Relationship satisfaction among spouse caregivers of service members and veterans with comorbid mild traumatic brain injury and post-traumatic stress disorder.

This study examined relationship satisfaction and health-related quality of life (HRQOL) among spouse caregivers assisting service members and veterans (SMV) with comorbid uncomplicated mild traumatic brain injury (MTBI) and post-traumatic stress disorder (PTSD). Spouse caregivers (N = 205) completed the Couples Satisfaction Index (CSI), 12 HRQOL measures, and the Mayo-Portland Adaptability Inventory 4th Edition (MPAI-4). T-scores were classified as "clinically elevated" using a cutoff of ≥60T. The sample was also classified into "Satisfied" (≥13.5, n = 113, 55.0%) or "Dissatisfied" (<13.5, n = 92, 44.0%) relationship categories. Using stepwise regression analysis, Anxiety, Family Disruption, Vigilance, Emotional Support, Feeling Trapped, and MPAI-4 Adjustment were identified as the strongest predictors of CSI total scores (p < 0.001), accounting for 41.6% of the variance. Squared semi-partial correlations revealed that 18.1% of the variance was shared across all six measures, with 7.8% to 1.5% of unique variance accounted for by each measure separately. When comparing the number of clinically elevated measures simultaneously, the Dissatisfied group consistently had a higher number of clinically elevated scores compared to the Satisfied group (e.g., 3-or-more clinically elevated scores: Dissatisfied = 40.2%, Satisfied = 8.8%, OR = 6.93, H = 0.76). Caring for a SMV with comorbid TBI and PTSD can have a profound impact on the spouse caregiver's HRQOL, relationship satisfaction, and family functioning. The findings from the current study continue to support the need for family involvement in the SMV's treatment plan, but more effort is needed to integrate behavioral health treatment that focuses on the family member's own issues into military TBI and PTSD systems of care.

En este estudio se analizó la satisfacción con la relación y la calidad de vida relacionada con la salud entre cónyuges cuidadores que asisten a miembros del servicio militar y veteranos con lesión cerebral traumática leve sin complicaciones concomitante con trastorno por estrés postraumático. Los cónyuges cuidadores (N=205) completaron el Índice de satisfacción de las parejas (Couples Satisfaction Index, CSI), la Encuesta de 12 ítems sobre la calidad de vida relacionada con la salud (12 HRQQL) y la Encuesta de Adaptabilidad Mayo-Portland 4.ª edición (Mayo-Portland Adaptability Inventory 4th Edition, MPAI-4). Los puntajes T se clasificaron en "clínicamente elevados" usando un valor de corte de ≥60T. La muestra también se clasificó en categorías de relaciones "satisfechas" (>13.5, n=113, 55.0%) o "insatisfechas" (<13.5, n=92, 44.0%). Utilizando un análisis de regresión paso a paso, se identificaron la ansiedad, la interrupción familiar, la vigilancia, el apoyo emocional, la sensación de estar atrapado y la adaptación de la MPAI-4 como los factores pronósticos más fuertes de los puntajes totales del CSI (p<.001), que representaron el 41.6% de la varianza. Las correlaciones semiparciales al cuadrado revelaron que el 18.1% de la varianza se compartió entre las seis medidas, con una varianza única de 7.8% a 1.5% representada por cada medida separadamente. Cuando se comparó el número de medidas clínicamente elevadas de manera simultánea, el grupo insatisfecho tuvo sistemáticamente un número más alto de puntajes clínicamente elevados en comparación con el grupo satisfecho (p. ej.: 3 o más puntajes clínicamente elevados: insatisfecho=40.2%, satisfecho=8.8%, OR=6.93, H=.76). cuidar a un miembro del servicio militar o a un veterano con lesión cerebral traumática leve y trastorno por estrés postraumático concomitantes puede afectar enormemente la calidad de vida relacionada con la salud del cónyuge cuidador, la satisfacción con la relación y el funcionamiento familiar. Los resultados del presente estudio continúan respaldando la necesidad de la participación familiar en el plan de tratamiento del miembro del servicio militar o veterano, pero se necesita más esfuerzo para integrar un tratamiento de salud conductual que se centre en los problemas propios del familiar en los sistemas de atención de militares con lesión cerebral traumática leve y trastorno por estrés postraumático.

The Association of Exposure to Military Sexual Trauma and Romantic Relationship Satisfaction Among Partnered Men Service Members/Veterans: The Influence of Compulsive Sexual Behavior.

