Immediate Impact of a Brief Suicide Prevention Training for Veteran Volunteers

ABSTRACT: Introduction. The concern that talking about suicide may intensify suicidal ideation is a common fear that has been dispelled by research, yet still lingers in popular consciousness. The aim of the current initiative was to develop a brief suicide prevention training for volunteers in a peer support program for veterans, given that layperson-facing approaches are critical to the U.S. national strategy for suicide prevention. Method. The study team adapted existing pedagogical approaches for use in a brief training and for a veteran population, and implemented the training with five new volunteer groups over 5 months (N = 45). Results. Anonymous pre- and posttraining questionnaires indicated immediate statistically significant improvements in self-reported preparation to talk openly about suicide, likelihood of asking about suicide, confidence in recognizing warning signs of suicide, and confidence in intervening and involving the National Suicide Hotline. Discussion. The project begins to demonstrate that self-reported suicide prevention knowledge and skills show immediate improvements after a brief training module nested within a broader new volunteer training. This work should support efforts to develop and implement research studies on brief suicide prevention training approaches in order to determine the extent to which they change behavior longitudinally and, ultimately, reduce rates of suicide. Read More...

Authors: Lapidos, A., Spinner, J., Garlick, J., Kees, M.

Navigating Toward Academic Success: Peer Support for Student Veterans

ABSTRACT: Student veterans have been an important presence on college campuses since the passage of the 1944 Montgomery GI Bill in support of World War II veterans. The Post-9/11 Veterans Education Assistance Program, or Post-9/11 GI Bill, took effect in 2009, and more than one million people benefited during its first four years (U.S. Department of Veterans Affairs, 2013). An estimated five million people will be classified as post-9/11 veterans by 2020, significantly increasing the potential use of these benefits (U.S. Government Accountability Office, 2013). Peer-support programs offer an innovative and effective approach for helping student veterans and the academic institutions they attend make the best use of the large-scale investment in veteran education. This chapter describes Peer Advisors for Veteran Education (PAVE), a nationwide peer program designed to help student veterans achieve personal and academic success. Read More...

Authors: Kees, M., Risk, B., Meadowbrooke, C., Spinner, J.L., Valenstein, M.

Fathers’ Perspectives on Strengthening Military Families: A Mixed Method Evaluation of a 10-Week Resiliency Building Program

ABSTRACT: A recent Institute of Medicine report on “The Assessment or Readjustment Needs of Veterans, Service Members, and Their Families” (2013) underscored the need for effective support for military families with young children, and that effective engagement into existing services remains a challenge. This mixed-method study involved 14 fathers (previously deployed military) who engaged in the Strong Military Families Program, a resiliency-building group for families with young children. The purpose of this paper was twofold: first, to identify the efficacy of this brief intervention for reducing mental health symptomatology among previously deployed military fathers who completed the group, and second to better understand the perceptions and reflections of fathers who completed an effective symptom management program in order to fill the literature gap around this issue and guide future efforts at increasing engagement of this population. Pre- and post-group assessments were administered including depression and posttraumatic stress symptom ratings. Assessments also included interviews designed to elicit fathers’ expectations before the program and to capture their reflections after completion. Quantitative analyses examined changes in symptoms pre- to post-group, and qualitative analyses aimed to better understand fathers’ experiences and help guide future efforts to increase engagement of this population. A grounded theory approach was employed to analyze interview content, and two themes were identified reflecting a desire for (1) connection and (2) learning. The prominence of these themes both before and after group underscored the value of connection to others who shared experience and opportunity for learning effective parenting strategies. Corresponding quantitative analyses indicated a significant decrease in self-reported posttraumatic stress (p < .05) and trend level reduction in depression (p < .10), suggesting participation may contribute to more effective symptom management. Subgroup analyses contrasting the pre-group interviews of fathers who endorsed higher (n = 9) versus lower (n = 5) levels of symptoms revealed that those with greater symptomatology expressed more themes related to fear of committing to the program. Discussion will focus on effective outreach and engagement, and the need to align programs to the interests of previously deployed fathers of young children. Read More...

