A Meta-Review to Guide Military Screening and Treatment of Gambling Problems.

INTRODUCTION: Excessive gambling can cause substantial biopsychosocial problems (e.g., difficulties with finances, relationships, mental, and physical health). For military Service Members, it can also result in security clearance denial or revocation, failure to achieve promotions, and premature career termination. Recent congressional mandates have obligated the U.S. Department of Defense to screen for problematic gambling, the predictive values of which are a function of (i) problem prevalence and (ii) tool sensitivity and specificity. This meta-review (i.e., systematic review of systematic reviews) on the screening properties of gambling assessment tools and the effectiveness of treatments for gambling disorder is to inform military services on responding to Service Members' gambling problems. MATERIALS AND METHODS: EBSCO Discovery Service, PubMed, PsycINFO, Ovid Medline, Social Care Online, Epistemonikos, International Health Technology Assessment, and the Cochrane Central Register of Controlled Trials electronic databases were searched up to December 2022 for systematic reviews and meta-analyses on measurements of adult subclinical or gambling, and interventions targeting individuals with GD. Three and four studies were included in each section of the current meta-review (i.e., assessment tools and treatment). For review 1, the estimated risk of bias was assessed using the Risk of Bias in Systematic Reviews. RESULTS: Thirty-one tools were identified through the three systematic reviews. All had modest sensitivities and specificities; combined with low prevalences in the general SM population, positive results would be incorrect 64-99% of the time. However, if screening were conducted with SMs referred for alcohol problems, a positive result on the best screening tools would be correct 76% of the time. Several commonly used treatment approaches had demonstrated efficacy for GD. CONCLUSIONS: The combination of low prevalence of GD and subclinical gambling problems in the general population, coupled with modest sensitivity and specificity, makes screening unfeasible in the general SM population. However, dual-phase screening in higher-prevalence subpopulations (i.e., SMs already identified with substance-abuse or mental-health problems) would be viable. Regarding treatment, several interventions-already used in military healthcare-with extensive empirical track records have been successfully used to treat adults with GD.

Evaluating the Relationship Between Intimate Partner Violence-Related Training and Mental Health Professionals' Assessment of Relationship Problems.

Intimate partner violence (IPV) is a serious public health problem associated with increased risk of developing mental health conditions. Assessment of IPV in mental health settings is important for appropriate treatment planning and referral; however, lack of training in how to identify and respond to IPV presents a significant barrier to assessment. To address this issue, the World Health Organization (WHO) advanced a series of evidence-based recommendations for IPV-related training programs. This study examines the relationship between mental health professionals' experiences of IPV-related training, including the degree to which their training resembles WHO training recommendations, and their accuracy in correctly identifying relationship problems. Participants were psychologists and psychiatrists (N = 321) from 24 countries who agreed to participate in an online survey in French, Japanese, or Spanish. They responded to questions regarding their IPV-related training (i.e., components and hours of training) and rated the presence or absence of clinically significant relationship problems and maltreatment (RPM) and mental disorders across four case vignettes. Participants who received IPV-related training, and whose training was more recent and more closely resembled WHO training recommendations, were more likely than those without training to accurately identify RPM when it was present. Clinicians regardless of IPV-related training were equally likely to misclassify normative couple issues as clinically significant RPM. Findings suggest that IPV-related training assists clinicians in making more accurate assessments of patients presenting with clinically significant relationship problems, including IPV. These data inform recommendations for IPV-related training programs and suggest that training should be repeated, multicomponent, and include experiential training exercises, and guidelines for distinguishing normative relationship problems from clinically significant RPM.

Evaluation of Two Approaches for Responding to Allegations of Family Maltreatment in the U.S. Army: Coordinated Community Response Impacts and Costs.