Civilian literature shows a strong, consistent association between exposure to sexual violence and poor romantic relationship satisfaction. The impact of sexual violence that occurred during military service, or military sexual trauma (MST), on romantic relationship satisfaction among partnered men service members/veterans (SM/Vs) is understudied. However, a recent study conducted in women observed that MST that involved an assault was associated with poorer relationship satisfaction through higher sexual dysfunction and lower sexual satisfaction. The current study extended the literature by examining sexual function as a mediator of the association of exposure to MST and romantic relationship satisfaction among partnered men SM/Vs (N = 499). Participants completed self-report measures of MST exposure, romantic relationship satisfaction, erectile dysfunction, and compulsive sexual behavior, as well as a demographic inventory. The average score on relationship satisfaction was in the distressed range. Sixty-four participants (12.83%) reported MST exposure. MST exposure was related to lower relationship satisfaction through higher compulsive sexual behavior. The model explained 16% of the variance in relationship satisfaction. The indirect effect of erectile dysfunction was nonsignificant. Current findings are consistent with research in women SM/Vs: the association of MST and romantic relationship satisfaction appears to be indirect, through the effects of sexual function. Couples' therapy may be most effective if it addresses sexual health concerns among men MST survivors, particularly engagement in compulsive sexual behaviors. Due to low endorsement of MST that involved assault, the impact of MST severity could not be examined.

La bibliografía sobre los civiles indica una asociación fuerte y constante entre la exposición a la violencia sexual y la insatisfacción con la relación amorosa. El efecto de la violencia sexual sufrida durante el servicio militar, o el trauma sexual militar, en la satisfacción con la relación amorosa entre miembros o veteranos masculinos del servicio militar se ha estudiado muy poco. Sin embargo, en un estudio reciente realizado en mujeres se observó que el trauma sexual militar que implicó abuso estuvo asociado con una peor satisfacción con la relación mediante una mayor disfunción sexual y una menor satisfacción sexual. El presente estudio amplió la bibliografía analizando la función sexual como mediadora de la asociación de la exposición al trauma sexual militar y la satisfacción con la relación amorosa entre miembros o veteranos masculinos del servicio militar que están en pareja (N=499). Los participantes completaron medidas de autoinforme sobre la exposición al trauma sexual militar, la satisfacción con la relación amorosa, la disfunción eréctil y el comportamiento sexual compulsivo, así como un inventario demográfico. El puntaje promedio de la satisfacción con la relación estuvo en el rango de riesgo. Sesenta y cuatro participantes (el 12.83 %) informaron exposición al trauma sexual militar. La exposición al trauma sexual militar estuvo relacionada con una menor satisfacción con la relación mediante un mayor comportamiento sexual compulsivo. El modelo explicó el 16 % de la varianza en la satisfacción con la relación. El efecto indirecto de la disfunción eréctil no fue significativo. Los resultados actuales coinciden con la investigación sobre las mujeres integrantes o veteranas del servicio militar: la asociación del trauma sexual militar y la satisfacción con la relación amorosa parece ser indirecta, mediante los efectos de la función sexual. La terapia de pareja puede ser más eficaz si aborda las preocupaciones sobre la salud sexual entre los hombres sobrevivientes al trauma sexual militar, particularmente la práctica de comportamientos sexuales compulsivos. Debido a un bajo informe de trauma sexual militar que haya implicado abuso, no se pudo analizar el efecto de la intensidad del trauma sexual militar.

When Fathers Are Involved: Examining Relational and Psychosocial Health among Military Families.

Father involvement can promote the psychosocial health of family members (i.e., fathers, mothers, and children). However, the association between father involvement and individual members' psychosocial health may depend on the quality of the marital relationship and the perceptions of the reporting family member. Research with multiple reporters from the same family is needed identify how family members perceive the impact of father involvement on family member well-being. Using a risk and resilience theoretical framework applied to a family systems perspective, the current study examines associations between father involvement, family flexibility, marital quality, and psychosocial health with a sample of 207 military families (including fathers, mothers, and their adolescents). After accounting for military context, a conditional structural equation model was used to examine the associations between fathers' involvement and family members' psychosocial health. Family flexibility was examined as a mediator between these associations and marital quality as a moderator. Findings suggest that when fathers are more involved, both mothers and fathers report less family flexibility, and that family flexibility was positively associated with family member (father, mother, and adolescent) well-being. Further, father involvement was indirectly related to mothers' psychosocial health through family flexibility, and father involvement was directly associated with better psychosocial health for fathers and adolescents. Marital quality moderated these associations for fathers, mothers, and adolescents. Given the combined benefits of father involvement, family flexibility, and positive marital relationships, clinical efforts to provide information to increase knowledge and skills around maintaining a healthy relationship could serve to promote psychosocial health by improving marital quality and family flexibility.

