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Crasta D, Funderburk JS, Gray TD, Cordova JV, Britton PC. Brief relationship support as a selective suicide prevention intervention: Piloting the Relationship Checkup in veteran couples with relationship and mental health concerns. Suicide Life Threat Behav 2023; 53:787-801. [PMID: 37594162 PMCID: PMC10591926 DOI: 10.1111/sltb.12983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 06/02/2023] [Accepted: 07/19/2023] [Indexed: 08/19/2023]
Abstract
INTRODUCTION Close relationship problems play a key role in many contemporary theories of suicide. However, the potential of relationship support in suicide prevention is understudied. This study explores the feasibility, safety, acceptability, and promise of utilizing the 3-session Relationship Checkup (RC) in veterans with mental health and romantic relationship concerns. METHODS We conducted a single-arm pilot of telehealth RC in veterans with a positive mental health screen and their romantic partners. Couples completed baseline and post-treatment assessments of study outcomes. RESULTS Feasibility analyses showed we were able to recruit an elevated-risk sample (30% history of attempts or interrupted attempts), take them through the service (90% treatment completion), and had minimal harm events (no suicidal behavior, no physical harm in arguments). Multimethod acceptability analyses suggested high satisfaction with the program, though some desired more intensive services. Couples reported improvements in relationship functioning, emotional intimacy, thwarted belongingness, depression, and posttraumatic stress. Perceived burdensomeness only improved for identified patients and drinking did not change for either partner. CONCLUSION The RC is a feasible, safe, and acceptable strategy for providing relationship support to couples at elevated risk. Although further randomized trials are needed, RC shows promise to reduce relationship-level and individual-level suicide risk factors.
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Affiliation(s)
- Dev Crasta
- Center of Excellence for Suicide Prevention, US Department of Veterans Affairs, Canandaigua, New York, USA
- Department of Psychiatry, University of Rochester Medical Center, Rochester, New York, USA
| | - Jennifer S Funderburk
- Department of Psychiatry, University of Rochester Medical Center, Rochester, New York, USA
- Center for Integrated Healthcare, Syracuse VA Medical Center, Syracuse, New York, USA
- Department of Psychology, Syracuse University, Syracuse, New York, USA
| | - Tatiana D Gray
- Department of Psychology, Springfield College, Springfield, Massachusetts, United States
| | - James V Cordova
- Department of Psychology, Clark University, Worcester, Massachusetts, USA
| | - Peter C Britton
- Center of Excellence for Suicide Prevention, US Department of Veterans Affairs, Canandaigua, New York, USA
- Department of Psychiatry, University of Rochester Medical Center, Rochester, New York, USA
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Gray TD, Dovala TK, Cordova JV. Affirmative Adaptations of the Relationship Checkup to Meet the Needs of LGBTQ Couples. Journal of Couple & Relationship Therapy 2022. [DOI: 10.1080/15332691.2022.2149652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Cigrang JA, Cordova JV, Gray TD, Fedynich AL, Maher E, Diehl AN, Hawrilenko M. Marriage checkup in integrated primary care: A randomized controlled trial with active-duty military couples. J Consult Clin Psychol 2022; 90:381-391. [PMID: 35604745 DOI: 10.1037/ccp0000734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE This study assessed the efficacy of the marriage checkup, as adapted to integrated primary care settings and active-duty military couples, for improving relationship health and depressive symptoms. METHOD Married couples (N = 244, Mage = 32.4, 67.6% Caucasian) in which at least one member was active-duty Air Force were recruited from bases across the U.S. via online advertisement, emails sent from medical clinics to enrolled beneficiaries, social media posts, and flyers, and randomly assigned to active treatment or waitlist control. Treatment and control couples were linked in pairs sequentially and pairs completed nine sets of questionnaires at baseline, 1-, and 6-month posttreatment. Outcome measures included the Couples Satisfaction Index, Intimate Safety Questionnaire, Responsive Attention Scale, Partner Compassion Scale, Communication Skills Test, and the Center for Epidemiologic Studies Depression Scale. RESULTS A three-level multilevel model indicated, after adjustment for multiple comparisons, treatment couples experienced statistically significant small-to-moderate improvements compared to the control group (Cohen's d from 0.21 to 0.55) at 1 month that were sustained at 6 months for relationship satisfaction, responsive attention, compassion toward their partners, communication skills, intimate safety, and depressive symptoms. CONCLUSIONS A longitudinal randomized control trial of the MC supports the hypothesis that the MC significantly improves relationship satisfaction, intimacy, communication, partner compassion, responsive attention, and depressive symptoms. Implications for theory, treatment, and dissemination are discussed. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
