Changes in life patterns and symptoms of low mood as reported by wives of severely brain-injured soldiers.

Tested hypotheses that (a) wives of brain-injured veterans would perceive greater changes in their family life 1 yr following their husbands' injury than wives of paraplegic veterans and (b) wives of brain-injured veterans would report more symptoms indicative of low mood than wives of paraplegics and controls. 27 Israeli wives (mean age, 26 yrs) whose husbands had fought in the Yom Kippur War 1 yr earlier responded to questions assessing family life, family interpersonal relations, marital roles, and disturbances in mood. Eight Ss had brain-injured husbands; 5 Ss had paraplegic husbands; and 14 Ss had uninjured husbands. Data support both hypotheses. Significant differences between groups appeared in each of the 4 major areas. It is suggested that future research consider "good adjustment" to the postwar return of paraplegic or brain-injured husbands. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Together in pain: Attachment-related dyadic processes and posttraumatic stress disorder.

We used actor–partner interdependence modeling to explore associations among attachment-related dyadic processes, posttraumatic stress disorder (PTSD) in war veterans, and secondary traumatic stress (STS) in their wives. A sample of 157 Israeli couples (85 former prisoners of war and their wives and a comparison group of 72 veterans not held captive and their wives) completed self-report scales assessing attachment insecurities (anxiety, avoidance) and PTSD symptoms. For both groups of veterans and their wives, attachment anxiety was associated with the severity of their own and their spouses' PTSD and STS. Avoidant attachment was associated with PTSD and STS only in couples that included a former prisoner of war. A complex pattern of associations involving avoidant attachment was observed in the actor–partner analyses of these couples. The study demonstrates that attachment-related dyadic processes play a role in the development and maintenance of PTSD in traumatized veterans and STS in their wives. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Family and couples treatment for newly returning veterans.

Civilian psychologists are being called on to assist the thousands of service members returning from Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF). Newly returning veterans are at risk for depression, posttraumatic stress disorder, and alcohol use disorders. In addition, veteran partners and families are at increased risk for stress and conflict. The following article provides clinicians with information on the impact of military service on the veteran and the family, then reviews ongoing family services available to veterans through the Veterans Health Administration (VHA). Finally, we describe recovery-oriented implications for practicing psychologists when treating veterans and their families. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Problems in families of male Vietnam veterans with posttraumatic stress disorder.

Interviews were conducted with a nationally representative sample of 1,200 male Vietnam veterans and the spouses or coresident partners of 376 of these veterans. The veteran interview contained questions to determine the presence of posttraumatic stress disorder (PTSD) and items tapping family and marital adjustment, parenting problems, and violence. The spouse or partner (S/P) interview assessed the S/P's view of these items, as well as her view of her own mental health, drug, and alcohol problems and behavioral problems of school-aged children living at home. Compared with families of male veterans without current PTSD, families of male veterans with current PTSD showed markedly elevated levels of severe and diffuse problems in marital and family adjustment, in parenting skills, and in violent behavior. Clinical implications of these findings are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Adjustment differences among male substance abusers varying in degree of combat experience in Vietnam.

Tested C. R. Figley's (1978) hypothesis that combat veterans will evidence more indications than will noncombat veterans of such posttraumatic stress reactions as sleep disturbances, emotional numbing, social withdrawal, and difficulties in controlling anger. 87 combat and 120 noncombat veterans seeking treatment for substance abuse were compared on demographic, family, and military variables; ratings on Figley's postmilitary problems list; traditional measures of personality (e.g., the MMPI); and childhood and present family environment scales. In combat–noncombat comparisons, combat Ss rated significantly more stress responses as problems than did noncombat Ss. Support for Figley's hypothesis was even stronger when comparing heavy with light combat-experienced Ss. Results strongly support contentions that stress responses persist long after combat experiences, that a subcategory of stress reactions may exist among some substance abusers, and that more specific and sensitive measures of stress reactions are needed beyond traditional measures of personality and environment. (11 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Distress in spouses of service members with symptoms of combat-related PTSD: Secondary traumatic stress or general psychological distress?