La participación del padre puede promover la salud psicosocial de los miembros de la familia (p. ej.: padres, madres e hijos). Sin embargo, la asociación entre la participación del padre y la salud psicosocial individual de los miembros de la familia puede depender de la calidad de la relación conyugal y de las percepciones del miembro de la familia que informa. Se necesitan investigaciones con varios informantes de la misma familia para identificar cómo los miembros de la familia perciben el efecto de la participación del padre en el bienestar de los miembros de la familia. Utilizando un marco teórico de riesgo y resiliencia aplicado a una perspectiva de sistemas familiares, el presente estudio analiza las asociaciones entre la participación del padre, la flexibilidad familiar, la calidad conyugal y la salud psicosocial con una muestra de 207 familias de militares (incluidos los padres, las madres y sus adolescentes). Después de tener en cuenta el contexto militar, se utilizó un modelo condicional de ecuaciones estructurales para analizar las asociaciones entre la participación de los padres y la salud psicosocial de los miembros de la familia. Se analizó la flexibilidad familiar como mediadora entre estas asociaciones y la calidad conyugal como moderadora. Los resultados sugieren que cuando los padres participan más, tanto las madres como los padres informan menos flexibilidad familiar, y que la flexibilidad familiar estuvo asociada positivamente con el bienestar de los miembros de la familia (padre, madre y adolescente). Además, la participación de los padres estuvo indirectamente relacionada con la salud psicosocial de las madres mediante la flexibilidad familiar, y la participación de los padres estuvo asociada directamente con una mejor salud psicosocial en los padres y los adolescentes. La calidad conyugal moderó estas asociaciones en el caso de los padres, las madres y los adolescentes. Teniendo en cuenta los beneficios combinados de la participación del padre, la flexibilidad familiar y las relaciones conyugales positivas, los esfuerzos clínicos para proporcionar información a fin de ampliar el conocimiento y las habilidades en torno al mantenimiento de una relación saludable podrían servir para promover la salud psicosocial mejorando la calidad conyugal y la flexibilidad familiar.

"This is not your Life and it becomes your Life": A Qualitative Exploration of Deployment-related Stress and Support needs in National Guard and Reserve spouses who are Mothers of Young Children.

The adverse effects of deployment-related stress (DRS) on military service members, spouses, and children are well documented. Findings from a recent Consensus Report on Military Families by the National Academies of Science, Engineering, and Medicine (2019) underscore the priority of gaining a more comprehensive understanding of the diversity of today's military families and their needs and well-being. While social support is generally regarded as helpful during times of stress, it has not been studied extensively in National Guard/Reserve spouses who are parents of young children. This qualitative study of 30 women examines the unique ways in which DRS affects women who are National Guard/Reserve spouses and mothers of young children, as well as the processes through which they encountered support to manage these stressors. Salient themes spanned experiences involving deployment cycle phases of separation and reintegration and included both anticipated and unanticipated changes in family-related division of labor, dynamics, and communication patterns. These were complicated by geographic, social, and cultural isolation and misguided efforts to support spouses initiated by civilians. Women managed these stressors primarily through seeking, acquiring, and repurposing existing sources of informal social support for themselves and formal supports for their children, with varying degrees of success.

Los efectos adversos del estrés relacionado con la movilización militar en los miembros del servicio militar, las esposas y los niños están bien documentados. Los resultados de un informe de consenso reciente sobre las familias de militares realizado por las Academias Nacionales de Ciencias, Ingeniería y Medicina [National Academies of Sciende, Engineering and Medicine (2019)] subrayan la prioridad de comprender de una manera más completa la diversidad de las familias de militares en la actualidad y sus necesidades y bienestar. Si bien el apoyo social generalmente se considera útil durante los momentos de estrés, no se ha estudiado ampliamente en las esposas de integrantes de la Guardia Nacional o de la Reserva Militar que son madres de niños pequeños. Este estudio cualitativo de 30 mujeres analiza las maneras únicas en las cuales el estrés relacionado con la movilización militar afecta a las mujeres que son esposas de integrantes de la Guardia Nacional o la Reserva Militar y madres de niños pequeños, así como los procesos por los cuales encontraron apoyo para manejar esos factores desencadenantes de estrés. Los temas destacados abarcaron experiencias relacionadas con las fases de separación y reintegración del ciclo de movilización militar e incluyeron los cambios tanto previstos como imprevistos en la división de los patrones de trabajo, de dinámica y de comunicación relacionados con la familia. Estos se complicaron por el aislamiento geográfico, social y cultural y los esfuerzos equivocados que hicieron los civiles para apoyar a las esposas. Las mujeres manejaron estos factores desencadenantes de estrés principalmente mediante la búsqueda, la adquisición y la readaptación de fuentes existentes de apoyo social informal para ellas y de apoyo formal para sus hijos, con diversos grados de éxito.

Protective Buffering by Service Members During Military Deployments: Associations with Psychological Distress and Relationship Functioning.

To shield a romantic partner from potential distress due to stressors occurring during deployment, service members (SMs) may engage in protective buffering, or withholding information or concerns from a romantic partner. This study utilized data from 54 couples collected before, during, and after a military deployment to assess whether SMs engaged in protective buffering while deployed and the possible associations between buffering and psychological, relationship, and contextual factors. Only 2% of SMs indicated never engaging in protective buffering during a deployment. In bivariate analyses, only partners' psychological distress prior to deployment was significantly associated (negatively) with protective buffering. In multilevel models with time nested within individuals, and individuals nested within couples, higher buffering was associated with less partner distress during deployment, but was also associated with higher SM distress both during and after deployment. In these multilevel models, protective buffering was not significantly associated with SM or partner marital satisfaction.

