Examining veterans' preferences for how to deliver couples-based treatments for posttraumatic stress disorder: Home-based telehealth or in-person?

Understanding the modality by which veterans prefer to receive couples-based posttraumatic stress disorder (PTSD) treatment (i.e., home-based telehealth, in-person) may increase engagement in PTSD psychotherapy. This study aimed to understand veterans' preferred modality for couples-based PTSD treatments, individual factors associated with preference, and reasons for their preference. One hundred sixty-six veterans completed a baseline assessment as part of a clinical trial. Measures included a closed- and open-ended treatment preference questionnaire, as well as demographics, clinical symptoms, functioning, and relational measures, such as relationship satisfaction. Descriptive statistics and correlations examined factors associated with preference. An open-ended question querying veterans' reasons for their preferred modality was coded to identify themes. Though veterans as a group had no clear modality preference (51% preferring home-based telehealth and 49% preferring in-person treatment), veterans consistently expressed high levels of preference strength in the modality they chose. The presence of children in the home was associated with stronger preference for home-based telehealth. Veterans who preferred in-person care found it to be more credible and had more positive treatment expectancies. Veterans who preferred home-based telehealth believed it was flexible and increased access to care. For both preference groups, veterans' preferred modality was viewed as facilitating interpersonal relations and being more comfortable than the alternative modality. Veterans expressed strong preference for receiving their desired treatment modality for couples-based PTSD treatment. Results suggest that it is important to offer multiple treatment delivery options in couples-based PTSD treatment and matching couples to their preferred modality supports individualized, patient-centered care. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

The role of veterans' PTSD symptoms in veteran couples' insomnia

Insomnia contributes to individual mental and physical health and relationship well-being. Veterans' PTSD symptoms are associated with their own insomnia. However, research has not explored whether and how veterans' PTSD symptoms are associated with their partners' insomnia. The present study examined the association between veterans' PTSD symptom severity and veterans' and partners' insomnia. Veterans (n = 192) and their partners (n = 192; total N = 384) completed baseline assessments in a PTSD treatment study for veterans with PTSD and their partners. Path analysis was used to examine the relation between veterans' PTSD symptom severity, as measured by the PTSD symptom checklist-5 (PCL-5) and veterans' and partners' insomnia, as measured by the Insomnia Severity Index (ISI). Veterans' full-scale PCL-5 was positively related to veterans' and partners' insomnia. For veterans, intrusion and arousal symptoms were positively related to their own insomnia severity, while veterans' negative alterations in cognition and mood were associated with partners' insomnia severity. In exploratory analyses, partners' depressive symptoms fully mediated the relation between veterans' negative cognitions and mood and partners' insomnia. PTSD symptoms impact both veterans' and partners' insomnia. However, different PTSD symptom clusters were related to insomnia for each partner, and the link for partners was explained by their own depression symptoms. PTSD, insomnia, and integrated treatments should consider strategies for including partners in treatment to address these interconnected problems.

VA family service access and utilization in a national sample of veterans

Relationship and family difficulties are common experiences for military veterans, who are able to access family services (i.e., couple and family therapy) through the Veterans Affairs (VA) Healthcare System. This study examines demographic, mental health, military, and referral source variables associated with referral to and utilization of family services using a large national VA dataset of 22,969 veterans who were referred to couple or family therapy from 2016 to 2019. Of those referred, 44.39% had a completed referral; among those who initiated therapy, 31.11% attended five or more sessions. Logistic regression was used to evaluate predictors of completed referrals and of attending five or more sessions of couple or family therapy. Veterans identifying as Black/African American, American Indian or Alaska Native were less likely to have a completed referral than non-Hispanic White veterans; moreover, veterans identifying as Black/African American or Hispanic were less likely to attend five or more sessions. Lower likelihood of a completed referral was also associated with rural county residence, being separated, post-9/11 service era, a substance use disorder diagnosis, and being referred by a psychiatrist, neurologist, physician, or nursing staff rather than a psychologist. Lower likelihood of attending five or more sessions was associated with a delay of 22 or more days to intake, an adjustment disorder diagnosis, and being referred from VA specialty care, or by a psychiatrist or neurologist. These findings may help inform efforts for outreach and service retention within VA family services in order to ensure equity in access to care and healthcare utilization. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Centering Asian American Women's Health: Prevalence of Health Care Discrimination and Associated Health Outcomes

