Multifamily Group to Reduce Marital Conflict and Disability in Veterans with mTBI

描述（由申请人提供）： 轻度创伤性脑损伤（mTBI）是一种与短暂的意识丧失或精神状态改变有关的损伤或脑震荡，在最近的伊拉克和阿富汗军事行动中，多达35%的士兵受伤。高达30%的受伤者报告持续的躯体、情感和认知脑震荡后症状（PCS），这可能对家庭生活和社区重新融合产生不利影响。54%的OEF/OIF夫妇报告的婚姻冲突和亲密伴侣暴力以及同时发生的心理健康问题可能会加剧认知功能障碍并延迟康复。婚姻冲突的一个关键因素是 缺乏对退伍军人状况的了解，也缺乏帮助他弥补记忆和计划方面常见缺陷的技能，这给家庭管理带来了挑战。尽管夫妻治疗PTSD的证据越来越多，但对于患有mTBI的OEF/OIF退伍军人没有建立以家庭为基础的治疗，这造成了关键的研究和服务差距。拟议的研究旨在通过评估一种新形式的多家庭小组治疗来填补这一空白，该治疗旨在通过培训配偶/伴侣来帮助康复并采用残疾适应性沟通和解决问题的技能来改善已婚/同居OEF/OIF退伍军人与mTBI的社区融合（CI），以减少婚姻冲突并提高婚姻满意度。在OEF/OIF时期持续存在mTBI的DVBIC筛查阳性的退伍军人（N = 180），经VA鉴定临床访谈和蒙特利尔认知评估（MoCA）评分e 19确认，将随机接受以下治疗之一：1）TBI夫妇多家庭小组（MFG-mTBI-C），一种心理教育，康复和技能建设干预，包括2个会议的多家庭教育讲习班，提供有关创伤性脑损伤和12个双每月举行一次多家庭小组会议，提供与认知/情感缺陷有关的解决问题和沟通方面的技能培训;或2）14次双月多家庭小组会议，提供无技能的健康教育 训练两种治疗之前都将进行2 - 3次单独的夫妻疗程。将在治疗前和治疗后以及治疗后6个月对受试者进行评估。将使用意向治疗分析对数据进行分析，并使用混合效应回归模型对治疗组之间的主要（退伍军人CI，护理人员负担）和次要（愤怒管理，社会支持的使用）结局变量进行配对比较。假设：1）与健康教育组中治疗的那些相比，用MFG-mTBI-C治疗的退伍军人将显示出改善的CI、愤怒管理和社会支持的使用，并且配偶/伴侣将显示出减轻的负担; 2）CI的改善将通过婚姻满意度和退伍军人愤怒管理和社会支持的改善来介导; 3）在基线时具有更完整认知功能的退伍军人将在CI，愤怒管理，社会支持和婚姻满意度方面表现出更大的改善。如果有效，MFG-mTBI-C有可能帮助退伍军人与mTBI和他们的合作伙伴在整个VA医疗保健系统。

DESCRIPTION (provided by applicant): Mild traumatic brain injury (mTBI), an injury or concussion associated with brief loss of consciousness or altered mental state, has affected as many as 35% of soldiers wounded during recent military actions in Iraq and Afghanistan. Up to 30% of those injured report persistent somatic, emotional and cognitive post- concussive symptoms (PCS) which may adversely impact family life and community re-integration. Marital conflict and intimate partner violence, reported by 54% of OEF/OIF couples, and co-occurring mental health problems may exacerbate cognitive dysfunction and delay rehabilitation. A key contributor to marital conflict is a lack of knowledge about the Veteran's condition and the skills needed to help him compensate for common deficits in memory and planning which create challenges in household management. Despite a growing evidence base for couples treatment for PTSD, there is no established family-based treatment for OEF/OIF Veterans with mTBI, creating a critical research and services gap. The proposed research aims to fill this gap by evaluating a novel form of multi-family group treatment designed to improve community integration (CI) among married/cohabiting OEF/OIF Veterans with mTBI by training spouse/partners to aid with rehabilitation and employing disability-adapted communication and problem-solving skills to reduce marital conflict and improve marital satisfaction. Veterans (N=180) with a positive DVBIC screen for mTBI sustained during the OEF/OIF era, confirmed by the VA Identification Clinical Interview and a Montreal Cognitive Assessment (MoCA) score e 19 will be randomized to receive either: 1) Multifamily Group for TBI for Couples (MFG-mTBI- C), a psychoeducational, rehabilitation and skills-building intervention consisting of a 2-session multifamily educational workshop providing information about TBI and 12 bi-monthly multifamily group meetings providing skills training in problem-solving and communication related to cognitive/emotional deficits; or 2) 14 bi-monthly multifamily group sessions delivering health education without skills training. Both treatments will be preceded by 2-3 individual couples sessions. Participants will be assessed pre- and post-treatment and 6 months post- treatment. Data will be analyzed using an intent-to-treat analysis with paired comparisons between treatment groups on primary (Veteran CI, caregiver burden) and secondary (anger management, use of social supports) outcome variables using mixed effects regression models. It is hypothesized that: 1) Veterans treated with MFG-mTBI-C will show improved CI, anger management and use of social support, and spouse/partners will show reduced burden compared with those treated in the health education group; 2) that improvement in CI will be mediated by improvement in marital satisfaction and Veteran anger management and social support; 3) that Veterans with more intact cognitive functioning at baseline will show greater improvement in CI, anger management, social support and marital satisfaction. If efficacious, MFG-mTBI-C has the potential to assist Veterans with mTBI and their partners throughout the VA Health Care System.