Para proteger a una pareja romántica del posible distrés debido a factores desencadenantes de estrés que se producen durante la movilización militar, los miembros de las fuerzas armadas pueden adoptar una conducta de atenuación protectora u ocultar información o preocupaciones a una pareja romántica. El presente estudio utilizó datos de 54 parejas recopilados antes, durante y después de una movilización militar para evaluar si los miembros de las fuerzas armadas adoptaron una conducta de atenuación protectora mientras estaban movilizados y las posibles asociaciones entre la atenuación y los factores psicológicos, relacionales y contextuales. Solo el 2% de los miembros de las fuerzas armadas indicaron no haber adoptado nunca una conducta de atenuación protectora durante una movilización militar. En los análisis bivariables, solo el distrés psicológico de las parejas antes de la movilización militar estuvo asociado considerablemente (negativamente) con la atenuación protectora. En los modelos multinivel, con el tiempo localizado dentro de las personas y las personas localizadas dentro de las parejas, una mayor atenuación estuvo asociada con menos distrés de la pareja durante la movilización militar, pero también estuvo asociada con un mayor distrés de los miembros de las fuerzas armadas tanto durante como después de la movilización militar. En estos modelos multinivel, la atenuación protectora no estuvo asociada de forma significativa con la satisfacción conyugal de la pareja o del miembro de las fuerzas armadas.

Everything Here is Fine: Protective Buffering by Military Spouses During a Deployment.

To minimize potential distractions for deployed military service members (SMs), some nondeployed romantic partners have reported engaging in protective buffering, or intentionally withholding information or concerns to protect their deployed partner. This study assessed the associations of protective buffering and psychological distress and marital satisfaction for military couples during and after deployment. Additionally, the study explored whether protective buffering was related to SM reports of being distracted during deployment by family matters. A total of 54 couples provided data before, during, and after an Army deployment. In multilevel models, higher protective buffering by partners was associated with higher psychological distress and lower marital satisfaction for both SMs and partners during, but not after, deployment. Additionally, partners reported frequent use of protective buffering during deployment; however, protective buffering was not significantly correlated with family related distraction for SMs during deployment. Limitations and implications of these findings are discussed.

Para minimizar posibles distracciones para miembros del servicio militar (SM) desplegados, algunas parejas románticas no desplegadas han informado que practican la amortiguación protectora, es decir, ocultan información o preocupaciones intencionalmente para proteger a su pareja desplegada. Este estudio evaluó las asociaciones de amortiguación protectora y angustia psicológica y satisfacción conyugal para parejas militares durante y después del despliegue. Además, el estudio exploró si la amortiguación protectora tenía relación con informes de los SM de estar distraídos durante el despliegue por cuestiones familiares. Un total de 54 parejas proporcionó datos antes, durante y después de un despliegue del ejército. En modelos multinivel, una amortiguación protectora mayor por parte de las parejas se asoció a mayor angustia psicológica y menor satisfacción conyugal tanto para los SM como para las parejas durante, pero no después del despliegue. Además, los socios informaron el uso frecuente de amortiguación protectora durante un despliegue; sin embargo, la amortiguación protectora no tuvo una correlación significativa con la distracción por motivos familiares para los SM durante el despliegue. Se discuten las limitaciones e implicaciones de estos hallazgos.

Lower Sexual Satisfaction and Function Mediate the Association of Assault Military Sexual Trauma and Relationship Satisfaction in Partnered Female Service Members/Veterans.

Little is known about the association of military sexual trauma (MST) and relationship satisfaction among partnered female service members/veterans (SM/Vs). Extant civilian literature shows a strong association between sexual trauma and poorer relationship outcomes, and theory suggests that sexual function and satisfaction may mediate this association. Given that as many as 40% of female SM/Vs report MST and roughly half of female veterans are partnered and in their peak sexual years, it is critical to understand the association of MST, relationship satisfaction, sexual function, and sexual satisfaction in this population. Female SM/Vs (N = 817) completed a demographic inventory, self-report measures of MST, relationship satisfaction, sexual function, and sexual satisfaction. One hundred fifty-one (18.48%) participants did not experience MST. Three hundred eighty-eight (47.49%) reported that they experienced harassment-only MST, and 278 (34.03%) reported assault MST. At the bivariate level, lower relationship satisfaction was associated with lower sexual function and satisfaction with large effect sizes. Assault MST was associated with lower relationship satisfaction and sexual function and satisfaction with small-to-medium effect sizes. No differences in relationship satisfaction, sexual satisfaction, and function between those with harassment-only and no MST were observed. Mediation analyses demonstrated that lower sexual function and satisfaction mediated the association of assault MST and relationship satisfaction. Couples' therapy offered to SM/Vs with MST should screen for type of MST, sexual function, and satisfaction. Addressing the sequelae of MST and increasing sexual function and satisfaction in these partnerships may be critical treatment targets.