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Darling EV, Byatt N, Maher EL, Gray TD, Simas TAM, Cordova JV. The Before Baby Relationship Checkup: A Couples-Based Intervention to Reduce Relationship Risk Factors for Perinatal Mood and Anxiety Disorders. J Clin Psychol Med Settings 2021; 29:295-309. [PMID: 34617155 DOI: 10.1007/s10880-021-09819-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/01/2021] [Indexed: 11/27/2022]
Abstract
Relationship conflict and lack of partner support are risk factors for perinatal mood and anxiety disorders. An intervention to strengthen couples' relationships before birth may reduce relationship risk factors for perinatal mood and anxiety disorders, though no research has explored this to date. The aims of this Stage 1 open-series non-experimental proof of concept study were to adapt the 'Marriage Checkup', an evidence-based intervention for relationship distress, as a preventative intervention for perinatal mood and anxiety disorders and to assess its feasibility and acceptability. Pregnant women receiving care at a university-based obstetric practice, and their partners, were recruited. Ten couples participated in the Before Baby Relationship Checkup, a personalized relationship health service offered in the obstetric clinic. Quantitative and qualitative data gathered suggests the intervention is feasible to implement in an obstetric setting, and acceptable to perinatal couples. Specific adaptations to the Marriage Checkup for perinatal couples are warranted and further testing is needed to evaluate efficacy.
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Affiliation(s)
- Ellen V Darling
- Department of Psychology, Clark University, Worcester, MA, USA.
| | - Nancy Byatt
- Department of Psychiatry, University of Massachusetts Medical School, Worcester, MA, USA
| | - Emily L Maher
- Department of Psychology, Clark University, Worcester, MA, USA
| | - Tatiana D Gray
- Department of Psychology, Clark University, Worcester, MA, USA
| | - Tiffany A Moore Simas
- Department of Obstetrics and Gynecology, University of Massachusetts Medical School, Worcester, MA, USA
| | - James V Cordova
- Department of Psychology, Clark University, Worcester, MA, USA
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Wischkaemper KC, Fleming CJE, Lenger KA, Roberson PNE, Gray TD, Cordova JV, Gordon KC. Attitudes toward relationship treatment among underserved couples. ACTA ACUST UNITED AC 2020. [DOI: 10.1037/cfp0000142] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Abstract
The association between relationship functioning and depressive symptoms is well established. This study examined the effects of the Marriage Checkup, a brief two-session Assessment and Feedback relationship intervention, on depressive symptoms. Two hundred and nine married couples participated in the Marriage Checkup and were randomized into Treatment (N = 108) and Waitlist-Control Conditions (N = 101). Compared to the control condition, intervention participants reported significant improvements in depressive symptoms (d = 0.55), with an even greater effect for those who were reporting more severe baseline depression symptoms (d = 0.67). These outcomes are comparable to those within long-term individual psychotherapy, couple therapy, and pharmacology trials, making this the briefest intervention to date to demonstrate significant improvements in depressive symptoms. Clinical implications are discussed.
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Cordova JV, Cigrang JA, Gray TD, Najera E, Havrilenko M, Pinkley C, Nielsen M, Tatum J, Redd K. Addressing Relationship Health Needs in Primary Care: Adapting the Marriage Checkup for Use in Medical Settings with Military Couples. J Clin Psychol Med Settings 2017; 24:259-269. [PMID: 29170878 DOI: 10.1007/s10880-017-9517-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The overall objective of this study was to pilot the Marriage Checkup (MC), a brief intervention for enhancing marital resiliency tailored to a military population, for use by internal behavioral health consultants (IBHCs) working in an integrated primary care clinic. The MC was revised to fit into the fast-paced environment of primary care (e.g., streamlined to fit within three 30-min appointments), and military-relevant material was added to the content. IBHCs working in primary care were then trained to offer the intervention. Thirty participants were enrolled in the study and completed a relationship checkup and one-month follow-up questionnaires. Analysis of post-test and one-month follow-up data showed statistically significant improvements in participants' marital health compared to pre-treatment. The MC intervention appeared to be well received by both couples and IBHCs.