Combat-related posttraumatic stress disorder (PTSD) is linked with elevated psychological distress in service members'/veterans' spouses. Researchers use a variety of terms to describe this distress, and recently, secondary traumatic stress and secondary traumatic stress disorder (STS/STSD) have become increasingly commonly used. Although STS/STSD connotes a specific set of symptoms that are linked to service members'/veterans' symptoms, researchers often use general measures of distress or generically worded measures of PTSD symptoms to assess STS/STSD. To determine how often scores on such measures appear to be an accurate reflection of STS/STSD, we examined responses to a measure of PTSD symptoms in 190 wives of male service members with elevated levels of PTSD symptoms. Wives rated their own PTSD symptoms, and then answered questions about their attributions for the symptoms they endorsed. Fewer than 20% of wives who endorsed symptoms on the PTSD measure attributed these symptoms completely to their husbands' military experiences. Moreover, compared with wives who attributed symptoms only to events in their own lives, wives who attributed symptoms completely or partially to their husbands' military experiences had a greater overlap between some of their responses on the PTSD measure and their responses to a measure of general psychological distress. These results suggest that most wives of service members/veterans with PTSD experience generic psychological distress that is not conceptually consistent with STS/STSD, although a subset does appear to endorse a reaction consistent with this construct. Implications of these findings for intervention and research with this vulnerable population are discussed. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

An examination of family adjustment among Operation Desert Storm veterans.

This study examined interrelationships among combat exposure, symptoms of posttraumatic stress disorder (PTSD), and family adjustment in a sample of male and female Operation Desert Storm veterans (N = 1,512). In structural equation models for both male and female veterans, higher combat exposure was associated with higher PTSD symptoms, which in turn were associated with poorer family adjustment, although these indirect effects did not reach statistical significance. The model for female veterans evidenced a significant direct negative association between combat exposure and family adjustment when it statistically accounted for PTSD symptoms. When the relative impacts of separate PTSD symptom groupings were examined, those reflecting withdrawal/numbing symptoms and arousal/lack of control symptoms significantly and indirectly accounted for the negative effects of combat exposure on family adjustment. Study findings indicate a number of possible pathways through which war-zone deployments negatively impact military families and suggest several avenues for future research. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Key factors involved in engaging significant others in the treatment of Vietnam veterans with PTSD.

In an effort to be responsive to the often complicated, multilayered family issues of people living with posttraumatic stress disorder, many well-intentioned therapists create a variety of family-based services--only to be discouraged when participation is very low. In the current project, 10 Vietnam veterans with posttraumatic stress disorder who were active in a stress recovery program and their live-in female partners completed separate semistructured interviews. Interviews explored each couple's perceptions about family participation in mental health treatment, including potential benefits and barriers. Findings revealed 9 key themes that elucidate many of the important issues in family engagement. The authors make 7 recommendations about how clinicians can overcome some of the possible obstacles to involving families in care. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Adult family members and their resemblance of coronary heart disease risk factors: the Cardiovascular Disease Study in Finnmark

Coronary heart disease tends to run in families, and the familial resemblance of major risk factors for the disease was examined among various types of adult family members. Family units were assembled from a total of 4,738 men and women who took part in a cross sectional health survey in four Norwegian municipalities where all inhabitants between 20 and 52 years of age were invited. After adjusting for age and other confounders, correlation coefficients were derived as a measure of the degree of resemblance. Viewed across all types of investigated familial relationships, similarity was found to be stronger for total cholesterol than for high-density lipoprotein cholesterol and triglycerides, and also stronger for systolic than for diastolic blood pressure. Between husbands and wives (3,060 subjects), correlations were small (between 0.02 and 0.06), except for 0.11 for total cholesterol. Lipid and blood pressure correlations ranged from 0.13 to 0.27 for parents and their offspring (471 subjects, p < 0.05) and from 0.11 to 0.22 among siblings (2,166 subjects, p < 0.01). Sibling correlations were consistent across age groups. Furthermore, reports from each individual on daily smoking (yes or no) revealed that husbands and wives had similar habits in 63.5% of all marriages as compared with the expected 49.4% had no smoking similarity at all been present. Smoking concordance was also demonstrated among siblings (p < 0.01). The persistent pattern of lipid and blood pressure aggregation among genetically related individuals from 20 to 52 years of age and the much weaker such similarity between husbands and wives, point towards genes or commonly shared environment at early ages as a major reason why coronary heart disease runs in families.     

Adapting the multifamily group model to the Veterans Affairs system: The REACH Program.

[Correction Notice: An erratum for this article was reported in Vol 41(4) of Professional Psychology: Research and Practice (see record 2010-17073-006). The copyright for this article was incorrectly listed. This article is in the Public Domain. The online version has been corrected.] The Oklahoma City Veterans Affairs (VA) Medical Center modified an evidence-based model of family psychoeducation (the multifamily group model; McFarlane, 2002) and implemented it for the first time in a VA setting and with veterans living with posttraumatic stress disorder (PTSD). Named the REACH Program (Reaching out to Educate and Assist Caring, Healthy Families), the 3-phase program begins with 4 weekly “joining sessions” with the individual veteran and his/her family focused on rapport building, assessment, and goal setting. Phase II consists of 6 weekly diagnosis-specific educational/support sessions for cohorts of 4 to 6 veterans and their families. In Phase III, veterans/families attend 6 monthly multifamily groups to support the maintenance of gains. This article describes the rationale for modifying the original Multifamily Group Program (MFG) for a unique setting (the VA) and the needs of families of veterans in a new diagnostic group (PTSD). The changes to the MFG curriculum are specifically described, and details of the new REACH intervention are explained. Attendance, retention, and satisfaction data for 2 diagnostic cohorts, PTSD and affective disorders, are also presented. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Family health and mental health six years after economic stress and unemployment