Se sabe muy poco acerca de la asociación del trauma sexual militar (TSM) y la satisfacción con la relación entre las mujeres militares/veteranas en pareja. La bibliografía existente sobre los civiles indica una asociación fuerte entre el trauma sexual y malos resultados en las relaciones, en consecuencia, la teoría sugiere que la disfunción sexual y la insatisfacción sexual pueden mediar esta asociación. Teniendo en cuenta que hasta el 40% de las mujeres veteranas informan TSM y que aproximadamente la mitad de las mujeres veteranas está en pareja y en el pico de sus años sexuales, es fundamental comprender la asociación del TSM, la satisfacción con la relación, la disfunción sexual y la insatisfacción sexual en esta población. Un grupo de mujeres militares/veteranas (N = 817) completaron una encuesta sobre datos demográficos, mediciones autoinformadas de TSM, satisfacción con la relación, función sexual y satisfacción sexual. Ciento cincuenta y una (18.48%) participantes no sufrieron TSM. Trescientas ochenta y ocho (47.49%) informaron que sufrieron TSM por acoso solamente, y 278 (34.03%) informaron TSM por agresión sexual. A nivel bivariado, una menor satisfacción con la relación estuvo asociada con una menor función y satisfacción sexual con mayores tamaños del efecto. El TSM por agresión sexual estuvo asociado con una menor satisfacción con la relación y la función y la satisfacción sexual con tamaños del efecto entre pequeños y medianos. No se observaron diferencias en la satisfacción con la relación, la satisfacción sexual y la función sexual entre aquellas con acoso solamente y ningún TSM. Los análisis de mediación demostraron que una menor función sexual y una menor satisfacción sexual mediaron la asociación del TSM por agresión sexual y la satisfacción con la relación. La terapia de pareja ofrecida a las veteranas con TSM debería detectar el tipo de TSM, la función sexual y la satisfacción sexual. Abordar las secuelas del TSM y reducir la disfunción y la insatisfacción sexual en estas asociaciones pueden ser objetivos fundamentales de tratamiento.

Identification of an Argentinean isolate of Spodoptera frugiperda granulovirus.

The fall armyworm, Spodoptera frugiperda (J.E. Smith) (Lepidoptera: Noctuidae), is an important maize pest. Due to the environmental impact and emergence of resistance caused by chemical pesticides and transgenic events, the use of baculoviruses becomes a safe and useful alternative for its control in integrated pest management strategies. Here we report the identification of a novel isolate of a granulovirus of S. frugiperda native to the central region of Argentina, named SfGV ARG. We observed that larvae infected with SfGV ARG showed a yellowish coloration, swollen body and, in some cases, severe lesions in the last abdominal segments. We confirmed the identity of the isolate by sequencing fragments of the lef-8, lef-9 and granulin genes and by calculating evolutionary distances using the Kimura-2-Parameter model. SfGV ARG DNA restriction pattern allowed to estimate a genome of at least 135 kb.

[German Military Families: A Qualitative Inquiry of Strategies of Coping with the Fathers' Absence]. / Kinder deutscher Soldatenfamilien: Qualitative Untersuchung zu Strategien im Umgang mit der Abwesenheit des Vaters.

German Military Families: A Qualitative Inquiry of Strategies of Coping with the Fathers' Absence Military families with experiences of deployment are subject to multiple stressors. In this research an explorative qualitative design was used to identify specific challenges, resources and strategies of coping within the families, focusing on the children's perspective. Results show that the fathers' absence causes vital changes in the family system, which demand specific strategies to deal with the abrupt emotional and social challenges. Four of these coping strategies will be presented in this article. Furthermore, resources embedded in the social environment as well as supportive structures provided by the German military will be discussed. Two hypotheses were formulated to outline the findings that the preparation for a deployment as well as patterns of communication about the father's absence are the most crucial factors for the children's resilience in the case of military families.

DEPLOYMENT STATUS: A DIRECT OR INDIRECT EFFECT ON MOTHER-CHILD ATTACHMENT WITHIN A CANADIAN MILITARY CONTEXT?

Research has suggested that military spouses experience increased depressive symptoms and parenting stress during a military member's deployment. A relationship between maternal depressive symptoms, parenting stress, and child attachment security has been found in the general population, as has an indication that social support may provide a buffering effect. While there appears to be an association between the emotional well-being of military spouses and child emotional well-being during deployment, data are limited regarding the association between maternal emotional well-being and child attachment security. The current study explores the association between deployment status and child attachment to the nonmilitary parent (i.e., the mother in this study) in a sample of 68 Canadian military families. Results revealed a significant impact of deployment status on maternal depressive symptoms and on quality of child attachment. The impact of deployment status on attachment was not mediated through the maternal variables, and despite a main effect of social support on the maternal variables, there was no moderating effect. Thus, our results suggest that deployment may affect child attachment independently of maternal well-being.

Relationship Education for Military Couples: Recommendations for Best Practice.