Asian American women routinely face multiple and intersectional forms of discrimination based on their marginalized social identities, including during their interactions within the US health care system. However, most research on discrimination against Asian American women is limited by its exclusive focus on race-, gender-, or language-based forms of discrimination; and research has yet to assess if their discriminatory health care experiences are associated with poor health outcomes. To address this gap, we centered the experiences of Asian American women (N = 905) from the Association of American Medical Colleges Biannual Consumer Survey of Health Care Access, a national survey of health care consumers conducted from 2011 to 2020. Prevalence rates were established for unfair treatment due to race, gender, culture, language, age, health insurance, and sexual orientation. Multiple regression models were used to assess how these discriminatory experiences were associated with health and functioning outcomes. Findings demonstrate a high prevalence (32.0%) and wide range of discriminatory experiences in health care settings among Asian American women. The majority of these discriminatory experiences were significantly associated with poorer health and functioning outcomes, even after controlling for demographic influences. Results highlight the need for further development of culturally sensitive medical practices and policies to improve the delivery of health care for Asian American women.

Sexual Minority Women and Discriminatory Health Care Experiences: An Intersectional Evaluation Across Race and Ethnicity

OBJECTIVE

Health care discrimination contributes to medical mistrust among marginalized communities. Sexual minority women of color (SM-WOC) are marginalized because of the intersection of their sexual orientation, gender, and race/ethnicity and regularly report poor health care experiences at the intersection of these identities. However, research has yet to quantify differences in the prevalence of reported health care discrimination across SM women of various racial/ethnic backgrounds. As such, this study compared the rates of discriminatory treatment during the most recent medical appointment between SM-WOC (Black, Hispanic, Asian American, Native American) and White SM women.

METHODS

We used nationally representative data from the Association of American Medical Colleges survey of health care services. Data were collected from 2010 to 2019 from N = 1,499 SM women (n = 458 SM-WOC). Binary logistic regressions compared frequencies of reported identity-based discrimination between each minoritized racial/ethnic group to White SM women.

RESULTS

Across the sample, 33% of SM-WOC reported discrimination during their last medical appointment compared with 19% of White SM women. Discriminatory treatment was more common among every minoritized racial/ethnic group of SM women compared with White SM women, with variability in frequency of specific forms of identity-based discrimination across minoritized racial/ethnic groups.

CONCLUSIONS

Although discriminatory treatment during the last medical appointment was common for all SM women, prevalence was higher for SM-WOC compared with White SM women. Findings have important implications for policy and practice to reduce health disparities, such as targeted interventions for SM-WOC and provider trainings in cultural humility, implicit bias, and common microaggressions.

Longitudinal Associations Among Adolescents' Sexual Attitudes, Beliefs, and Behaviors

Youth sex and relationship education programs aim to improve adolescent well-being by changing their knowledge, beliefs, and attitudes regarding sex and their health. However, there is a gap in existing research linking these cognitive targets to relevant behaviors, and a particular dearth of data on links with sexual behaviors. The current study tested longitudinal links between cognitive factors related to sex (attitudes about sex, normative beliefs, risk-avoidant intentions, and confidence in refusal skills) and outcomes of sexual behaviors (recent sexual encounters, number of sexual partners, and frequency of condom use). Data were drawn from three waves of data from a panel study of US high-school students and were analyzed using cross-lagged structural equation modeling. We hypothesized direct, reciprocal links between intentions and behaviors, but this hypothesis was not supported. Instead, more conservative attitudes about sex emerged as the most consistent prospective predictor of fewer sexual encounters and sexual partners, though with small effect sizes (βs = - .08 to - .131, ps < .05). Further, bidirectional interrelationships were observed among several of the cognitive and behavioral variables over time. These results highlight attitudes about sex as a potentially useful intervention target, but also suggest that sex and relationship education curricula and evaluations should consider multiple pathways of links between cognition and behavior. Continued research is needed on causal links between adolescents' sexual attitudes, knowledge, intentions, and behavior.

Sexual Minority Women, Health Care Discrimination, and Poor Health Outcomes: A Mediation Model Through Delayed Care

Purpose: Sexual minority (SM) women are a heterogeneous group who commonly report negative health care experiences at the intersection of their diverse sexual orientations and racial/ethnic identities. However, scarce research has evaluated how negative health care experiences may affect health outcomes among this population. Informed by the Health Equity Promotion Model for SM health, this study evaluated mediation models in which delayed care mediated the association between provider discrimination and poor health outcomes in SM women. Sexual orientation (plurisexual or monosexual) and race/ethnicity (women of color or White) were evaluated as moderators of the direct and indirect pathways. Methods: The sample included SM women (N = 1530) from the nationally representative Association of American Medical Colleges biannual Consumer Survey of Healthcare Access (2010-2020). Mediation models were conducted with lavaan structural equation modeling software. Results: Reported discrimination from a health care provider was associated with higher physical and emotional impairment, and these associations were partially mediated through delayed care. Sexual orientation and race/ethnicity also moderated several indirect and direct pathways. Conclusion: Results provide evidence of delayed care as a possible mediation pathway between provider discrimination and worse health in SM women and that the strength of these associations may vary by sexual orientation and race/ethnicity. Results indicate a need for policy change and clinical trainings to reduce the harm of provider discrimination on SM women.