INTRODUCTION: The U.S. Air Force (USAF) conducted a program of research to develop and disseminate reliable and valid criteria for partner and child maltreatment (comprising abuse [physical, emotional/psychological, and sexual] and neglect). These criteria are now used in all branches of the U.S. military. The U.S. Army was the first service outside the USAF to adopt the criteria sets and computerized decision support tool but maintained the original committee composition (the "Case Review Committee" [CRC]) instead of adopting the entire assessment, allegation determination, and treatment planning process (the "Field-tested Assessment, Intervention-planning, and Response" [FAIR] system). The Army commissioned this study to compare the CRC and FAIR processes by testing (1) intra-committee process (i.e., three facets of committee functioning-fidelity to regulations, cohesion and team process, outsized influence of unit representatives); (2) coordinated community response to maltreatment (i.e., perceptions of fairness to alleged offenders and victims, impact on unit representatives, and (3) collaboration between the Family Advocacy Program (FAP, the military's maltreatment response agency) and outside agencies; and (4) the time expended and cost. MATERIALS AND METHODS: New York University's Institutional Review Board approved the study protocol, and the Army's Human Research Protection Office provided permission to collect data. The ten Army garrisons with the most annual maltreatment cases participated. Committee members, FAP social workers, unit commanders, and independent observers completed assessments of individual meetings and of their overall impression of the processes. A test of whether the means significantly differed between phases was then performed separately for each outcome, and 95% CIs of the unstandardized mean difference between phases were estimated. RESULTS: Independent observers rated FAIR meetings as significantly more faithful to regulations. Unit representatives (i.e., commanders and/or first sergeants) perceived the committee to function better during FAIR (although other committee members and independent observers did not perceive differences). Unit representatives not only rated FAIR as significantly more fair to both alleged offenders and victims (ratings from other committee members did not differ), but also were more likely to attend FAIR meetings and, when they did, rated their ability to serve soldiers and families higher during FAIR. However, FAP social workers rated their relationships with units as being better during CRC, and outside agencies rated their relationship with FAP as significantly better during CRC. Costs to the Army were nearly identical in the two committee structures. CONCLUSION: Results indicated that the CRC and FAIR processes cost almost identical amounts to run and that the FAIR system was superior in ways most likely to impact service members: (1) independent observers judged its meetings to be more faithful to Army and DoD Instructions; (2) unit representatives were more likely to attend and believed the FAIR system to be fairer (to both alleged offenders and victims) and better functioning. Care should be taken, however, in nurturing relationships between FAP and (1) unit representatives and (2) outside agencies, which may have weakened during FAIR.

In-home conversations of couples with advanced cancer: Support has its costs.

OBJECTIVE: The goal of this study was to describe the quality of naturalistic communication between patients with advanced cancer and their spouse caregivers using observational methods. We also assessed the association between patient and caregiver communication behaviors and psychological and physical health using the actor-partner interdependence model. METHODS: Data on 81 dyads were gathered as part of a prospective observational study. Patients with advanced cancer and their spouse caregivers completed demographic, physical health, and emotional well-being questionnaires. Cancer and relationship communication captured in "day-in-the-life" audio recordings were coded using Gottman's Turning System to assess the quality of bids for attention and responses. RESULTS: Bids for attention were most often informational (Low Bids) and responses were mostly positive and effortful (Turn Towards); patients and caregivers did not significantly differ in communication behavior. More effortful bids for attention (High Bids) were associated with more positive and effortful responses. Patient communication behaviors were significantly associated with caregiver emotional well-being, whereas caregiver communication behaviors were significantly associated with their own emotional well-being and patient physical health. CONCLUSIONS: While patients may benefit from caregivers' more positive and engaged communication at home, the emotional labor of focusing on and engaging the patient may take a toll on caregivers' own well-being. This work contributes to the understanding of what everyday communication looks like for patients with advanced cancer and their spouse caregivers and how this communication may impact physical and psychological health. Our findings provide a foundation to develop guidelines for psychosocial couple-based interventions.

Money matters: an analysis of advanced cancer couples' communication about financial concerns.

Even for the insured, cancer treatment can be expensive and financially burdensome for families, especially in advanced disease. PURPOSE: To determine if advanced cancer patient-caregiver spousal dyads identified and/or discussed financial concerns. METHODS: Advanced cancer spousal dyads (n = 26) were asked to discuss their concerns (including finances) for 10 min. Discussions were audio-recorded and transcripts were analyzed for content and depth. We used the constant comparative analysis to analyze communication and demographic data from those who identified financial concerns relevant to cancer treatment. RESULTS: Of the 26 couples identifying finances as a concern relevant to cancer, there was variability in perception of their overall financial situation, and roughly a third had discordant reports on the degree of financial concern. Thirty-five percent of dyads (n = 9) did not discuss finances during the audio-recorded discussions; for the other dyads, financial conversations varied in depth and breadth for specific concerns. CONCLUSIONS: Couples were discordant in reports of concern about finances and perceptions of their financial situations. Even if finances were identified as a concern, many couples chose not to discuss financial concerns in depth. Some degree of shielding or avoidance between spouses may be beneficial, but couple financial discussions are important, especially when decisions may impact long-term plans. More research is needed to determine how to facilitate financial conversations to improve patient's and caregiver's well-being.