Military couples have a number of distinctive strengths and challenges that are likely to influence their relationship adjustment. Military couples' strengths include stable employment, financial security, and subsidized health and counseling services. At the same time, military couples often experience long periods of separation and associated difficulties with emotional disconnect, trauma symptoms, and reintegrating the family. This paper describes best practice recommendations for working with military couples, including: addressing the distinctive challenges of the military lifestyle, ensuring program delivery is seen as relevant by military couples, and providing relationship education in formats that enhance the accessibility of programs.

Pathways of Risk and Resilience: Impact of a Family Resilience Program on Active-Duty Military Parents.

Over the past decade, studies into the impact of wartime deployment and related adversities on service members and their families have offered empirical support for systemic models of family functioning and a more nuanced understanding of the mechanisms by which stress and trauma reverberate across family and partner relationships. They have also advanced our understanding of the ways in which families may contribute to the resilience of children and parents contending with the stressors of serial deployments and parental physical and psychological injuries. This study is the latest in a series designed to further clarify the systemic functioning of military families and to explicate the role of resilient family processes in reducing symptoms of distress and poor adaptation among family members. Drawing upon the implementation of the Families Overcoming Under Stress (FOCUS) Family Resilience Program at 14 active-duty military installations across the United States, structural equation modeling was conducted with data from 434 marine and navy active-duty families who participated in the FOCUS program. The goal was to better understand the ways in which parental distress reverberates across military family systems and, through longitudinal path analytic modeling, determine the pathways of program impact on parental distress. The findings indicated significant cross-influence of distress between the military and civilian parents within families, families with more distressed military parents were more likely to sustain participation in the program, and reductions in distress among both military and civilian parents were significantly mediated by improvements in resilient family processes. These results are consistent with family systemic and resilient models that support preventive interventions designed to enhance family resilient processes as an important part of comprehensive services for distressed military families.

Defining military sexual trauma: establishing parameters and perspectives.

Background: The term military sexual trauma [MST] is increasingly used to describe instances of sexual harassment/assault that occur between serving personnel during military service. However, in the absence of a clear universal definition, MST is an increasingly contested term, with confusion about its scope, application to differing jurisdictions and implications for responses and treatment.Objective: This editorial provides a universal definition of MST, decoupled from any national system or framework.Method: Drawing on existing international evidence about the nature and impact of MST.Results and Conclusion: We argue that MST terminology provides a unique framing which recognises the institutional nature of MST victimisation and situates the context, behaviours, and impact on a continuum of violence.

MST terminology provides understanding and acknowledgement of the nuances of sexual harassment/assault in the military institution.MST terminology should encompass a continuum of sexual violence.Drawing on existing military health research, the authors contend that MST should be considered as a distinctive traumatic stressor.

Mental healthcare utilisation among Danish formerly deployed military personnel and their civilian counterparts: a cohort study.

Background: Prior studies comparing the mental healthcare utilisation (MHU) of Danish formerly deployed military personnel (FDP) with the general population have not included data on psychotherapy through the Defence or talking therapy with the general practitioner. This study included these and several other data sources in a comprehensive comparison of MHU between Danish FDP and civilians.Methods: First-time deployed military personnel (N = 10,971) who had returned from a mission to Kosovo, Afghanistan, Iraq or Lebanon between January 2005 and July 2017 were included. A sex and birth-year-matched civilian reference group was randomly drawn from the entire Danish non-deployed population (N = 253,714). Furthermore, a sub-cohort, including male FDP and civilians deemed eligible for military service, was defined. These cohorts were followed up in military medical records and registers covering the primary and secondary civilian health sectors from 2005 to 2018, and the rates of MHU were compared.Results: Approximately half of the initial help-seeking for FDP took place through the Defence (49.4%), and the remainder through the civilian healthcare system. When help-seeking through the Defence was not included, MHU was significantly lower among FDP in the main cohort during the first two years (IRR = 0.84, 95% CI: [0.77, 0.92]) compared to civilians. When help-seeking through the Defence was included, MHU was significantly higher among FDP compared to civilians both in the first two years of follow-up (IRR = 2.01, 95% CI: [1.89, 2.13]) and thereafter (IRR = 1.18, 95% CI: [1.13, 1.23]). In the sub-cohort, these differences were even more pronounced both in the first two years of follow-up and thereafter.Conclusions: MHU was higher among Danish FDP compared to civilians only when data from the Defence was included. The inclusion of data on both civilian and military healthcare services is necessary to evaluate the full impact of deployment on MHU among Danish FDP.

This study compared mental healthcare utilisation among Danish deployed military personnel and civilians.Most personnel sought help first through the Defence.When all data sources were included, mental healthcare utilisation was significantly higher among military personnel.

[Translated article] Return to full duty after anterior cruciate ligament reconstruction surgery in military personnel: A meta-analysis.