Moderated mediation in relationship education: Communication, commitment, and sociodemographic disadvantage

This study tested moderated mediation-that is, whether the mechanisms of program impacts are different for different groups of people-in the Supporting Healthy Marriage (SHM) study of relationship education (RE) programs for low-income married couples. Large-scale evaluations of RE programs have yielded small effects in community settings. Understanding program mechanisms specific to disadvantaged populations may help improve program impacts. This study explored whether communication and commitment mediated program effects on relationship outcomes in the SHM study for participants with relatively higher or lower levels of sociodemographic disadvantage. The present study included all 6,298 couples who enrolled in the SHM study. Data on self-reported communication skills, commitment, happiness, warmth/support, conflict, and psychological abuse were used from wives' and husbands' 12-month follow-up assessments, and a risk index was constructed from nine baseline indicators of social, economic, and demographic disadvantage. Analyses used structural equation modeling to test (a) mediation by communication and commitment, and (b) moderation of the mediation paths by level of disadvantage. The programs improved all relationship outcomes measured. Communication mediated program impacts only for couples with moderate or low disadvantage. Commitment mediated program impacts for participants reporting lowest disadvantage only, with more evidence of mediation for wives than husbands. Further research is needed to determine mechanisms of RE among highly disadvantaged populations to improve services for those at highest risk of relationship distress and dissolution. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Online relationship education for help-seeking low-income couples: A Bayesian replication and extension of the OurRelationship and ePREP programs

Low-income couples are at increased risk for relationship instability and divorce. In response, online relationship education programs such as ePREP and OurRelationship have been developed to more easily reach this population. A previous trial indicated that these programs promote relationship functioning (Doss et al., 2020) and individual well-being (Roddy et al., 2020a). However, given that these effects were notably larger than previous studies of in-person relationship education and approached effect sizes observed in couple therapy, it is possible that the magnitude of these effects was somewhat spurious; therefore, these findings need replication. The current manuscript seeks to replicate these programs' previous effects on relationship functioning and determine whether these effects are stable. Using a sample of 671 low-income couples seeking relationship help (N = 1337 individuals) and Bayesian estimation, the current study replicated previous findings that the OurRelationship and ePREP programs offered with four coaching calls produced reliable improvements in relationship functioning relative to a 6-month waitlist control group. There were no statistically reliable differences between the two active interventions. Bayesian analyses indicated that the effects of the two online programs were larger than the average effects of in-person relationship education for low-income couples reported in previous studies, roughly equivalent to efficacy studies of in-person relationship education reported in previous studies, smaller than those that resulted from the OurRelationship program delivered to distressed couples without an income requirement and smaller than couple therapy.

Use of telemental health for VA family services before and during the COVID-19 pandemic

Military veterans experiencing relationship or family difficulties are able to access family services (i.e., couple and family therapy) through the Veterans Affairs (VA) Health Care System. Although family services have historically been provided face-to-face (F2F), the COVID-19 pandemic necessitated a sudden shift to the provision of care via telemental health, which includes videoconferencing (TMH-V) or audio-only phone appointments. This study demonstrated an unprecedented 16-fold increase in the number of TMH-V appointments for family services in VA during the first 9 months of the pandemic. The present study also examined demographic, mental health, and military variables associated with TMH-V utilization before and during the pandemic using a large national VA data set of 13,344 veterans who were referred to couple or family therapy from October 2017 through December 2020. Logistic regression was used to evaluate predictors of having any appointments via TMH-V before and during COVID-19, respectively, as well as predictors of having 50% or more of family service appointments via TMH-V versus phone versus face-to-face appointments during the COVID-19 era. Pre-COVID predictors of TMH-V utilization were limited to obsessive-compulsive disorder diagnosis and history of psychiatric hospitalization, suggesting that TMH-V usage was largely related to clinical indications. In the COVID-19 era, older and rural veterans were less likely to attend appointments via TMH-V than younger and suburban/urban veterans, while Hispanic veterans were more likely to do so than non-Hispanic veterans. The findings from the present study may aid efforts to ensure equity in access to care among veterans in the VA Health Care System. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Impact and implementation findings from a cluster randomized trial of a youth relationship education curriculum

The current study presents implementation and impact data from a cluster randomized trial of a youth relationship education curriculum. High school students (n = 1,135) were randomized at the school level to receive curricula-as-usual or a healthy relationships program delivered by facilitators who were not employed by the high schools. Program evaluators reported high engagement and students indicated high satisfaction with the program, but multilevel models showed no statistically significant impacts on healthy relationship skills, attitudes, and behaviors at three and nine months post-intervention. Strengths and limitations of the research design and program implementation, as well as implications for evaluating youth relationship education more broadly, are discussed.