Authors: Dodge, J., Gonzalez, M., Muzik, M., Rosenblum K.

Peer Advisors for Veteran Education (PAVE): Implementing a Sustainable Peer Support Program for Student Veterans on College Campuses

ABSTRACT: Student veterans have been attending college in greater numbers since the passing of the Post/9-11 GI Bill. Although similar to other nontraditional students, student veterans face unique transition challenges that can affect their pursuit of higher education. Many student veterans could benefit from dedicated programs to help them succeed in college, which in turn would enable them to secure employment in the civilian world. Facilitating the success of student veterans also makes wise use of the financial and institutional resources invested in their education. Peer support programs can help by providing an established community of other student veterans who can normalize transition experiences, offer social support, reduce stigma associated with help-seeking, and connect to useful services on and off campus. This paper describes the iterative development of a nationwide peer support program for student veterans, Peer Advisors for Education (PAVE), which uses trained peers to provide outreach, support, and linkage to resources to assist student veterans. Through a hybrid technology platform for training and program management, PAVE has been delivered on 40 college campuses nationwide and is well-positioned for larger scale national rollout. Read More...

Authors: Kees, M., Risk, B., Meadowbrooke, C., Nellett, T., Spinner, J.

Couples Coping Through Deployment: Findings from a Sample of National Guard Families

ABSTRACT: Military families face numerous changes and stresses as they negotiate deployments and other life transitions. How they cope with these events is an important part of their overall wellbeing and resilience. This longitudinal study on coping in a sample of National Guard couples examined the association between the predeployment coping (active vs. avoidant) of each in the relationship, and their own and their significant others’ mental health (anxiety, depression, posttraumatic stress disorder [PTSD]) and family well-being (dyadic adjustment and parenting stress) postdeployment. Read More...

Authors: A. J., Bowles, R. P., Farero, A., Subramaniam, S., Lappan, S., Nichols, E., Gorman, L., Kees, M., & Guty, D.

The Special Case of Civilian Service Members: Supporting Parents in the National Guard and Reserves

National Guard and Reserve (NG/R) service members have been central to fighting the Global War on Terror, with more than 675,000 National Guard and Reserve troops deployed in combat since 2001 (U.S. Department of Defense, 2012 ). National Guard and Reserve families are also cycling through these military deployments, with 46 % of NG/R service members married and nearly 43 % with children
(U.S. Department of Defense, 2014 ). Researchers and clinicians have started to consider the unique needs of NG/R families, particularly because they may experience frequent, lengthy deployments that can be related to increases in stress and other adverse mental health disorders (Blow et al., 2012 ). Some stressors may be similar to those faced by service members in active duty, while other stressors may
differentially impact Active Duty and Reserve Component families.

Authors: Schuh, A. & Kees, M., Blow, A., Gorman, L.

A Comparative Case Study of Risk, Resiliency, and Coping Among Injured National Guard

ABSTRACT: An injury during deployment disrupts family and life functioning. The purpose of the present study was to provide an in-depth examination of three injured National Guard soldiers showing how differential experiences of navigating multiple systems to obtain treatment for injury resulted in different adjustment trajectories for these soldiers and their families. A comparative case study examined three families where a soldier’s injury was a central theme of family adjustment. Qualitative data were drawn from interviews conducted conjointly with both the soldier and spouse to provide an in-depth perspective of adjustment, meaning, and resource utilization patterns. In addition, survey data were collected at three time points in the deployment cycle (predeployment, 90 days post, and 1 year). These data were integrated into the case analysis, including mental health, marital relationship, treatment history, and characteristics of resilience. Study findings suggest that a delay in diagnosis, wait time for treatment, and the lack of comprehensive formal and financial support for a soldier following nonhostile injury lead to a pileup of stressors that are detrimental to the soldier’s physical and mental health, financial stability, and family well-being. Further study is needed to understand how these system level issues impede resilience among National Guard families. Read More...

