and end of school year. Over the course of the school year, parents in intervention schools reported their child exhibited less internalizing behavior than nonintervention school parents; there were no differences in parent report of child externalizing behavior. Children in SSWS schools reported greater perceived social support than children in control schools. Findings from this small-scale randomized controlled trial suggest that SSWS might be efficacious in supporting MCC in civilian elementary schools and support a larger scale implementation to test its efficacy further.

Complicated Grief Among Military Service Members and Veterans Who Served After September 11, 2001.

Minimal research is available on the prevalence and impact of complicated grief (CG) in military service members and veterans, despite high reported rates of loss in this population. The present study aimed to examine prevalence rates of CG in a sample of treatment-seeking military service and members and veterans who served after September 11, 2001. Additionally, the study aimed to examine characteristics associated with CG as well as the association between CG and quality of life. In a sample of 622 military service members and veterans who served after September 11, 2001, 502 reported a significant loss (80.7%). Usable data were available for a total of 468 participants. Of these 468 participants, 30.3% (n = 142) met diagnostic criteria for CG, as defined by a score of 30 or more on the Inventory of Complicated Grief (ICG; Prigerson et al., 1995). We conducted a series of t tests and chi-square tests to examine the differences between individuals who met criteria for CG and those who did not. The presence of CG was associated with worse PTSD, d = 0.68, p < .001; depression, d = -1.10, p < .001; anxiety, d = -1.02, p < .001; stress, d = 0.99, p < .001; and quality of life, d = 0.76, p < .001. Multiple regression analyses examined the independent impact of CG on quality of life. Complicated grief was associated with poorer quality of life above and beyond PTSD, ß = -.12, p = .017. In addition, in a separate regression, CG was associated with poorer quality of life above and beyond depression, ß = -.13, p < .001. Overall, our findings highlight the impact of CG on this population, and have implications for assessment and treatment.

Examining the Relationship Between Parent and Child Psychopathology in Treatment-Seeking Veterans.

This study aimed to examine: (1) the relationship between parental psychopathology and child psychopathology in military families and (2) parenting sense of competence as a mediator of the relationship between veteran psychopathology and child psychopathology. As part of their standard clinical evaluations, 215 treatment-seeking veterans who reported having a child between the ages of 4 and 17 were assessed for psychopathology (posttraumatic stress disorder, depression, anxiety, and stress), their sense of competence as a parent, and their child's psychopathology (internalizing, externalizing, and attentional symptoms). A path analysis model examining parenting sense of competence as a mediator of the relationship between veteran psychopathology and child psychopathology showed significant indirect effects of veteran depression on all child psychopathology outcomes via parenting sense of competence. Parental sense of competence may be a critical mechanism linking veteran depression and child psychopathology, and may therefore be an important target for intervention.

Posttraumatic Stress Disorder and Military-Connected Families: The Relevance of a Family-Centered Approach.

Since the September 11, 2001, terrorist attacks, military service in the United States has been linked to a range of behavioral health and physical injuries in a significant number of the almost three million service members who have returned from wartime deployment. These injuries have occurred in the larger context of wartime military service, which is characterized by an array of stressors that have been associated with increased risk for behavioral health problems not only for service members but also for their family members. For the past 15 years, military-connected (defined as active-duty, reserve component, and veteran) family members have shared their own experiences of military service, including multiple deployments in the context of danger, high operational stress within their communities, and living with the physical and behavioral health injuries and ongoing care needs of a loved one. This article provides an overview of the evolving research on the specific impact of posttraumatic stress disorder (PTSD) and other war zone-related behavioral health problems among families in the context of contemporary warfare, as well as research on the impact of family adjustment on veteran recovery and care. We propose an empirically supported, family-centered framework to inform a continuum of prevention and care for veterans with PTSD and their families. Gaps in the current continuum of behavioral health services for veterans with PTSD are identified, as well as efforts underway to develop trauma-informed, family-centered screening, prevention, and treatment approaches. Future research recommendations are provided.

Staying Strong With Schools: A Civilian School-Based Intervention to Promote Resilience for Military-Connected Children.

Since September 11, 2001, over 2 million U.S. service members have been deployed to Iraq or Afghanistan, resulting in hundreds of thousands of military-connected children (MCC) having experienced a parental deployment. Although parental deployments have significantly burdened these children, few evidence-based interventions designed to support their resilience to these stressors are available. To address this gap, we developed a civilian school-based intervention to promote resilience in MCC living in the community. Our intervention, Staying Strong With Schools (SSWS), aims to deliver: a training to all school professionals early in the school year to educate them about challenges for children and families experiencing parental deployment and signs of deployment-related distress; and a year-long training for the school guidance counselor who coordinates communication and provides psychosocial support to MCC within the school community. We piloted SSWS in two civilian elementary schools and found promising feasibility and acceptability.