Adverse childhood experiences, mental health, and relationship satisfaction in military couples

Adverse Childhood Experiences (ACEs) have been found to influence one's own mental health and relationship satisfaction in adulthood; however, the association between one's own ACEs and their partner's individual and relationship functioning has not been explored. Veterans (n = 103) and their significant others (S-O; total N = 206) completed assessments on ACEs, depression, relationship satisfaction, and Posttraumatic Stress Disorder (PTSD) symptom severity as part of a baseline assessment in a treatment outcome study for veterans with PTSD and their S-Os. Actor Partner Interdependence Moderation Modeling (APIMoM) was conducted. Higher ACE score was positively related to PTSD for all participants. Female S-O's ACE score was positively related to their own depression, and male S-Os reported higher depression and lower relationship satisfaction when their partners reported a higher ACE score. Surprisingly, female veterans experienced higher relationship satisfaction when their S-Os reported a higher ACE score. ACEs are related differently to one's own and one's partner's mental health and relationship satisfaction and should be assessed when conducting couple's interventions. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Posttraumatic stress disorder and relationship functioning: Examining gender differences in treatment-seeking veteran couples

Posttraumatic stress disorder (PTSD) symptoms are robustly associated with intimate relationship dysfunction among veterans, but most existing research has focused on male veterans and their female partners. Links between PTSD and relationship functioning may differ between female-veteran couples and male-veteran couples. The current study used actor-partner interdependence models (APIMs) to test the associations between PTSD symptoms (i.e., veteran self-report or significant others' collateral-report) and each partner's reports of six domains of relationship functioning, as well as whether these links were moderated by the gender composition of the couple. Data were from 197 mixed-gender couples (N = 394 individuals) who completed baseline assessments for a larger randomized controlled trial of a couple-based PTSD treatment. Significant others' collateral PTSD reports were associated with their own ratings of relationship satisfaction, negotiation, psychological aggression, sexual pleasure, and sexual desire frequency, |β|s = .19-.67, and with veterans' ratings of negotiation and sexual desire frequency, |β|s = .20-.48. In contrast, veterans' self-reported PTSD symptoms were only associated with their own ratings of psychological aggression, β = .16. Gender moderated the associations between significant others' collateral PTSD reports and five of the six outcome variables; findings from exploratory subgroup analyses suggested links between reported PTSD symptoms and relationship functioning were generally more maladaptive for male-veteran couples, whereas female veterans showed more neutral or even helpful impacts of higher partner-perceived PTSD symptoms. These findings have implications for clinicians treating relational impacts of PTSD and emphasize the need for further research with female-veteran couples.

Genetic sensitivity predicts long-term psychological benefits of a relationship education program for married couples

OBJECTIVE

Relationship education programs have proven effective in promoting relationship quality and preventing divorce among married couples. However, according to theories of Environmental Sensitivity, people differ for genetic reasons in their sensitivity to environmental influences with some more affected by both negative and positive experiences, including psychological interventions.

METHOD

Here we test in two studies whether the positive effects of the established Prevention and Relationship Education Program (PREP) are moderated by two different polygenic scores (PGS) for environmental sensitivity, one based on nine established candidate genes and one based on several thousand variants across the genome, derived from recent genome-wide association study (GWAS) results. Analyses were conducted in a randomized controlled study on PREP (N = 242) and then repeated in an independent replication trial (N = 183).

RESULTS

Several significant PREP-X-PGS interactions indicated moderation of long-term treatment effects across the two studies, most of them involving the genome-wide score. Generally, higher genome-wide genetic sensitivity was associated with stronger intervention effects on almost all measures of relationship quality across the follow-up period.