Authors: Gorman, L.A., Huebner, A.J., Hirschfeld, M.K., Sankar, S., Blow, A.J., Guty, D., Kees, M., & J.S. Ketner

Changing the Personal Narrative: A Pilot Study of a Resiliency Intervention for Military Spouses

ABSTRACT: The more than decade long tempo of war has taken a considerable toll on military families, with the rates of mental health concerns in non-deployed spouses on the rise. To date, few evidence-based programs exist to meet the unique needs of military spouses. The current study presents early findings from the development and implementation of HomeFront Strong (HFS), an 8 week group-based resiliency intervention designed to support military spouses through deployment transitions. In three group cohorts, 20 women completed the HFS intervention, and 14 of those participants provided evaluation data at the pre-group and 3 month follow up (3MFU) assessments, including a semi-structured interview designed to elicit a personal narrative about deployment experiences. Thematic analyses of the personal narratives demonstrated that negative cognitions (e.g., helplessness; feeling unsupported) about deployment were associated with higher rates of depression prior to group participation. At 3MFU, personal narratives included more positive cognitions and fewer negative cognitions, suggesting that HFS changed the way spouses thought about their deployment experiences. Moreover, participants reported fewer symptoms of depression, higher levels of social support, and greater life satisfaction at 3MFU. While this Phase I study is small and lacks a comparison group, the demonstration of positive results is promising and warrants further attention. Read More...

Authors: Kees, M., Nerenberg, L., Bachrach, J., & Somers, L.

Evaluation of a Psychological Health and Resilience Intervention for Military Spouses: A Pilot Study

ABSTRACT: The decade long conflicts in Iraq and Afghanistan have placed considerable strain on military families. Given robust data showing high rates of deployment-related psychological health problems in spouses and children, and the near absence of evidence-based psychological health programs for military families in the community, interventions are urgently needed to support and strengthen spouses as they adjust to deployment transitions and military life experiences. This Phase 1 pilot study evaluated the feasibility and acceptability of a resiliency intervention for military spouses in civilian communities (HomeFront Strong; HFS), and generated preliminary efficacy data regarding impacts on psychological health and adjustment. Through two group cohorts, 14 women completed the intervention, with 10 women providing pre- and postgroup assessment data. Findings support feasibility of the intervention and high rates of program satisfaction. Participants reported learning new strategies and feeling more knowledgeable in their ability to use effective coping skills for managing deployment and military-related stressors. Participation in HFS was also associated with reduction in levels of anxiety and perceived stress, and improvements in life satisfaction and life engagement. HFS is a promising community-based intervention for military spouses designed to enhance resiliency, reduce negative psychological health symptoms, and improve coping. Read More...

Authors: Kees, M. & Rosenblum, K.

Socioeconomic Status and Mental Health Service Use Among National Guard Soldiers

Objective: Convergent evidence suggests that low socioeconomic status (SES) may be related to reduced mental health service use. However, this relationship has not been tested in the National Guard (NG) population, in which the prevalence of mental health symptoms is high.

Methods: Surveys were completed by 1,262 NG soldiers. SES was measured by education and income. Adjusted multivariable regression models assessed associations between SES, overall service use, and use of specific types of services.

Results: SES was not associated with overall use but was associated with use of certain types of services. Higher SES was associated with lower likelihood of psychotropic medication use (odds ratio5.83, 95% confidence interval5.72–.96), and higher SES strengthened the positive relationship between PTSD and use of individual therapy.

Conclusions: Higher SES may increase the use of individual therapy among soldiers with PTSD. Barriers to care among individuals with low SES merit continued attention and outreach efforts. Read More...

Authors: Sripada, R.K., Richards, S.K.H., Rauch, S.A.M., Walters, H., Ganoczy, D., Bohnert, K.M., Gorman, L.A., Kees, M., Blow, A.J., & Valenstein, M.

