Gender Differences in OEF/OIF Veterans’ Partnerships and PTSD Symptomology

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Research has shown that Veterans experience better clinical outcomes and are more consistently engaged in mental health treatment when their families are involved in their mental health care. While recent changes in Department of Veterans Affairs (VA) policy place greater emphasis on family involvement in Veterans' mental health care, rates of family psychotherapy provision remain low (under four percent) and have not increased as a proportion of total mental health care service use. More troubling, rates of family psychotherapy for female Veterans are declining as a proportion of service use, despite preliminary evidence that women may benefit most from family involvement. The proposed project will identify patterns of behaviors within marital and cohabitating partnerships that support Veterans' recovery from PTSD and successful family reintegration post-deployment, paying particular attention to gender differences in these associations. Further understanding of the basic processes within partnerships that facilitate or hinder Veterans' reintegration will help providers more effectively engage families in Veterans' mental health care. The proposed mentored career development award (CDA-1) application details a two-year plan that will provide training to advance candidate Dr. Holly Laws toward a career as an independent researcher at the VA. The project aims to identify patterns of behavior within marital and cohabiting partnerships that are related to male and female Veterans' recovery from PTSD and successful family reintegration as they separate from military service. To accomplish this goal, Dr. Laws will leverage her expertise in dyadic (or two-person) multilevel data analysis and will integrate training in three new areas: 1) VA family research and psychotherapy initiatives, 2) gender differences in Veterans' experiences, and 3) PTSD course, treatment, and evaluation. Mentors expert in these areas will guide Dr. Laws' training activities, provide project mentorship, and support her professional development as an early career VA family researcher. Research that includes both Veterans and their partners is only beginning to be conducted regularly, with a majority of prior research relying on Veterans' self-reports of their relationships and well-being. This means that VA clinicians have a mandate to include Veterans' families members (most often spouses or partners) in their mental health care, with only limited research indicating how partners' unique characteristics and perspectives can help Veterans' mental health treatment. Further, there are no published studies that compare the partnerships of female Veterans to those of male Veterans. The proposed study aims to address these two gaps in the current research on Veteran couples by examining how relationship qualities such as distress, trauma disclosure, and conflict relate to PTSD symptoms and family reintegration in Veterans after discharge from military service. The specific contributions of this project are twofold. First, it will differentiate partnership processes as reported by Veterans from those reported by their partners. By disentangling these perspectives, findings can be used to inform Veteran- and partner-specific intervention and engagement strategies in couples' psychotherapy. Second, this project will identify gender differences in how relationship qualities relate to male Veterans' versus female Veterans' well- being. Results from the proposed work will inform a CDA-2 proposal to apply these findings in the development of an evaluation and screening tool that incorporates gender-specific information to meet the differential family engagement needs of male versus female Veterans. A more fine-grained understanding of how processes within partnership relate to the well-being of male and female Veterans could inform targeted psychosocial interventions to change maladaptive patterns within partnerships, or to reinforce those associated with Veterans' improved well-being.