CONCLUSIONS

Findings provide further evidence that people differ substantially in their response to the positive effects of psychological intervention as a function of individual differences in genetic sensitivity, with more sensitive participants potentially benefitting more from relationship education. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

We are not all the same: The importance of perceived difference in racial ideology and Afrocentricity for African American relationships

A large body of existing research on African American relationships perpetuates a deficit model that assumes Eurocentric norms and emphasizes between-group differences (e.g., cross-racial comparisons with the majority group-European Americans). The current study examined within-group variability and the influence of culturally unique factors, Afrocentricity, racial ideology, and perceived discrepancy between self and partner on African American relationship processes. Data were collected from 137 self-identified African American adults in same-race, cross-gender relationships. Consistent with the literature on protective values of Afrocentricity, there was an association between reported relationship quality and high levels of one's own and perceived partner's Afrocentricity. Discrepancies between self and partner Afrocentricity were not associated with relationship processes, but higher perceived discrepancies across all four subscales of racial ideology were associated with lower relationship dedication. Higher perceived discrepancies on the humanist and assimilationist subscales were also related to higher levels of conflict. These findings have important clinical implications and demonstrate a need for further research into the nuances of individual factors and dyadic processes that are unique to African American couples.

Utilizing the couple relationship to prevent suicide: A preliminary examination of Treatment for Relationships and Safety Together

OBJECTIVE

To evaluate the feasibility, preliminary effects, and acceptability of the first comprehensive couple-based treatment for suicide, called Treatment for Relationships and Safety Together (TR&ST).

METHOD

In a preliminary examination, five couples (N = 10) participated in 10 weekly sessions of TR&ST. All couples included a veteran who reported active suicidal ideation at baseline and their partner. Couples completed measures of relationship functioning, perceived burdensomeness, thwarted belonging, and suicidal ideation at baseline, mid-treatment, and posttreatment.

RESULTS

TR&ST was feasible to deliver. Veteran and partner relationship functioning improved and veteran perceived burdensomeness, thwarted belonging, and suicidal ideation decreased. There were no suicide related behaviors, hospitalizations, or crisis line calls during the study. TR&ST seemed acceptable to couples (100% retention and high satisfaction ratings).

CONCLUSION

Couple-based suicide prevention may provide an additional avenue for suicide prevention in veterans.

The development of Couple HOPES: a guided online intervention for PTSD and relationship satisfaction enhancement

Background: Couple HOPES (Helping Overcome PTSD and Enhance Satisfaction) was created to help overcome a range of barriers to accessing psychotherapy for posttraumatic stress disorder (PTSD) and commonly associated intimate relationship problems. Objective: Couple HOPES is a guided, online self-help intervention adapted from Cognitive-Behavioural Conjoint Therapy for PTSD that aims to improve PTSD and enhance relationship satisfaction. Method/Results: This paper describes the processes and principles used to develop the Couple HOPES intervention platform as well as the coaching model and manual used to promote engagement and adherence to the intervention. Conclusions: Current research and future directions in testing Couple HOPES are outlined.

Intimate partner violence in female same-gender couples: An investigation of actor-partner correlates within the past year

Objective: Female same-gender couples experience higher rates of intimate partner violence (IPV) as compared to other couples, yet research on IPV in this population is limited and almost exclusively focused on individual-level correlates. Given the interdependent nature of IPV, the current study examined actor and partner associations of recent IPV use in female same-gender couples. Method: Data were collected from 103 adult female same-gender couples (N = 206) and analyzed using actor-partner interdependence models. Results: The odds of engaging in physical assault in the last year were positively associated with partner (but not actor) discrimination, alcohol use, and anxiety symptoms and negatively associated with both actor and partner relationship adjustment, emotional intimacy, and partner (but not actor) dedication and social support. The odds of engaging in high levels of psychological aggression in the last year were positively associated with actor and partner depressive and anxiety symptoms, actor (but not partner) negative communication, and partner (but not actor) discrimination and negatively associated with both actor and partner emotional intimacy, actor (but not partner) relationship adjustment, dedication, and social support. Conclusion: These findings demonstrate the interdependent nature of IPV-associated factors in female same-gender couples. Clinical implications include evaluating factors associated with recent IPV use that take into account dyadic associations between partners. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Maintenance of Relationship and Individual Functioning Gains Following Online Relationship Programs for Low-Income Couples