Reported Barriers to Mental Health Care in Three Samples of U.S. Army National Guard Soldiers at Three Time Points

ABSTRACT: 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]). Read More...

Authors: Valenstein, M., Gorman, L., Blow, A. J., Ganoczy, D., Walters, H., Kees, M., Pfeiffer, P. N., Kim, H. M., Lagrou, R., Wadsworth, S.M., Rauch, S. A. M. and Dalack, G. W.

Strong, Safe, and Secure: Negotiating Early Fathering and Military Service Across the Deployment Cycle

ABSTRACT: Military fathers of young children often endure repeated separations from their children, and these may disrupt the early parent–child relationship. Postdeployment reunification also poses challenges; disruptions that have occurred must often be repaired in the context of heightened emotions on the part of each family member at a time when fathers are themselves readjusting to the routines and responsibilities of family life. The current study employed qualitative research with the central aim of informing a richer understanding of these experiences. Interviews were conducted with 14 military fathers of young children who had experienced separation from their families during deployment. Narratives were coded using principles of grounded theory, and common parenting themes were extracted. Fathers shared their hopes that their young children would develop qualities of strength, confidence, and self-sufficiency. They also discussed difficulty in supporting the development of these qualities in their young children due to problems dealing with the negative emotions and difficult behaviors that their children exhibited. Reliance on their parenting partner was commonly cited as an effective strategy as fathers transitioned back to family life. Implications for intervention programs include the provision of parenting and self-care skills and inclusion of the father’s parenting partner in the intervention. Read More...

Authors: Dayton, C.J., Walsh. T.B., Muzik, M., Erwin, M., Rosenblum, K.L.

Strong Military Families: A Multifamily Group Approach to Strengthening Family Resilience

ABSTRACT: Military Families frequently display remarkable resilience in the face of significant challenges, and yet deployment and parental separation are significant stressors for parents, particularly those with infants and young children. The Strong Military Families preventive intervention is a multifamily parenting and self-care skills group that aims to strengthen protective factors and promote military family resilience. In this article the authors present the core pillars of the Strong Military Families program and how they contribute to the strengthening of protective factors that help parents cope with stressors and promote family resilience. Read More...

Authors: Rosenblum, K., Muzik, M., Waddell, R., Thompson, S., Rosenberg, L., Masini, G., Smith, K.

Hazardous Drinking and Family Functioning in National Guard Veterans and Spouses Postdeployment

ABSTRACT: The current study examined rates of alcohol misuse among National Guard (NG) service members and their spouses/partners, concordance of drinking behaviors among couples, and the effects of alcohol misuse, depression, and posttraumatic stress disorder (PTSD) on three measures of family functioning. This study is important because it addresses the topics of heavy drinking and family functioning in an at-risk population—NG service members returning from a combat zone deployment. We surveyed NG service members (1,143) and their partners (674) 45–90 days after returning from a military deployment. Service member rates of hazardous drinking were 29.2% and spouses/partners 10.7%. Of the 661 linked couples, 26.2% were discrepant where only one member met the criteria for hazardous drinking and 5.4% were congruent for alcohol misuse where both members met hazardous drinking criteria. Service members belonging to either congruent or discrepant drinking groups were more distressed in their marriages/relationships than those in the nonhazardous group. In dyadic analyses, an unexpected partner effect was found for parenting outcomes; that is, when service members drink more, their spouses/partners are less stressed when it comes to parenting. Importantly, both service member and spouse/partner depression was significantly associated with negative family outcomes. Results from this study suggest that when working with these families, it is important to understand the drinking status of both soldier and spouse and to treat depression in addition to alcohol misuse. Read More...

Authors: Blow, A.J., Ganoczy, D., Kees, M., Kashy, D., Valenstein, M., Gorman, L., Marcus, S.M., Fitzgerald, H.E., Chermack, S.F.

