PTSD service dogs foster resilience among veterans and military families

Military deployment and reintegration challenges permeate the lives and relationships of Veterans, their spouses, and their families. Among these challenges, 23% of post-9/11 Veterans have been diagnosed with posttraumatic stress disorder (PTSD). Psychiatric service dogs have been found to help clinically alleviate PTSD symptoms when used as a complementary intervention. However, minimal research exists that explores the role of the service dog as a mechanism for cultivating resilience within the military family system. Researchers utilized a qualitative, constant comparative approach to analyze self-reported experiences of 101 individuals, including Veterans (n = 67) and their spouses (n = 34). Analyzed through the framework of the Theory of Resilience and Relational Load (Afifi et al., 2016), findings suggest complex communication processes that facilitate relational and family adaptation. These processes encompassed (a) the role of the service dog in building emotional reserves, (b) relational load introduced when caring for the service dog, and (c) the service dog's facilitation of relational maintenance behaviors among family members that contributed to communal orientation. Based on the results of this qualitative analysis, researchers suggest educational interventions where service dog trainers and mental health practitioners can incorporate relational maintenance strategies and family-focused approaches to integrating service dogs as military family members.

Grit but Not Help-Seeking Was Associated with Food Insecurity among Low Income, At-Risk Rural Veterans

Rural veterans have poorer health, use healthcare services less often than their urban counterparts, and have more prevalent food insecurity than average U.S. households. Food insecurity and resource use may be influenced by modifiable psychological attributes such as grit and help-seeking behaviors, which may be improved through interventions. Grit and help-seeking have not been previously evaluated among rural veterans. Thus, this cross-sectional study evaluated the hypothesis that grit and help-seeking were associated with food insecurity and the use of resources. Food security, resource use, grit, and help-seeking behavior were assessed among rural veterans (≥18 years) from five food pantries in southern Illinois counties (n = 177) from March 2021 to November 2021. Adjusted multiple regression was used to estimate the relationship between the odds of food insecurity and the use of resources with grit and help-seeking scores. Higher grit scores were significantly associated with lower odds of food insecurity (OR = 0.5, p = 0.009). No other associations were detected. The results provided evidence to inform the content of future educational interventions to improve food insecurity and address health disparities among rural veterans by addressing grit. The enhancement of psychological traits such as grit is related to food security and has the potential to benefit other aspects of well-being.

Focus Forward Fellowship: Evaluation of a program for women student service members and veterans

The Focus Forward Fellowship was designed to support women student service members and veterans (SSM/Vs) in developing skills and resources to promote persistence to graduation and career attainment. Despite their accomplishments and strengths, women SSM/Vs can be challenged by their military and gender identities in a university environment surrounded by peers who differ in age and life experience (Iverson et al., 2016). Guided by King's (2004) meaning of life meta-model, the Fellowship was designed to increase sense of belonging, understanding of self, and engagement in behaviors tied to academic and career success. We gathered longitudinal evaluation data from two early program cohorts comprising 19 women. Analyses indicated that women reported significant gains in knowledge and use of personal strengths, identity integration, resume preparation, and networking skills, with baseline assessments controlled. No gains were found for sense of belonging or engagement in networking with career professionals or military peers. Based on existing literature, improvement in identity integration is a particularly positive contribution to women students' academic and career success. Program refinements will aim to strengthen contributions to the "belonging" domainof the program.

Grit Was Associated With Food Insecurity Among Low Income, At-Risk Rural Veterans

Objectives

Rural veterans have poorer health, use health care services less often than their urban counterparts, and have more prevalent food insecurity than average U.S. households. Food insecurity and resource use may be influenced by modifiable psychological attributes such as grit, the determination and perseverance for long-term goals, and help-seeking behaviors, yet no previous studies have evaluated grit and help-seeking among rural veterans. Therefore, the association of grit and help-seeking behavior with food insecurity and use of resources was determined among rural veterans.

Methods

Rural veterans from five food pantries in southern Illinois counties with U.S. Department of Agriculture (USDA) rurality scores ≥5 of at least 18 years (n = 176) were recruited from March 2021 to November 2021 for this cross-sectional study. Food security range (USDA 6-item Household Food Security Survey Module), use of resources, grit (Short Grit Scale) and help-seeking behavior (General Help-Seeking Questionnaire) were assessed upon recruitment. Characteristics linked to each outcome variable were determined using chi-square tests. Food security and resource use were compared by grit and help-seeking scores. Regression estimated the relationship between odds of food insecurity and use of resources with grit and help-seeking, with adjustment for covariates.