This study is a follow-up of 39 working class couples who were interviewed after suffering economic stress or unemployment and again six years later. Repeated measures related to economics, stress, family functioning, anxiety, and depression were collected and analyzed for couples and for husbands and wives separately. A model of long-term coping was suggested for future testing. Initially stressed families appeared to grow stronger. Mental health correlated negatively to family problems. Depressed wives seemed to maintain their depression over time if they perceived family life as stressful. Irrespective of marital problems, husbands were less likely to stay depressed.     

Correction to Sherman et al. (2009).

Reports an error in "Adapting the multifamily group model to the Veterans Affairs system: The REACH Program" by Michelle D. Sherman, Ellen P. Fischer, Kristen Sorocco and William R. McFarlane (Professional Psychology: Research and Practice, 2009[Dec], Vol 40[6], 593-600). The copyright for this article was incorrectly listed. This article is in the Public Domain. The online version has been corrected. (The following abstract of the original article appeared in record 2009-23462-008.) The Oklahoma City Veterans Affairs (VA) Medical Center modified an evidence-based model of family psychoeducation (the multifamily group model; McFarlane, 2002) and implemented it for the first time in a VA setting and with veterans living with posttraumatic stress disorder (PTSD). Named the REACH Program (Reaching out to Educate and Assist Caring, Healthy Families), the 3-phase program begins with 4 weekly “joining sessions” with the individual veteran and his/her family focused on rapport building, assessment, and goal setting. Phase II consists of 6 weekly diagnosis-specific educational/support sessions for cohorts of 4 to 6 veterans and their families. In Phase III, veterans/families attend 6 monthly multifamily groups to support the maintenance of gains. This article describes the rationale for modifying the original Multifamily Group Program (MFG) for a unique setting (the VA) and the needs of families of veterans in a new diagnostic group (PTSD). The changes to the MFG curriculum are specifically described, and details of the new REACH intervention are explained. Attendance, retention, and satisfaction data for 2 diagnostic cohorts, PTSD and affective disorders, are also presented. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Coping with illness: Interrelationships across family members and predictors of psychological adjustment.

This study examined coping in families in which there was a chronically ill parent. Husbands, wives, and one child (aged 7–18 yrs) from 75 families in which the husband had hemophilia participated. Coping styles and psychological adjustment were assessed, and patterns of coping among family members were examined. Avoidant coping was associated with poorer adjustment for all family members. In addition, the coping style of one family member was found to be related to the psychological adjustment of other family members. Avoidant coping by one spouse related to poorer psychological functioning in the other spouse, and avoidant coping by either parent related to greater child adjustment problems for girls and boys. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Job transfer and well-being.

Investigated the relationship between job transfer mobility and well-being of 350 mobile male employees (aged 25–60 yrs), their wives, and their children. Ss, all of whom had been transferred domestically by a US corporation, were compared with 3 samples drawn from the 1977 Quality of Employment Survey, the 1978 Quality of American Life Survey, and the 1976 Mental Health Survey. Ss were assessed on variables of work, self, marriage and family life, friendships, and standard of living. The major finding, repeated across aspects of well-being, was that there were few differences between more and less mobile and stable Ss. Mobile Ss and their wives were more satisfied with their lives, families, and marriages than were stable Ss and their wives; however, mobile Ss and their wives were less satisfied with social relationships. Moving created problems for children, but there was little evidence that mobility was related to lasting social integration problems. (31 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Multifamily group treatment for veterans with traumatic brain injury.