Peers and Peer-Based Interventions in Supporting Reintegration and Mental Health Among National Guard Soldiers

ABSTRACT: National Guard soldiers experience high levels of mental health symptoms following deployment to Iraq and Afghanistan, yet many do not seek treatment. We interviewed 30 National Guard soldiers with prior deployments to Iraq or Afghanistan to assess mental health treatment barriers and the role of peers in treatment engagement. Interview transcripts were analyzed by a multidisciplinary research team using techniques drawn from grounded theory. The following themes were identified: (1) personal acceptance of having a mental health problem rather than treatment access is the major barrier to treatment entry; (2) tightly connected, supportive peer networks can decrease stigma related to mental health problems and encourage treatment; however, soldiers in impoverished or conflicted peer networks are less likely to receive these benefits; and (3) soldiers are generally positive about the idea of peer-based programs to improve treatment engagement, although they note the importance of leadership support, peer assignment, and unit specialty in implementing these programs. We conclude that some, but not all, naturally occurring peer networks serve to overcome stigma and encourage mental health treatment seeking by soldiers. Formal peer-based programs may assist soldiers not sufficiently benefitting from natural peer networks, although there are barriers to implementation. Read More...

Authors: Pfeiffer, P.N., Blow, A.J., Miller, E., Dalack, G.W., Valenstein, M.

Fathering After Military Deployment: Parenting Challenges and Goals of Fathers of Young Children

ABSTRACT: Although often eagerly anticipated, reunification after deployment poses challenges for families, including adjusting to the parent–soldier’s return, re-establishing roles and routines, and the potentially necessary accommodation to combat-related injuries or psychological effects.  Fourteen male service members, previously deployed to a combat zone, parent to at least one child under seven years of age, were interviewed about their relationships with their young children.  Principles of grounded theory guided data analysis to identify key themes related to parenting young children after deployment.  Participants reported significant levels of parenting stress and identified specific challenges, including difficulty reconnecting with children, adapting expectations from military to family life, and co-parenting.  Fathers acknowledged regret about missing an important period in their child’s development and indicated a strong desire to improve their parenting skills.  They described a need for support in expressing emotions, nurturing, and managing their tempers.  Results affirm the need for support to military families during reintegration and demonstrate that military fathers are receptive to opportunities to engage in parenting interventions.  Helping fathers understand their children’s behavior in the context of age-typical responses to separation and reunion may help them to renew parent–child relationships and reengage in optimal parenting of their young children. Read More...

Authors: Walsh, T.B., Dayton, C.J., Erwin, M.S., Muzik, M., Busuito, A., and Rosenblum, K.

Civilian Employment Among Recently Returning Afghanistan and Iraq National Guard Veterans

OBJECTIVE: National Guard service members face deactivation from active duty soon after they return to the United States and rapid entry into the civilian workforce; therefore, it is important to examine employment among these Veterans. Methods: The sample included 585 National Guard service members. Bivariate and multivariable analyses were conducted examining the associations between mental health symptoms, alcohol use, number of deployments, and combat exposure with employment status and full-time versus part-time employment as outcomes. Results: Fortyone percent of National Guard service members were employed 45 to 60 days following demobilization. Among those who were employed, 79% were employed full-time. Age, family income, and combat exposure were associated with employment; income and health status were associated with part-time versus full-time employment. Conclusions: Mental health status may not be strongly associated with initiating civilian employment among National Guard service members; however, better mental health status is associated with being employed full-time versus part-time. Read More...

Authors: Burnett-Zeigler I., Valenstein M., Ilgen M., Blow A., Gorman L.A., Zivin K.

Prevalence and Correlates of Alcohol Misuse Among Returning Afghanistan and Iraq Veterans

OBJECTIVE: Several studies have reported high rates of alcohol misuse and low rates of substance use treatment among OEF/OIF military service members. This study assessed the prevalence and correlates of alcohol misuse and the factors associated with treatment utilization among recently returned National Guard service members.