Results

Logistic regression indicated higher grit scores were significantly associated with lower odds of food insecurity (OR = 0.2, p = 0.009). Help seeking was not significant in simple or adjusted regression models.

Conclusions

The study provided evidence to inform the content of future educational interventions to improve food insecurity and address health disparities among rural veterans by addressing grit. Enhancement of psychological traits like grit might improve quality of life independently from food security and potentially benefit other aspects of well-being.

Funding Sources

McCormick Foundation; Lilly Endowment; Purdue University College of Pharmacy Center for Health Equity and Innovation.

Posttraumatic stress disorder service dogs and the wellbeing of veteran families

BACKGROUND

Benefits and challenges associated with service dogs for veterans with posttraumatic stress disorder (PTSD) may extend beyond veterans to their families.

OBJECTIVE

The purpose of the current study is to evaluate the impact of veterans' PTSD service dogs on spouses and families in a parallel-group, longitudinal design with assessments at baseline and three months follow-up.

METHOD

A total of 88 United States military veteran spouses completed a survey composed of multiple standardized measures at baseline and three months later. In the intervention group (n = 48), veterans received service dogs shortly after baseline while the waitlist control group (n = 40) did not.

RESULTS

Linear regression analyses demonstrated significantly lower caregiver satisfaction, higher caregiver burden and higher participation in life activities among spouses who had service dogs in their homes compared to those on the waitlist. Though not significant, small effect sizes were present among additional measures.

CONCLUSION

Results suggest that although previous literature demonstrates service dogs may offer significant improvements for veterans, spouses and children may not experience those same benefits. Clinicians should consider how to prepare veteran spouses and families for integrating service dogs into their home. Future studies should explore family-focused approaches for service dog integration, defining an optimal strategy for the benefit of the entire family.

HIGHLIGHTS

Though service dogs may improve wellbeing for veterans with posttraumatic disorder, families of veterans may not experience those same benefits. Researchers and clinicians should consider how to best prepare veteran families for integrating service dogs into their homes.Though posttraumatic stress disorder (PTSD) service dogs are trained specifically for veterans, recent studies have demonstrated that their impact may go beyond veterans themselves (McCall, Rodriguez, Wadsworth, Meis, & O'Haire, 2020; Nieforth, Craig, Behmer, MacDermid Wadsworth, & O'Haire, 2021). PTSD service dogs may provide both benefits and challenges for veteran families.

Youth's Sibling Relationships Across the Course of a Parent's Military Deployment: Trajectories and Implications

The present exploratory study explored the trajectories and implications of at-home (military unaffiliated) parents' perceptions of youth's sibling relationships across the course of a parent's military deployment. Participants included 109 families with at least two siblings (older sibling and younger siblings age: M = 10.85, SD = 3.92 and M = 7.89, SD = 3.58, respectively) and one parent serving in the National Guard. Data were collected via in-home interviews, at six time points across the deployment cycle. A series of multilevel models revealed increases in sibling disharmony during the months a deployed parent was away, but showed signs of recovery in the year after they returned. Increases in sibling disharmony were positively associated with increases in youth's externalizing behaviors above and beyond the effects of parenting.

Military Spouses' Self- and Partner-Directed Minimization in the Context of Deployment

In light of technological advances enabling military couples to communicate throughout deployment, spouses of deployed service members often make decisions about what to share with service members, and how to respond to service members' concerns. In doing so, they manage an emotional boundary between service members and their families. This study focused on two behaviors military spouses may use when managing this boundary, namely their minimization of (1) their own concerns (i.e., self-directed minimization) and (2) service members' concerns (i.e., partner-directed minimization). The purpose of the current study was to identify correlates and consequences of these behaviors. Findings from a longitudinal structural equation model utilizing three waves of data from a sample of 154 married military couples in which the husband was a male National Guard soldier indicated that spouses were more likely to minimize both their own-and service members'-concerns when they themselves reported higher levels of depressive symptomology prior to deployment. Spouses' minimization of service members' concerns during deployment, in turn, predicted higher levels of service members' depressive symptomology at reintegration, even after accounting for their initial depressive symptomology and combat exposure. Implications for intervention efforts aimed at promoting individual and couple adjustment to deployment are discussed.

