ABSTRACTThis pilot study evaluated the validity and reliability of an Experience of Neighborhood (EON) measure developed to assess neighborhood characteristics that shape reintegration opportunities for returning service members and their families. A total of 91 post-9/11 veterans and spouses completed a survey administered at the Minnesota State Fair. Participants self-reported on their reintegration status (veterans), social functioning (spouses), social support, and mental health. EON factor structure, internal consistency reliability, and validity (discriminant, content, criterion) were analyzed. The EON measure showed adequate reliability, discriminant validity, and content validity. More work is needed to assess criterion validity because EON scores were not correlated with scores on a Census-based index used to measure quality of military neighborhoods. The EON may be useful in assessing broad local factors influencing health among returning veterans and spouses. More research is needed to understand geographic variation in neighborhood conditions and how those affect reintegration and mental health for military families.

ABSTRACTThe reintegration period when service members return from deployment and transition back into family life is usually filled with joy, but can also involve unique stressors and challenges. In this review, the authors synthesize the empirical literature on the well-being of military spouses during reintegration across 6 domains: mental health, social/role functioning, relationship functioning, spiritual functioning, physical health, and financial well-being. In each domain, the authors provide an overview of current support programs available to military spouses to aid in reintegration. Recommendations for future research and programming are offered.

ABSTRACTThe U.K. media suggest that U.K. military personnel have high divorce rates; to date, these claims are not substantiated. Marital status distribution of the general population and military were compared using data from the Office for National Statistics' marital projections and a military cohort study. Overall, military personnel were more likely to be married and less likely to be divorced than were the general population. Women in the military and married military personnel younger than 30 years of age are more likely to report divorce. Military welfare services might target these groups with programs assisting marital relationships.

ABSTRACTRecognizing the impact of parental mental health on child development, the purpose of this scoping review was to identify and synthesize the research literature describing the impact of parental operational stress injury (OSI) on children and youth from military and veteran families. Arksey and O'Malley's 2005 guidelines for conducting scoping reviews were followed. A total of 18 separate databases were searched, in addition to three university-based discovery platforms. From this search, 506 potential sources were identified; 64 proceeded to full data extraction and analysis. This study identified two significant themes in the current literature. First, there are multiple ways in which parental OSIs can impact children and youth. Families need to renegotiate parenting roles and responsibilities, experience changes in spousal relationships that can cascade into parenting, and face shifting family dynamics. In addition, children and youth can experience secondary traumatization, be at risk for child maltreatment, and manifest general impacts on their mental health and development. Second, responding to the impacts through collaboration and innovation. Future directions include informing research with the voices of all members of the family. Knowledge translation strategies are necessary for collaboration across all areas to support this population.

ABSTRACTUnderstanding the contribution of specific combat experiences to postdeployment post-traumatic stress disorder (PTSD) may inform preventive and therapeutic interventions. This study investigated the associations of combat experiences with PTSD among Canadian military personnel after return from deployment to Afghanistan. Most experiences had positive associations with PTSD, but shooting, calling in fire, and clearing buildings had negative associations. The items most strongly associated with PTSD were those that were uncommonly experienced, might not be expected, and involved some measure of interpretation or violation of one's morality. These are potential targets for pre- and posttrauma interventions with military personnel.

ABSTRACTThis study examined the effectiveness of iRest meditation for chronic pain in veterans with moderate traumatic brain injury (TBI). Veterans were randomly assigned to iRest (n = 4) or treatment as usual (n = 5) for eight weeks. Patient-reported pain intensity and interference were assessed at baseline, end point, and four-week follow-up. Veterans receiving iRest reported clinically meaningful reductions in pain intensity (23% to 42%) and pain interference (34% to 41%) for most outcome measures and time points. Effect sizes were large for pain interference (g = 0.92–1.13) and medium to large for intensity (g = 0.37–0.61). We conclude that iRest is a promising self-management approach for chronic pain in veterans with moderate TBI.

ABSTRACTDisrupted sleep is common among combat veterans and can negatively impact response to mental health treatments. A trial of cognitive-behavioral therapy for insomnia (CBT-I) and imagery rehearsal therapy (IRT) for nightmares was conducted with 14 combat veterans who had been diagnosed with insomnia and who were experiencing posttraumatic stress and/or depression. In the case series that follows, veterans experienced clinically significant changes in sleep, and statistically significant reductions in insomnia, nightmare, depression, and posttraumatic stress severity, following treatment. Combined CBT-I and IRT is a promising treatment for patients with combat-related trauma and psychiatric morbidity.

abstractEffective interventions may experience a delay being incorporated into routine care. Aimed at closing this service delivery gap, federal agencies are championing the use of implementation science strategies and quality improvement initiatives. The establishment of a Stakeholder Council (SC) was one unique mechanism the Mental Health Quality Enhancement Research Initiative (MH QUERI) utilized to involve key partners—or stakeholders—throughout the course of the research continuum. The SC was a unique, collaborative, consultation service that allowed researchers access to key partner feedback at multiple points throughout the research process, from project conceptualization to data interpretation and dissemination. This article presents the heuristic model for implementation of the MH QUERI SC, outlines the context in which the SC is implemented, describes in detail each of the four stages of implementation, and discusses lessons learned and preliminary implications of the SC.

Past suicidal behaviors are among the strongest and most consistent predictors of eventual suicide and may be particularly salient in military suicide. The current study compared characteristics of suicide attempts in veterans (N = 746) and active-duty service members (N = 1,013) receiving treatment for acute suicide risk. Baseline data from six randomized controlled trials were pooled and analyzed using robust regression. Service members had greater odds of having attempted suicide relative to veterans, though there were no differences in number of attempts made. Service members also had higher rates of premilitary suicide attempts and nonsuicidal self-injury (NSSI). Veterans disproportionately attempted suicide by means of overdose. In veterans, combat deployment was associated with lower odds of lifetime suicide attempt, while history of NSSI was associated with greater attempt odds. Neither was significantly associated with lifetime suicide attempt in service members. Implications for suicide assessment and treatment are discussed.

Five articles appear in a special section of this issue of the journal reporting analyses of data pooled from clinical trials funded by the Department of Defense on interventions for active-duty service members and veterans at risk of suicide. An overview of the studies contributing data and participant characteristics is provided. The rationale for pooling data along with the costs and benefits of such efforts is discussed. It is concluded that utilizing pooled data, in keeping with efforts being conducted by other large funders of clinical trials, is challenging but that the benefits outweigh the costs. The articles in the special section are useful for clinicians, researchers, and policymakers.