METHODS: The sample included 585 members of the National Guard who volunteered to complete an anonymous survey assessing mental health and substance use problems, functional status, and past treatment experiences. Bivariate and multivariate logistic regression analyses were performed examining the significance of associations between alcohol misuse and mental health service use as outcomes and demographic variables, mental health symptoms, and military service characteristics as predictors. Barriers to treatment and factors facilitating treatment were also examined.

RESULTS: Thirty-six percent of the service members met criteria for alcohol misuse. Of those misusing alcohol, 31% reported receiving any mental health treatment and 2.5% reported receiving specific substance use treatment in the past year. The barrier to treatment most commonly endorsed by those misusing alcohol was concern that the information about treatment would appear in their records. Among those misusing alcohol who had received services, spouses were most commonly endorsed as facilitating the pursuit of care.

CONCLUSIONS: Rates of alcohol misuse are high and rates of substance use treatment are low among National Guard service members. Additional research is needed to identify means of overcoming barriers to care and establish more effective approaches to facilitate linkage to care and receipt of appropriate interventions. Read More...

Authors: Burnett-Zeigler I, Ilgen M, Valenstein M, Zivin K, Gorman L, Blow A, Duffy S. Chermack, S.

Working Together to Meet the Needs of Army National Guard Soldiers: An Academic-Military Partnership

The conflicts in Afghanistan and Iraq have greatly increased the number of veterans returning home with combat exposure, reintegration issues, and psychiatric symptoms. National Guard soldiers face additional challenges. Unlike active duty soldiers, they do not return to military installations with access to military health services or peers. The authors describe the formation and activities of a partnership among two large state universities in Michigan and the Michigan Army National Guard, established to assess and develop programming to meet the needs of returning soldiers. The process of forming the partnership and the challenges, opportunities, and benefits arising from it are described. Read More...

Authors: Dalack, Gregory W, MD; Blow, Adrian J, PhD; Valenstein, Marcia, MD, MS; Gorman, Lisa, PhD; Spinner, Jane, MSW, MBA; et al.

Buddy-to-Buddy, A Citizen Soldier Peer Support Program to Counteract Stigma, PTSD, Depression, and Suicide

Citizen soldiers (National Guard and Reserves) represent approximately 40% of the two million armed forces deployed to Afghanistan and Iraq. Twenty-five to forty percent of them develop PTSD, clinical depression, sleep disturbances, or suicidal thoughts. Upon returning home, many encounter additional stresses and hurdles to obtaining care: specifically, many civilian communities lack military medical/psychiatric facilities; financial, job, home, and relationship stresses have evolved or have been exacerbated during deployment; uncertainty has increased related to future deployment; there is loss of contact with military peers; and there is reluctance to recognize and acknowledge mental health needs that interfere with treatment entry and adherence. Approximately half of those needing help are not receiving it. To address this constellation of issues, a private–public partnership was formed under the auspices of the Welcome Back Veterans Initiative. In Michigan, the Army National Guard teamed with the University of Michigan and Michigan State University to develop innovative peer-to-peer programs for soldiers (Buddy-to-Buddy) and augmented programs for military families. Goals are to improve treatment entry, adherence, clinical outcomes, and to reduce suicides. Read More...

Authors: John F. Greden, MD (1,3); Marcia Valenstein, MD, MS (1,2); Jane Spinner, MSW, MBA (1); Adrian Blow, PhD (4); Lisa A. Gorman, PhD (4); Gregory W. Dalack, MD (1); Sheila Marcus, MD (1); and Michelle Kees, PhD (1)
1 – University of Michigan Department of Psychiatry and Comprehensive Depression Center, University of Michigan, Ann Arbor, Michigan. 2 – Ann Arbor Veterans Administration Hospital, University of Michigan, Ann Arbor, Michigan. 3 – Molecular and Behavioral Neurosciences Institute, University of Michigan, Ann Arbor, Michigan. 4 – Michigan State University, Lansing, Michigan