Communication and connection during deployment: A daily-diary study from the perspective of at-home partners

In this study, 87 partners of deployed National Guard service members completed daily diaries in which they recorded for up to 7 consecutive days the channels (e.g., phone) by which they communicated with their service member, the communication activities (e.g., support provision) they and their service member engaged in, and how connected they felt to their service member. Multilevel modeling was used to explore two types of associations between couples' communication activities and partners' feelings of connection for partners who communicated with their service member via phone and/or video during the week. Findings indicated that, across the week, partners who reported that their service member provided them with higher levels of support and who made decisions together more often as a couple felt more connected to their service member (between-person associations). Additionally, on days when partners reported they provided support during phone calls more than they did on average, or their service member provided them support during video calls more than their service member did on average, they reported greater feelings of connection (within-person associations). Future research should explore how daily fluctuations in deployment communication may reinforce or challenge existing relationship processes, thus impacting how couples maintain their relationships after, as well as during, deployment. (PsycINFO Database Record

Overview of depression, post-traumatic stress disorder, and alcohol misuse among active duty service members returning from Iraq and Afghanistan, self-report and diagnosis

Previous studies have found deployment to combat areas to be associated with an increased risk of post-traumatic stress disorder (PTSD), depression, and alcohol abuse, but many previous studies were limited by samples that were not representative of the deployed military as a whole. This study presents an overview of these three mental health problems associated with deployment among Air Force, Army, Marine Corp, and Navy service members returning from deployment to Iraq and Afghanistan between January 2007 and March 2008. With postdeployment health data on over 50,000 service men and women, including diagnostic information, we were able to estimate prevalence of those who screened positive for risk of each disorder in self-report data at two time points, as well as prevalence of diagnoses received during health care encounters within the military health care system. The prevalence ranges of the three disorders were consistent with previous studies using similar measures, but service members in the Navy had higher rates of screening positive for all three disorders and higher prevalence of depression and PTSD diagnoses compared to the other branches. Further, PTSD risk was higher for service members returning from Afghanistan compared to Iraq, in contrast to previous findings.

The Impact of Deployment on Parental, Family and Child Adjustment in Military Families

Since 9/11, military service in the United States has been characterized by wartime deployments and reintegration challenges that contribute to a context of stress for military families. Research indicates the negative impact of wartime deployment on the well being of service members, military spouses, and children. Yet, few studies have considered how parental deployments may affect adjustment in young children and their families. Using deployment records and parent-reported measures from primary caregiving (N = 680) and military (n = 310) parents, we examined the influence of deployment on adjustment in military families with children ages 0-10 years. Greater deployment exposure was related to impaired family functioning and marital instability. Parental depressive and posttraumatic stress symptoms were associated with impairments in social emotional adjustment in young children, increased anxiety in early childhood, and adjustment problems in school-age children. Conversely, parental sensitivity was associated with improved social and emotional outcomes across childhood. These findings provide guidance to developing preventive approaches for military families with young children.

Help seeking by parents in military families on behalf of their young children

Over the past decade, many children have experienced a parental deployment, increasing their risk for emotional and behavioral problems. Research in the general population has shown that while many services are available for families with children experiencing problems, the rate of service utilization is low. This study examined help-seeking processes in military families in relation to children's problems. We collected data on emotional and behavioral problems from a sample of military parents with children ranging in age from zero to 10 years. While prevalence of children with problems was similar to prior research, results in this study suggested that military parents were alert to problems. Although military parents' help-seeking processes were similar to those documented in civilian studies in many respects, we did not find a significant gender difference in the recognition of problems. Furthermore, we found that children's experiences of deployment were related to use of services. Families who used services most often relied on primary care providers. These findings suggest military families are mindful of the possibility of their children having problems. In addition, many families utilize civilian services. Therefore, it is important to ensure that front-line civilian providers fully understand the context of military family issues.

Accumulation of Risk and Promotive Factors Among Young Children in US Military Families

In the families of the new cohort of war veterans now entering the civilian population in the United States are over two million young children (Cozza, Haskins & Lerner, 2013; Institute of Medicine, 2013). Several noteworthy studies have shown that children exposed to separation from a parent due to combat-related deployment are at elevated risk for a variety of negative consequences (Lester & Flake, 2013). Cozza et al. (2013) argue that existing studies of military children focus too much on the stresses or deficits they experience, failing to give sufficient attention to their strengths, the strengths of their families, or the supports around them. In the current study we focus on risk and promotive factors in the lives of children aged 0-10 in military families. We examine the likelihood of negative outcomes as functions of additive, cumulative, and interactive relationships between risk and promotive factors and children's outcomes. Risk factors, particularly parental depression, community poverty, and cumulative risk, were more strongly associated with children's outcomes than promotive factors. There was, however, a significant risk-protective relationship between accumulations of risk and promotive factors, consistent with promotive conditions operating in a protective fashion under conditions of elevated risk.