Initial evidence suggests that gains in relationship functioning from brief, web-based programs are maintained through one year following the intervention; however, whether these results generalize to a low-income sample is unclear. Furthermore, previous research from in-person couple therapy suggests there may be different shapes of maintenance slopes for behavioral versus acceptance-based techniques. This study contacted 668 individuals who enrolled in online behavioral (ePREP) or acceptance-based (OurRelationship) programs one year following completion of the program. Multilevel modeling was used to examine linear and quadratic rates of change in the year following the online intervention as well as total amount of change from pretreatment to 12-month follow-up for both relationship and individual functioning. The majority of couples who responded continued to be in a relationship with the same partner (68.3%). Examinations of relationship functioning indicated couples in both programs maintained their gains over follow-up (i.e., no significant linear or quadratic changes), with medium-to-large within-group effect sizes from pre- to one-year follow-up. There were no significant differences in relationship outcomes between OurRelationship and ePREP. Similarly, examinations of individual functioning outcomes indicated couples maintained their gains over follow-up or continued to improve. In total, couples experienced small-to-medium within-group effect sizes from pretreatment to one-year follow-up, with larger effects for individuals who were initially distressed. These results suggest that online programs create lasting change for low-income couples in relationship and individual functioning, with minimal differences between behavioral and acceptance-based orientations.

Effectiveness of online OurRelationship and ePREP programs for low-income military couples

OBJECTIVE

Military couples need and desire relationship interventions. Online interventions improve access; however, their effectiveness within the military population is untested. Using a subsample from a larger randomized controlled trial of OurRelationship and ePREP online relationship programs for low-income couples, this study examined baseline characteristics of military compared with civilian couples enrolled (Aim 1), treatment effects within military couples (Aim 2), and treatment differences between military and matched civilian participants (Aim 3).

METHOD

Military couples (n = 90 couples) in which 1 or both partners were active duty (11%) or veterans (89%) were selected from the larger randomized controlled trial along with a matched civilian sample selected using propensity scores.

RESULTS

No differences were found between military and civilian couples regarding baseline individual or relationship functioning. Program completion was lower among military couples (57%) compared with civilians (71%), whereas program satisfaction was equally positive. Among military couples, relationship satisfaction, conflict, emotional support, and breakup potential were significantly improved after treatment (between-groups d = 0.31-0.46) and maintained at follow-up; intimate partner violence and individual functioning domains did not improve. When comparing military and civilian samples, there was a pattern of stronger treatment impacts on individual functioning for civilians, although only the impact on insomnia evidenced a significant difference.

CONCLUSIONS

These online relationship interventions improved relationship functioning for military couples. More research is needed to test these interventions among clinically impaired military populations and to explore potential for improving program completion and effects on relationship violence and individual wellbeing. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Online programs improve relationship functioning for distressed low-income couples: Results from a nationwide randomized controlled trial

OBJECTIVE

Although low-income couples experience greater relationship challenges, they have limited access to effective relationship interventions. Furthermore, most previous efforts to improve low-income couples' relationships have yielded very small effects (Hawkins & Erickson, 2015). In an effort to overcome these limitations, this study investigated the effectiveness of 2 web-based interventions for low-income couples.

METHOD

In total, 742 low-income couples (N = 1,484 individuals; mean [M] age = 33; 55% White, non-Hispanic; 52% married; median [Mdn] annual household income = $27,000) were recruited nationally and randomized to the OurRelationship program, the ePREP program, or a waitlist control group. Couples were repeatedly assessed for 6 months using self-report measures of relationship satisfaction, communication conflict, intimate partner violence, emotional support, and breakup potential. Relationship status was assessed at 6-month follow-up.

RESULTS

Compared to the control group, intervention couples experienced significantly greater improvements in all 5 domains of relationship functioning (Mdn |d| = 0.46) by the end of the program; these effects were maintained in the 4 months after treatment. However, neither program significantly reduced the frequency of breakups by the 6-month follow-up. Differences between couples in the two interventions were minimal (Mdn Cohen's |d| = 0.11); however, couples in the OurRelationship program experienced significantly greater decreases in conflict (d = 0.24).

CONCLUSIONS

The results indicate that brief, web-based interventions can serve a central role in delivering effective services to low-income couples. Additionally, the general equivalence of the two interventions indicates that both communication-focused and problem-focused interventions can be successful in improving the relationship functioning of low-income couples. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

The Association Between Sexual Functioning and Suicide Risk in U.S. Military Veteran Couples Seeking Treatment for Post-Traumatic Stress Disorder

Intimate relationship distress has been identified as one of the most common precipitants of suicidal thoughts for U.S. military populations. Sexual functioning is associated with relationship distress and has recently been identified as a predictor of suicidal ideation with female military personnel; however, no studies have examined this association among a treatment-seeking sample of male and female veterans and their partners. Couples (N = 138) completed baseline assessments of sexual functioning, relationship functioning, suicidal ideation, and mental health prior to evaluation for engagement in a couples-based PTSD treatment study. Analyses revealed that decreased sexual pleasure and decreased frequency of sexual intercourse were associated with more recent suicidal ideation for male veterans, whereas increased sexual frequency was marginally associated with increased suicidal ideation for female veterans, controlling for PTSD and depression symptoms, relationship satisfaction, and medications. These findings stress the importance of assessing sexual functioning as a risk factor for suicide and taking into consideration the possibility that sexual functioning may be protective or predictive of suicidality depending on the person and context.