A common clinical problem encountered by clinicians treating veterans who incurred traumatic brain injury (TBI) while serving in Afghanistan in support of Operation Enduring Freedom (OEF) or in Iraq in support of Operation Iraqi Freedom (OIF) is lack of knowledge about TBI on the part of the veterans' family members. Insufficient information can exacerbate marital or family conflict and lead to psychological distress and social isolation for the veteran and family, and suboptimal illness management for the veteran. To address this problem, we adapted Multifamily Group Treatment (MFGT), an evidence-based practice for treatment of serious mental illness (SMI), for treatment of OEF/OIF veterans with TBI and their families. We have implemented the adapted treatment (MFG-TBI) in four groups of veterans and families (N = 20 veterans and 20 family members) across two sites: the Durham VA Medical Center (VAMC) in North Carolina and the JJ Peters VAMC in the Bronx, New York. Adaptations focused on contents and format of the educational components, specification of a protocol for conjugal couples, and the addition of an ecomap to identify support systems during the joining (i.e. assessment) phase, a shorter (9 months) intervention duration, and a more active clinician role including use of motivational enhancement, intersession support, and coordination with other service providers. Biweekly group sessions were supervised and rated for adherence. We illustrate how MFG-TBI both educates and builds problem-solving skills with clinical examples. Suggestions for effective use of problem-solving skills with this population are offered. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

The perception of social-environmental characteristics in kibbutz families with family-based and communal sleeping arrangements.

Compared the perception of social-environmental characteristics in 38 families from kibbutzim with family-based sleeping arrangements (FBA) with those of 47 families from kibbutzim with communal sleeping arrangements (CA), using the Family Environment Scale—Form R. In the FBA families, the mean age of fathers was 42.2 yrs and of mothers, 37.9 yrs. The 38 children of these families were primarily in Grades 5 and 6. In the CA families, the mean age of fathers was 42.1 yrs and of mothers 38.6 yrs. Their 47 children were also primarily in Grades 5 and 6. Significant differences were obtained between the family profiles of the 2 groups. FBA families were higher in cohesion and expressiveness than were CA families. FBA families were also lower in active-recreational orientation and organization. In both groups of families, there were no differences in the perception of family climate between the husbands and wives, whereas children's perceptions differed significantly from those of their parents. (35 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Longitudinal analyses of family functioning in veterans and their partners across treatment.

Objective: This study evaluated the relations between posttraumatic stress disorder (PTSD) symptoms and poor family functioning in veterans and their partners. Method: Data were collected from Caucasian veterans with PTSD (N = 1,822) and their partners (N = 702); mean age = 53.9 years, SD = 7.36. Veterans completed the Posttraumatic Checklist Military Version (PCL-M) and, along with their partners, completed the McMaster Family Assessment Device (FAD-12). Assessments were conducted at intake into a treatment program at 3 months and 9 months posttreatment. Results: Structural equation models (SEMs) were developed for veterans as well as for veterans and their partners. Poor family functioning for veterans at intake predicted intrusion (β = .08), hyperarousal (β = .07), and avoidance (β = .09) at 3 months posttreatment. At 3 months posttreatment, family functioning predicted hyperarousal (β = .09) and avoidance (β = .10) at 9 months. For veterans and their partners, family functioning at intake predicted avoidance (β = .07) at 3 months, and poor family functioning at 3 months predicted intrusion (β = .09) and hyperarousal (β = .14) at 9 months. The reverse pathways, with PTSD symptoms predicting poor family functioning, were only evident with avoidance (β = .06). Conclusion: Family functioning may play a role in treatment for veterans. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Prewar factors in combat-related posttraumatic stress disorder: Structural equation modeling with a national sample of female and male Vietnam veterans.

Structural equation modeling was used to examine relationships among prewar factors, dimensions of war-zone stress, and current posttraumatic stress disorder (PTSD) symptomatology using data from 1,632 female and male participants in the National Vietnam Veterans Readjustment Study (R. A. Kulka et al; 1990). For men, previous trauma history (accidents, assaults, and natural disasters) directly predicted PTSD and also interacted with war-zone stressor level to exacerbate PTSD symptoms for high combat-exposed veterans. Male veterans who entered the war at a younger age displayed more symptoms. Family instability, childhood antisocial behavior and age had indirect effects on PTSD for men. For women, indirect prewar effects emanated from family instability. More attention should be given to critical developmental conditions, especially family instability and earlier trauma exposure, in conceptualizing PTSD in adults. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Veteran interest in family involvement in PTSD treatment.

[Correction Notice: An erratum for this article was reported in Vol 7(3) of Psychological Services (see record 2010-17074-004). The copyright for the article was listed incorrectly. This article is in the Public Domain. The online version has been corrected.] The present study examined interest in family involvement in treatment and preferences concerning the focus of family oriented treatment for veterans (N = 114) participating in an outpatient Veterans Affairs outpatient posttraumatic stress disorder (PTSD) program. Most veterans viewed PTSD as a source of family stress (86%) and expressed interest in greater family involvement in their treatment (79%). These results suggest the need to consider increasing family participation in the clinical care of individuals with PTSD and to develop specialized family educational and support services for this population. (PsycINFO Database Record (c) 2010 APA, all rights reserved)