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Affiliation(s)
- James V Cordova
- Psychology Department, Clark University, 950 Main St., Worcester, MA, 01610, USA.
| | - Jeffrey A Cigrang
- School of Professional Psychology, Wright State University, Dayton, OH, USA
| | - Tatiana D Gray
- Psychology Department, Clark University, 950 Main St., Worcester, MA, 01610, USA
| | - Elizabeth Najera
- Wilford Hall, Ambulatory Services Center, Lackland Air Force Base, San Antonio, TX, USA
| | - Matt Havrilenko
- Psychology Department, Clark University, 950 Main St., Worcester, MA, 01610, USA
| | - Crystal Pinkley
- United States Air Force School of Aerospace Medicine, Dayton, OH, USA
| | - Matthew Nielsen
- Air Force Medical Operations Agency, Lackland Air Force Base, San Antonio, TX, USA
| | - JoLyn Tatum
- Wright-Patterson Medical Center, Dayton, OH, USA
| | - Kristen Redd
- Wright-Patterson Medical Center, Dayton, OH, USA
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Cigrang JA, Cordova JV, Gray TD, Najera E, Hawrilenko M, Pinkley C, Nielsen M, Tatum J, Redd K. The Marriage Checkup: Adapting and Implementing a Brief Relationship Intervention for Military Couples. Cognitive and Behavioral Practice 2016. [DOI: 10.1016/j.cbpra.2016.01.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Hawrilenko M, Gray TD, Córdova JV. The heart of change: Acceptance and intimacy mediate treatment response in a brief couples intervention. J Fam Psychol 2016; 30:93-103. [PMID: 26524618 PMCID: PMC4742399 DOI: 10.1037/fam0000160] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
In this study, we examined mediators of a brief couples intervention. Intimate safety, acceptance, and activation were examined in 2 roles: their contribution to marital satisfaction gains in the first 2 weeks after treatment (contemporaneous effects), and how early changes in the mediators influenced longer term changes in marital satisfaction over 2 years of follow-up (lagged effects). Married couples (N = 215) were randomized to either an intervention group or a wait-list control group and followed for 2 years. Latent change-score models were used to examine contemporaneous and time-lagged mediation. A booster intervention in the 2nd year was used for a replication study. Changes in intimate safety and acceptance were uniquely associated with contemporaneous treatment effects on relationship satisfaction in Year 1, but only acceptance was uniquely associated with contemporaneous effects in Year 2. With respect to lagged effects, early changes in acceptance partially mediated later changes in marital satisfaction in Year 1, whereas the same effect for intimate safety was marginally significant. These lagged paths were moderate in size and indirect effects were small. No lagged effects were significant in Year 2. Change in activation was not significant as either a contemporaneous or a lagged predictor of change in relationship satisfaction. We found moderate support for acceptance and more limited support for intimate safety as mediators of short- and long-term treatment response, suggesting that these processes play an important role in sustaining marital health.
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Cordova JV, Fleming CJE, Morrill MI, Hawrilenko M, Sollenberger JW, Harp AG, Gray TD, Darling EV, Blair JM, Meade AE, Wachs K. The Marriage Checkup: a randomized controlled trial of annual relationship health checkups. J Consult Clin Psychol 2014; 82:592-604. [PMID: 24932565 DOI: 10.1037/a0037097] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE This study assessed the efficacy of the Marriage Checkup (MC) for improving relationship health and intimacy. METHOD Cohabiting married couples (N = 215, Mage women = 44.5 years, men = 47 years, 93.1% Caucasian) recruited from a northeastern U.S. metropolitan area through print and electronic media were randomly assigned to MC treatment or wait-list control. Treatment but not control couples participated in assessment and feedback visits, at the beginning of the study and again 1 year later. All couples completed 9 sets of questionnaires over 2 years. Outcome measures included the Quality of Marriage Index, the Global Distress subscale of the Marital Satisfaction Inventory-Revised, the Intimate Safety Questionnaire, and the Relational Acceptance Questionnaire. RESULTS A latent growth curve model indicated significant between-group differences in intimacy at every measurement point after baseline (d ranged from .20 to .55, Md = .37), significant between-group differences in women's felt acceptance for every measurement point after baseline (d ranged from .17 to .47, Md = .34), significant between-group differences in men's felt acceptance through the 1-year 2-week follow-up (d across follow-up ranged from .11 to .40, Md = .25), and significant between-group differences in relationship distress through 1-year 6-month follow-up (d across follow-up ranged from .11 to .39, Md = .23). CONCLUSIONS Longitudinal analysis of the MC supports the hypothesis that the MC significantly improves intimacy, acceptance, and satisfaction. Implications for dissemination are discussed.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Amy E Meade
- Harvard Medical School Department of Psychiatry
| | - Karen Wachs
- Psychological and Life Skills Association of Woodbridge
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