Political Party Identification and Romantic Relationship Quality

Although there are studies on voting similarity in mate selection, very little research has examined party identification and relationship quality. We assessed associations between reports of personal and partner voting behavior (Democrat, Republican, or Independent) and both relationship adjustment and commitment to one's partner. We used a national (U.S.) sample of individuals (N = 510) in their 20s and 30s who were mostly in different-sex, serious relationships (Mdn duration = 5.25 years; 50% married). Controlling for age, college graduation, income, religiosity, minority status, and duration of relationship, voting Republican was associated with higher levels of commitment compared to voting Democrat. Similarly, being partnered with someone voting Republican was associated with higher relationship adjustment and commitment compared to being partnered with someone voting Democrat. Notably, differences in commitment were found only among those who were not already married or engaged. Findings were largely consistent with numerous online reports of survey data that have shown modestly greater relationship quality among those who report being politically conservative. While research has shown that people are less attracted to those who vote differently and that voting differently can be associated with lower relationship quality, we did not generally find perceived voting similarity to be associated with relationship adjustment or commitment. There was one exception: In exploratory analyses, Republicans paired with Democrats tended to report substantially lower relationship adjustment than if paired with Republicans. Implications for political differences among intimate partners and clinical work around these themes are discussed.

Associations of Army Fathers' PTSD Symptoms and Child Functioning: Within- and Between-Family Effects

This study examined the within-family and between-family associations between fathers' military-related PTSD symptoms and parent ratings of children's behavioral and emotional problems. The sample included married couples (N = 419) with children composed of a civilian wife and an active-duty husband serving in the U.S. Army. Results indicate that changes in fathers' PTSD symptoms over time were associated with corresponding changes in both mothers' and fathers' reports of child behavioral and emotional problems. These within-family findings were independent from between-family effects, which showed that higher average PTSD symptomatology was associated with more overall behavioral and emotional problems for children. This study uses advances in statistical methodologies to increase knowledge about how PTSD symptoms and child problems are related, both across different families and over time within families.

Sexuality Within Female Same-Gender Couples: Definitions of Sex, Sexual Frequency Norms, and Factors Associated with Sexual Satisfaction

Despite a growing number of female same-gender (FSG) relationships, couples-based research and interventions have focused primarily on mixed-gender couples. Consequently, research has applied a heteronormative lens to understanding some relationship factors, including sexuality. The current study sought to provide descriptive data regarding frequency and conceptualizations of sex across partners in FSG relationships, as well as to analyze how relationship factors are associated with sexual satisfaction in this population. Participants (N = 206) were 103 adult FSG couples who had been together for at least 2 months. Individuals provided self-report data on how they conceptualized sex, and actor-partner models were utilized to assess relationship factors associated with sexual satisfaction. Findings indicated that women in FSG relationships hold broad definitions of sex, with the majority of behaviors conceptualized as sex, including acts that involved partnered genital touching. In dyadic actor-partner models, sexual satisfaction was predicted by several factors including sexual frequency, emotional intimacy, and sexual intimacy. Unexpectedly, higher desired sexual frequency was associated with lower sexual satisfaction; however, this finding only emerged after controlling for actual sexual frequency, suggesting that discrepancies between desired and actual sex frequency may be important for FSG couples. Implications for clinical practice with FSG couples are explored, including a strength-based focus on broad conceptualizations of sex within this population and targeting relationship factors associated with sexual satisfaction.

Once a Cheater, Always a Cheater? Serial Infidelity Across Subsequent Relationships

Although there is a large body of research addressing predictors of relationship infidelity, no study to our knowledge has specifically addressed infidelity in a previous relationship as a risk factor for infidelity in a subsequent relationship. The current study addressed risk for serial infidelity by following adult participants (N = 484) longitudinally through two mixed-gender romantic relationships. Participants reported their own extra-dyadic sexual involvement (ESI) (i.e., having sexual relations with someone other than their partner) as well as both known and suspected ESI on the part of their partners in each romantic relationship. Findings from logistic regressions showed that those who reported engaging in ESI in the first relationship were three times more likely to report engaging in ESI in their next relationship compared to those who did not report engaging in ESI in the first relationship. Similarly, compared to those who reported that their first-relationship partners did not engage in ESI, those who knew that their partners in the first relationships had engaged in ESI were twice as likely to report the same behavior from their next relationship partners. Those who suspected their first-relationship partners of ESI were four times more likely to report suspicion of partner ESI again in their next relationships. These findings controlled for demographic risk factors for infidelity and held regardless of respondent gender or marital status. Thus, prior infidelity emerged as an important risk factor for infidelity in next relationships. Implications for novel intervention targets for prevention of serial relationship infidelity are discussed.