OBJECTIVE: A meta-analysis was carried out to evaluate the clinical-functional results of anterior cruciate ligament surgery in military population, as well as the complications associated with it. MATERIAL AND METHOD: Three major database sources up to December 2022 (PubMed, Google Scholar, and ScienceDirect) were searched for outcomes after anterior cruciate ligament surgery in military personnel. The systematic review was carried out following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses -PRISMA- standards, and the inclusion criteria following the PICO strategy. Data from included studies were analysed using Review Manager 5.4 software. RESULTS: A total of seven retrospective studies were selected. The general rate of return to full duty in military personnel was 62.3% (61.5% for the non-officer group versus 68.3% for the officer group) without this difference being significant (p=0.92). The general rate of meniscal injury in the military was 58.8%, without this difference being significant (p=0.88). The homogeneity in both cases was good (I2=0%, p=0.99). CONCLUSION: Return to full military duty can be used in the military population as a marker of success after anterior cruciate ligament reconstruction. It should be noted that a large number of military personnel experience permanent activity limitations that prevent full return to service.

Return to full duty after anterior cruciate ligament reconstruction surgery in military personnel: A meta-analysis. / Retorno a la actividad completa tras cirugía de reconstrucción de ligamento cruzado anterior en personal militar: metaanálisis.

OBJECTIVE: A meta-analysis was carried out to evaluate the clinical-functional results of anterior cruciate ligament surgery in military population, as well as the complications associated with it. MATERIAL AND METHOD: Three major database sources up to December 2022 (PubMed, Google Scholar, and ScienceDirect) were searched for outcomes after anterior cruciate ligament surgery in military personnel. The systematic review was carried out following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses -PRISMA- standards, and the inclusion criteria following the PICO strategy. Data from included studies were analyzed using Review Manager 5.4 software. RESULTS: A total of 7 retrospective studies were selected. The general rate of return to full duty in military personnel was 62.3% (61.5% for the non-officer group vs. 68.3% for the officer group) without this difference being significant (p=0.92). The general rate of meniscal injury in the military was 58.8%, without this difference being significant (p=0.88). The homogeneity in both cases was good (I2=0%, p=0.99). CONCLUSION: Return to full military duty can be used in the military population as a marker of success after anterior cruciate ligament reconstruction. It should be noted that a large number of military personnel experience permanent activity limitations that prevent full return to service.

Male sex and hazardous alcohol use following military sexual assault increase suicide risk among US service members and veterans.

Background: Higher alcohol use and military sexual assault (MSA) are associated with increased risk of death by suicide. Risk for death by suicide is rapidly increasing among females, who report higher rates of MSA, yet actual death by suicide and alcohol use are higher among males. It is not well understood whether higher alcohol use confers greater suicide risk in male or female service members and veterans who have experienced MSA.Objective: To determine whether the association between alcohol misuse and suicide risk was moderated by biological sex in a sample of male and female service members (N = 400, 50% female) who reported MSA.Method: Participants completed surveys of alcohol use and suicide risk as well as a demographic inventory. Linear regression with an interaction term was used to determine if suicide risk differed by sex and alcohol use severity after accounting for discharge status, sexual orientation, and age.Results: Average scores on the suicide risk measure were consistent with an inpatient psychiatric sample and scores on the AUDIT-C were indicative of a probable positive screen for alcohol misuse. Suicide risk was most pronounced among males who reported higher levels of hazardous alcohol use. A sensitivity analysis examining suicide risk by sex and screening results for alcohol misuse (positive/negative) showed that men with a probable positive screen had higher suicide risk.Discussion: The current study provides novel findings on suicide risk among survivors of military sexual violence by including both male and female survivors. Interventions to decrease suicide risk following MSA may consider alcohol reduction strategies, and optimizing these interventions in males. Engaging military culture at both the US Departments of Defense and Veterans Affairs to encourage more healthy alcohol consumption may mitigate this public health concern. Future research may consider how country of origin relates to these associations.

Average scores for the suicide risk measure and alcohol use were high among a sample of male and female survivors of military sexual assault.Suicide risk was most pronounced among males who reported higher levels of hazardous alcohol use.A sensitivity analysis examining suicide risk by sex and screening results for alcohol misuse (positive/negative) showed that men with a probable positive screen had higher suicide risk.

The nature and impacts of deployment-related encounters with children among Canadian military Veterans: a qualitative analysis.

Background: As armed conflict grows increasingly complex, the involvement of children in armed violence across diverse roles is rising. Consequently, military personnel are more likely to encounter children during deployment. However, little is known about deployment-related encounters with children and their impact on the mental health of military personnel and Veterans.Objective: This study qualitatively examines the nature and impacts of deployment-related encounters with children.Methods: We conducted semi-structured interviews with 16 Canadian Armed Forces Veterans, eliciting rich information on the nature of child encounters on deployment, the psycho-social-spiritual impacts of these encounters, and perceptions of support. Interview transcripts were analysed using thematic analysis.Results: Six primary themes were identified: types of encounters (i.e. factual aspects of deployment-related encounters with children), contextual factors (i.e. aspects of the mission, environment, and personal context relevant to one's experience of the encounter), appraisals of encounters (i.e. sensory or sense-making experiences relevant to the encounter), impacts of encounters (i.e. psycho-social, existential, and occupational impacts), coping strategies engaged in both during and after deployment, and support experiences, describing both formal and informal sources of support.Conclusions: Encounters with children are diverse and highly stressful, resulting in impacts pertinent to mental health, including psychological and moral distress, and difficulties with identity, spirituality, and relationships. These impacts are prompted by complex interactions among appraisals, expectations of morality, cultural norms, and professional duties and are amplified by various personal factors (e.g. childhood maltreatment history, parenthood), feelings of unpreparedness, and lack of post-deployment support. Implications for prevention, intervention, and policy are discussed with the aim of informing future efforts to safeguard and support military personnel facing a high likelihood of encounters with children.

