Complicated Family Reintegration in OEF-OIF Veterans
Steven L. Sayers PhD
Philadelphia VA Medical Center, Philadelphia, PA
Philadelphia, PA
Funding Period: June 2010 - May 2015

BACKGROUND/RATIONALE:
There is extensive evidence that PTSD, Depression, and other psychiatric complications of combat trauma can have a negative impact on marital and family functioning. It is not clear, however, the pathway or mechanism by which the sequelae of combat exert this impact. Most of the existing models of trauma applied to the understanding of combat veterans and their family members do not take into account the family reintegration processes that these families experience.

OBJECTIVE(S):
The purpose of this research project is to understand better how war-related psychiatric symptoms of OEF/OIF veterans may interfere with family reintegration and negatively affect family functioning. This study will test whether difficulties with family reintegration account for the impact of psychiatric symptoms on overall family functioning over time.

METHODS:
The proposed cross-sectional and longitudinal study will use a sequential mixed methods design with the qualitative aspect secondary to the quantitative aspect. The quantitative aspect of the study will be a non-treatment two-wave (Baseline and 12-month follow-up) clinical assessment of military veterans (target N=220 with complete data) and their family members recruited within 2 years of their return from OEF-OIF deployments. We hypothesize that psychiatric symptoms at baseline assessment will predict lower levels of family functioning at the 12 month follow-up and that family reintegration will mediate the association between Baseline psychiatric functioning and family functioning at 12 months. Lastly, we hypothesize that depressive mood, trauma-related avoidance, and emotional numbing will be most highly associated with reintegration problems. The qualitative aspect of the study will consist of semi-structured interviews, administered separately to each spouse. Qualitative interviews will be conducted after entry into the study with only a purposive-subsample of veterans and their spouses (N= 40 dyads). Interview data will be generated from open-ended and interviewer follow-up questions, with data analysis following the grounded theory approach.

We will target recruitment of OEF-OIF veterans who are married/partnered, returned from deployment within the last two years, and who receive care in the Philadelphia VA Medical Center, and their partners. A 20% attrition across the 12 months of the study is estimated, making the target recruitment N = 270 over 5 years. This should ensure the final minimum of approximately N = 220 with complete data. Recruitment will be done through evaluation referrals, primary care, and the Women's Clinic providers. Assessments will be conducted with the veteran, his/her spouse by interview at the VA Medical Center, or by telephone using a structured set of interview assessments. The interviews will assess anxiety, depressive and other psychiatric symptoms, family reintegration, overall family functioning, and a range of demographic and military service covariates. Baseline interviews will take approximately 55 - 65 minutes for each member of the couple. Each spouse will be paid from $60 to $80 for each interview for their participation depending on how many interviews in which each takes part. The qualitative interviews will take 45-60 minutes. All interviewers will be conducted separately with each spouse. Data analyses will use structural equations modeling to test the major study hypotheses. These results will be integrated with the qualitative findings in order to full understand family difficulties faced by these Veterans.

FINDINGS/RESULTS:
The data are currently being collected, so there are no findings as yet.

IMPACT:
Findings from this study will be used to develop recommendations for specific interventions for veterans and their family members that will promote veterans' health.

PUBLICATIONS:

Journal Articles

1. Dausch BM, Cohen AN, Glynn SM, McCutcheon S, Perlick DA, Rotondi AJ, Sautter FJ, Sayers SL, Sherman MD, Dixon L. An intervention framework for family involvement in the care of persons with psychiatric illness: further guidance from Family Forum II. American Journal of Psychiatric Rehabilitation. 2012 Mar 9; 15(1):5-25.
2. Sayers SL. Family reintegration difficulties and couples therapy for military Veterans and their spouses. Cognitive and behavioral practice. 2011 Feb 1; 18(1):108-119.
3. Adler DA, Possemato K, Mavandadi S, Lerner D, Chang H, Klaus J, Tew JD, Barrett D, Ingram E, Oslin DW. Psychiatric status and work performance of veterans of Operations Enduring Freedom and Iraqi Freedom. Psychiatric services (Washington, D.C.). 2011 Jan 1; 62(1):39-46.
4. Pomerantz AS, Sayers SL. Primary care-mental health integration in healthcare in the Department of Veterans Affairs. Families, Systems & Health. 2010 Jun 1; 28(2):78-82.

Conference Presentations

1. Sayers SL. Military and Civilian Partnerships: Extending the Bridge to Meet the Short- and Long-Term Needs of Military Families and Their Young Children. Paper presented at: National Training Institute Annual Conference; 2011 Dec 8; National Harbor, MD.
2. Sayers SL, Whitted P, Straits-Troster K, Hess T, Fairbank J. Families At Ease: A National Veterans Health Administration Service for Family Members of Veterans to Increase Veteran Engagement in Care. Paper presented at: Association for Behavioral and Cognitive Therapies Annual Convention; 2011 Nov 13; Toronto, Canada.
3. Sayers SL. Coaching into care: a pilot program to enhance outreach to military Veterans and their family members. Paper presented at: VA Mental Health Annual Conference; 2011 Aug 23; Baltimore, MD.
4. Sayers SL. Families-at-ease: a pilot program to enhance outreach to military Veterans and their family members. Paper presented at: American Psychological Association Annual Convention; 2011 Aug 7; Orlando, FL.
5. Sayers SL. Can't you just make him go to treatment? Coaching family members as a means of increasing Veteran engagement in care. Paper presented at: American Psychological Association Annual Convention; 2011 Aug 7; Orlando, FL.
6. Sayers SL. Families-at-ease: a pilot program to enhance outreach to military Veterans and the family members. Paper presented at: Association for Behavioral and Cognitive Therapies Annual Convention; 2010 Nov 19; San Francisco, CA.
7. Clark L, Sayers SL, Starver K, Tew J, Good CB, Peters J, Burke T, Haas GL, Pasquale A, Ehman K, Klaus J. Improving access and safety of varenicline for smoking cessation using telephone care management. Poster session presented at: VA Implementing a Public Health Model for Meeting the Mental Health Needs of Veterans Annual Mental Health Conference; 2010 Jul 28; Baltimore, MD.
8. Schmitz T, McCabe A, Barron A, Dichter ME, Sayers SL. Impact of fear related to domestic violence on treatment seeking in a sample of recently returned military veterans (OEF/OIF). Poster session presented at: VA Implementing a Public Health Model for Meeting the Mental Health Needs of Veterans Annual Mental Health Conference; 2010 Jul 28; Baltimore, MD.

DRA: Military and Environmental Exposures, Mental, Cognitive and Behavioral Disorders
DRE: Treatment - Observational
Keywords: Anxiety Disorders, Caregiving, Deployment, Depression, Family, Gender Differences, Operation Enduring Freedom, Operation Iraqi Freedom, Reintegration Post-Deployment
MeSH Terms: none