Within- and Between-Family Associations of Marital Functioning and Child Well-being

This study clarifies within-family and between-family links between marital functioning and child wellbeing. Expanding on existing prospective research, this study tests whether changes in parents' marital functioning are associated with corresponding changes in their children's wellbeing, independent from associations that exist when comparing different families. Participants (N = 1033) were members of married, opposite-sex couples with children who participated in five waves of a larger study of marriage in the U.S. Army. Spouses' constructive communication, verbal conflict, and marital satisfaction each showed between-family associations with parent-reported child internalizing and externalizing problems. In contrast, within-family associations were significant only for parents' communication behaviors. That is, parents who reported lower levels of marital satisfaction also reported lower child wellbeing, whereas change in parents' communication was associated with change in child wellbeing over time. Isolating within-family effects is important for understanding marital and child functioning and for identifying potential targets for effective intervention.

Affinity maturation of human botulinum neurotoxin antibodies by light chain shuffling via yeast mating

Botulism is caused by the botulinum neurotoxins (BoNTs), the most poisonous substance known. Because of the high potency of BoNT, development of diagnostic and therapeutic antibodies for botulism requires antibodies of very high affinity. Here we report the use of yeast mating to affinity mature BoNT antibodies by light chain shuffling. A library of immunoglobulin light chains was generated in a yeast vector where the light chain is secreted. The heavy chain variable region and the first domain of the constant region (V(H)-C(H)1) from a monoclonal antibody was cloned into a different yeast vector for surface display as a fusion to the Aga2 protein. Through yeast mating of the two haploid yeasts, a library of light chain-shuffled Fab was created. Using this approach, the affinities of one BoNT/A and two BoNT/B scFv antibody fragments were increased from 9- to more than 77-fold. Subcloning the V-genes from the affinity-matured Fab yielded fully human IgG1 with equilibrium binding constants for BoNT/A and BoNT/B of 2.51 x 10(-11) M or lower for all three monoclonal antibodies. This technique provides a rapid route to antibody affinity maturation.

Evidence for the preferential localization of glutamate receptor-1 subunits of AMPA receptors to the dendritic spines of medium spiny neurons in rat striatum

Although immunohistochemical studies have typically found the perikarya of striatal projection neurons to be devoid of immunohistochemical labelling for the GluR1 AMPA type glutamate receptor subunit, the striatal neuropil is rich in GluR1 immunolabelling and in situ hybridization histochemistry has indicated the presence of GluR1 message in many striatal neurons. To explore the possibility that GluR1 subunits may be synthesized by many striatal projection neurons, but selectively localized to their dendrites, we have used light-microscopic and electron-microscopic immunohistochemistry in combination with single-cell reverse transcription-polymerase chain reaction. Light-microscopic immunohistochemical studies confirmed the presence of abundant GluR1 immunoreactivity in the striatal neuropil in rats. Perikaryal labelling was restricted to neurons previously identified as parvalbuminergic neurons. Single-cell reverse transcription-polymerase chain reaction for individual striatal neurons in rats confirmed that most striatal projection neurons (i.e. containing either or both substance P message or enkephalin message) make GluR1 message. For example, 94% of enkephalin-containing neurons, 75% of substance P-containing neurons, and 87% of enkephalin and substance P co-containing neurons expressed GluR1 messenger RNA. Electron-microscopic immunohistochemistry revealed that GluR1 immunolabelling was prominent in 61% of dendritic spines and 53% of dendritic shafts. While prominent perikaryal GluR1 immunolabelling was observed only in a small population of interneurons, sparse perikaryal GluR1 immunolabelling was found associated with the rough endoplasmic reticulum, the Golgi apparatus, the outer membranes of the mitochondria, and the outer envelope of the nucleus of about 30% of striatal projection neurons (identified by their non-indented nuclei). These results indicate that striatal projection neurons selectively target GluR1 subunits to their spines and dendritic shafts. Our finding has implications for the functioning of striatal projection neurons and for the general issue of whether neurons can control the subcellular localization of glutamate receptors.