Deployment-related encounters with children result in diverse impacts, including psychological and moral distress, along with disruptions in identity, spirituality, and interpersonal relationships.Encounters with children during military deployments are diverse and highly stressful, characterized by complex interactions among appraisals and expectations of morality, cultural norms, and professional duties.Emphasis on feeling unprepared for encounters with children highlights the need for future efforts to safeguard and support military personnel facing such situations.

Characterization of wound infections among patients injured during the Ruso-Ukrainian war in a Role 4 hospital.

INTRODUCTION: The management of infections in war wounds is a problem aggravated by the presence of multiresistant bacteria and requires a combined approach with surgery. Literature has identified the risks and patterns of antibiotic resistance in previous armed conflicts, but the Russian-Ukrainian conflict has required the study of specific bacterial resistance patterns. METHODS: We included war-injured patients from the Russian-Ukrainian conflict transferred for treatment to the General Defense Hospital of Zaragoza from May 2022 to October 2023. Epidemiological data, factors related to the injury, presence of infection and microbiological results were collected; These data were subsequently analyzed statistically. RESULTS: Fifty-three patients were included in the study, with a mean age of 35.6 years; 83% were injured by an explosive mechanism and all received antibiotic therapy prior to transfer. Seventeen patients had skin, soft tissue or joint infection. Correlation was demonstrated with the presence of bone lesion (p 0.03), skin coverage defect (p 0.000) and presence of foreign bodies (p 0.006). Nine patients had monomicrobial cultures, and the most frequently isolated microorganisms were Gram negative bacilli (GNB) and Staphylococcus aureus. Virtually all GNB presented some resistance mechanism. CONCLUSION: Our work shows the correlation of war wound infection with the presence of foreign bodies and affected tissues. Likewise, the presence of polymicrobial wounds is emphasized, with a predominance of GNB and multidrug-resistant S. aureus.

Cognitive-behavioural conjoint therapy versus prolonged exposure for PTSD in military service members and veterans: results and lessons from a randomized controlled trial.

Military personnel and veterans are at heightened risk for exposure to traumatic events and posttraumatic stress disorder (PTSD), as well as intimate relationship problems associated with PTSD.The purpose of this study was to evaluate the relative efficacy of CBCT and PE in improving intimate relationship functioning in active duty military personnel or veterans and their intimate partners; both conditions were hypothesized to significantly improve PTSD. Method: In this study, 32 military service members or veterans with PTSD and their intimate partners were randomized to receive either Cognitive-Behavioral Conjoint Therapy for PTSD (n = 15; CBCT; [Monson, C. M., & Fredman, S. J. (2012). Cognitive-behavioral conjoint therapy for posttraumatic stress disorder: Harnessing the healing power of relationships. Guilford]), a trauma-focused couple therapy, or Prolonged Exposure (n = 17; PE; [Foa, E. B., Hembree, E. A., Dancu, C. V., Peterson, A. L., Cigrang, J. A., & Riggs, D. S. (2008). Prolonged exposure treatment for combat-related stress disorders - provider's treatment manual [unpublished]. Department of Psychiatry, University of Pennsylvania]), a front-line evidence-based individual treatment for PTSD.There were significant challenges with recruitment and a significant difference in dropout from treatment for the two therapies (65% for PE; 27% for CBCT). Treatment dropout was differentially related to pre-treatment relationship functioning; those with below average relationship functioning had higher dropout in PE compared with CBCT, whereas those with above average relationship functioning did not show differential dropout. In general, CBCT led to relational improvements, but this was not consistently found in PE. Clinician- and self-reported PTSD symptoms improved with both treatments.This study is the first to test a couple or family therapy against a well-established, front-line recommended treatment for PTSD, with expected superiority of CBCT over PE on relationship outcomes. Lessons learned in trial design, including considerations of equipoise, and the effects of differential dropout on trial analyses are discussed. This trial provides further support for the efficacy of CBCT in the treatment of PTSD and enhancement of intimate relationships.

Differential dropout from trial of couple versus individual therapy for PTSD.General pattern of improvements in relationship outcomes in couple therapy for PTSD.PTSD symptoms improved in the individual and couple therapy for PTSD.Lessons learned in trial design, including considerations of equipoise, and the effects of differential dropout by condition on trial analyses are discussed.