A Research Program Testing the Effectiveness of a Preventive Intervention for Couples with a Newborn.

Noxious family environments are associated with a wide range of adverse child outcomes. In order to prevent couple and parent-child relationship problems, a number of programs have been developed for couples with newborns. The current paper describes a program of research evaluating the American version of couple CARE for parents of newborns. This version of CCP was administered to low-income, unmarried couples with a new baby in an uncontrolled demonstration project (Study 1), compared with a waitlist control condition in a randomized controlled trial (Study 2), and evaluated with low-income parents recruited from urban hospitals in two major metropolitan areas of the United States (Study 3 and Study 4). Despite participant satisfaction with CCP, preventive effects of the program were limited and there was one potential iatrogenic effect. Results were likely impacted by major challenges with recruiting participants and maintaining their engagement in CCP for the duration of the program. We discuss methodological differences between this series of studies and previous trials of prevention programs and make recommendations for improving service delivery to at-risk new parents. These results have implications for public policies that aim to benefit children and families.

Los latinos de bajos recursos están expuestos a amplias desigualdades relacionadas con la salud mental en los Estados Unidos. Recientemente, un resurgimiento de relatos antiinmigratorios han llevado a los inmigrantes latinos vulnerables a sufrir considerables factores desencadenantes de estrés contextual con varias consecuencias perjudiciales para su bienestar general, por ejemplo, interrupciones significativas a sus prácticas de crianza. Dentro de este contexto de adversidad, y a pesar de los múltiples beneficios asociados con las intervenciones preventivas de capacitación para padres, la disponibilidad de intervenciones de capacitación para padres contextualmente y culturalmente relevantes siguen siendo limitadas en las comunidades latinas marginadas. Este artículo constituye un aporte a este déficit de conocimiento mediante la presentación de un modelo de aplicación de intervenciones utilizado en la difusión de versiones culturalmente adaptadas de la intervención de base factual, conocida como GenerationPMTO.© El modelo propuesto también describe un proceso de cambio que hemos documentado en la investigación empírica con padres inmigrantes latinos de bajos recursos que han estado expuestos a las intervenciones adaptadas. El manuscrito está organizado en cuatro secciones. Primero, se debate una presentación general del modelo junto con un breve resumen de teorías principales. Luego, se describen los componentes principales del modelo, complementados por la presentación de un caso práctico. Finalmente, se debaten las consecuencias para la prevención y la intervención clínica.

Development of a multilevel prevention program for improved relationship functioning in active duty military members.

The relationships and families of active duty (AD) service members have been tremendously strained by deployments and high operations' tempo. This study involves the first steps in developing a multilevel approach to preventing relationship problems that integrates universal, selective, and indicated prevention/intervention. Such an approach has tremendous empirical support for parenting problems, but no similar program exists for couple problems. We conducted two studies with U.S. Air Force Security Forces members. Study 1 elicited the target population's topics of highest interest. For almost all topics, 70% to 95% of participants who desired information reported being underserved by current prevention offerings (i.e., not receiving needed information). Using the top topics generated in Study 1, we developed prevention information/action planning sheets on 18 relationship issues. In Study 2, we had AD members who gave feedback on the form and content of the sheets. Overall, AD members believed that the sheets were moderately to very useful and were presented well, had pithy but comprehensive information and conveyed the content well. Results imply that a multilevel approach may be a useful complement to formal services in meeting underserved military members' needs and that further research and development of this dissemination vector for evidence-based information is warranted.

Unique risk and protective factors for partner aggression in a large scale air force survey.

The objective of this study is to examine risk factors of physical aggression against a partner in a large representative Active Duty Air Force sample. A stratified sample of 128,950 United States Active Duty members were invited to participate in an Air Force-wide anonymous online survey across 82 bases. The final sample (N = 52,780) was weighted to be representative of the United States Air Force. Backward stepwise regression analyses were conducted to identify unique predictors of partner physical aggression perpetration within and across different ecological levels (individual, family, organization, and community levels). Relationship satisfaction, alcohol problems, financial stress, and number of years in the military were identified as unique predictors of men's and women's perpetration of violence against their partner across ecological levels. Parental status, support from neighbors, personal coping, and support from formal agencies also uniquely predicted men's but not women's perpetration of violence across ecological levels. This study identified specific risk factors of partner violence that may be targeted by prevention and intervention efforts aimed at different levels of impact (e.g., family interventions, community-wide programs).