Factors Associated With Civilian Employment, Work Satisfaction, and Performance Among National Guard Members

OBJECTIVE

Employment is a vital part of the postdeployment return to civilian life. This study investigated factors associated with employment-related outcomes (employment status, self-reported work performance, and self-reported work satisfaction) among National Guard members returning from Operation Enduring Freedom, Operation Iraqi Freedom, or Operation New Dawn deployments.

METHODS

The sample consisted of 1,151 National Guard service members who had returned from overseas deployments approximately six months earlier. Bivariate and multivariable analyses were performed to examine associations between predictors and employment-related outcome variables.

RESULTS

Higher-risk alcohol use was associated with reduced odds of being employed as well as with lower ratings of work satisfaction, whereas psychiatric symptom load was associated with lower self-reported work performance and work satisfaction ratings. Perceived social resources were associated with higher self-reported work performance and work satisfaction, whereas better physical functioning was associated with better self-reported work performance.

CONCLUSIONS

Policy makers and clinicians may need to consider and assess alcohol use among unemployed National Guard members. They may also need to consider psychiatric symptom load and physical functioning among employed service members who perceive poor work performance and have low work satisfaction. Further research is needed on causal links between these predictors and employment outcomes.

Associations of military divorce with mental, behavioral, and physical health outcomes

BACKGROUND

Divorce has been linked with poor physical and mental health outcomes among civilians. Given the unique stressors experienced by U.S. service members, including lengthy and/or multiple deployments, this study aimed to examine the associations of recent divorce on health and military outcomes among a cohort of U.S. service members.

METHODS

Millennium Cohort participants from the first enrollment panel, married at baseline (2001-2003), and married or divorced at follow-up (2004-2006), (N = 29,314). Those divorced were compared to those who remained married for mental, behavioral, physical health, and military outcomes using logistic regression models.

RESULTS

Compared to those who remained married, recently divorced participants were significantly more likely to screen positive for new-onset posttraumatic stress disorder, depression, smoking initiation, binge drinking, alcohol-related problems, and experience moderate weight gain. However, they were also more likely be in the highest 15(th) percentile of physical functioning, and be able to deploy within the subsequent 3-year period after divorce.

CONCLUSIONS

Recent divorce among military members was associated with adverse mental health outcomes and risky behaviors, but was also associated with higher odds of subsequent deployment. Attention should be given to those recently divorced regarding mental health and substance abuse treatment and prevention strategies.

Reported barriers to mental health care in three samples of U.S. Army National Guard soldiers at three time points

The military community and its partners have made vigorous efforts to address treatment barriers and increase appropriate mental health services use among returning National Guard soldiers. We assessed whether there were differences in reports of treatment barriers in 3 categories (stigma, logistics, or negative beliefs about treatment) in sequential cross-sectional samples of U.S. soldiers from a Midwestern Army National Guard Organization who were returning from overseas deployments. Data were collected during 3 time periods: September 2007-August 2008 (n = 333), March 2009-March 2010 (n = 884), and August 2011-August 2012 (n = 737). In analyses using discretized time periods and in trend analyses, the percentages of soldiers endorsing negative beliefs about treatment declined significantly across the 3 sequential samples (19.1%, 13.9%, and 11.1%). The percentages endorsing stigma barriers (37.8%, 35.2%, 31.8%) decreased significantly only in trend analyses. Within the stigma category, endorsement of individual barriers regarding negative reactions to a soldier seeking treatment declined, but barriers related to concerns about career advancement did not. Negative treatment beliefs were associated with reduced services use (OR = 0.57; 95% CI [0.33, 0.97]).

Prospective evaluation of mental health and deployment experience among women in the US military

Previous research has shown that military women often experience potentially severe health outcomes following deployment. Data from the Millennium Cohort Study, a 21-year longitudinal study examining the health effects of military service, were used to examine this issue. In longitudinal analyses (2001-2008) carried out among US military women (n = 17,481), the authors examined positive screens for depression, anxiety, panic, and posttraumatic stress disorder in relation to deployment in support of the operations in Iraq and Afghanistan, while adjusting for relevant baseline and time-varying covariates. Women who were deployed and reported combat-related exposures had greater odds than nondeployed women of reporting symptoms of a mental health condition (odds ratio = 1.91, 95% confidence interval: 1.65, 2.20), after adjustment for demographic, military, and behavioral covariates. In addition, higher stress, problem drinking, and a history of mental illness were significantly associated with increased risk of later mental health conditions. In contrast, women in the Reserves or National Guard and those with higher education were at decreased risk of mental health conditions (all P 's < 0.01). As the roles and responsibilities of women in the military expand and deployments continue, designing better prevention and recovery strategies specifically for women are critical for overall force health protection and readiness.