Moral injury among first responders: Experience, effects, and advice in their own words.

Moral injury is a serious concern among first responders. Not only does moral injury occur with notable frequency among first response groups such as police, fire safety, and emergency medical personnel, but it also poses considerable mental health challenges. Despite a recent explosion of research on moral injury, the literature would benefit from a systematic investigation of how first responders describe their experiences in their own words. We conducted semistructured interviews with 36 graduates of a first responder trauma healing course. Participants described moral injury as (a) a byproduct of being a first responder, (b) occurring frequently but being difficult to identify, and (c) involving feelings of helplessness and guilt. Effects of moral injury included (a) wide-ranging negative consequences, (b) diminished self-esteem, (c) isolation from and suspicion of others, and (d) spiritual distress. When asked about the advice they would give to other people experiencing moral injury, first responders recommended (a) talking openly about the experience of moral injury, (b) being proactive in seeking help, (c) breaking free from the stigma of needing assistance, and (d) building a network of support. Taken together, these results suggest important guidelines for helping first responders cope with the aftermath of moral injury. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

The REBOOT First Responders Program: Insights of U.S. Graduates.

The REBOOT First Responders program offers spiritual care for occupational stress. Although prior work suggests benefits to the program, no research has considered attendees' experiences in an open-ended way. The aim of this study was to document first responders' thoughts about the effectiveness, evaluation, and effects of the course in their own words. Interviews with 36 graduates living in the U.S. indicated favorable perceptions of the course. Reasons for success included the program's tangible benefits, community atmosphere, and faith-based approach (RQ1). Strengths involved helping first responders realize they are not alone and educating them about trauma; recommended upgrades involved customizing to specific occupations and offering ongoing support (RQ2). Effects included more self-acceptance, enhanced spirituality, better relationships, a more constructive view of trauma, and greater optimism about the future (RQ3). These results have implications for improving spiritual care for first responders.

Relationship Maintenance among Military Couples.

A burgeoning body of research on the relationship maintenance of military couples over the past two decades suggests the time is right to organize, assimilate, and critique the literature. We conducted a systematic review informed by the integrative model of relationship maintenance (Ogolsky et al., 2017) that considered issues of intersectionality (Crenshaw, 1991). Our literature search identified 81 relevant journal articles representing 62 unique samples. With respect to theory, 59.3% of the journal articles employed one or more formal theoretical frameworks. In terms of research design, 88.7% of the studies focused on the U.S. military, 83.9% of the studies recruited convenience samples, 54.8% of the studies utilized quantitative methods, and 30.6% of the studies collected longitudinal data. Among the studies reporting sample demographics, 96.8% of participants were married, 77.2% of participants identified as non-Hispanic White, and only one same-sex relationship was represented. Our narrative synthesis integrated findings about relationship maintenance from studies examining (a) relationship maintenance overtly, (b) communicating to stay connected across the deployment cycle, (c) disclosure and protective buffering, (d) support from a partner, (e) dyadic coping, and (f) caregiving and accommodating a partner's symptoms. We interpret our results with an eye toward advancing theory, research, and practice.

Partner Effects: Analyzing Service Member and Spouse Drinking Over Time.

INTRODUCTION: Excessive alcohol use is a significant problem in the military. Although there is a growing emphasis on family-centered alcohol prevention approaches, little is known about the interplay between partners' drinking behaviors. This study examines how service members and their spouses influence each other's drinking behavior over time and explores the complex individual, interpersonal, and organizational factors that may contribute to alcohol use. METHODS: A sample of 3,200 couples from the Millennium Cohort Family Study was surveyed at baseline (2011-2013) and follow-up (2014-2016). The research team estimated how much partners' drinking behaviors influenced one another from baseline to follow-up using a longitudinal structural equation modeling approach. Data analyses were conducted in 2021 and 2022. RESULTS: Drinking patterns converged between spouses from baseline to follow-up. Participants' own baseline drinking had a small but significant effect on changes in their partners' drinking from baseline to follow-up. Results from a Monte Carlo simulation showed that the longitudinal model could reliably estimate this partner effect in the presence of several potential sources of bias, including partner selection. The model also identified several common risk and protective factors for drinking shared by both service members and their spouses. CONCLUSIONS: Findings suggest that changing the drinking habits of one spouse could lead to a change in the drinking habits of the other, which supports family-centered alcohol prevention approaches in the military. Dual-military couples especially may benefit from targeted interventions because they face a higher risk of unhealthy alcohol consumption.

A prospective study of marital distress and mental health symptoms across the deployment cycle.

Although recent findings imply that marital distress and mental health symptoms are intertwined among military personnel, a prospective longitudinal study is needed to evaluate the bidirectionality of the link between marital distress and mental health symptoms across the deployment cycle. We investigated over time associations using data from the Pre-Post Deployment Study component of the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS). Married soldiers (N = 2,585) reported on their marital distress, anxiety symptoms, depressive symptoms, and posttraumatic stress disorder (PTSD) symptoms 1 month before deploying to Afghanistan and 3 months and 9 months after they returned home. The data were analyzed using cross-lagged panel models, adjusting for a variety of demographic and military covariates (including deployment stress, measured 1 month after homecoming). Results indicated (a) no associations between marital distress and mental health symptoms during the 13-month lag from predeployment to postdeployment, (b) bidirectional associations between marital distress and symptoms of anxiety and depression during the 6-month lag from 3 to 9 months after homecoming, and (c) a unidirectional association from PTSD symptoms to marital distress during the 6-month lag from 3 to 9 months after homecoming. These findings shed light on a lingering debate about the directionality of the longitudinal association between marital distress and psychopathology. They also imply points of intervention to help buffer military personnel from the harmful effects of marital distress and mental health symptoms across the deployment cycle. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Spiritual care for combat trauma: A qualitative evaluation of REBOOT Combat Recovery.

Combat trauma experienced in a warzone can hamper the physical, mental, and spiritual health of military service members and Veterans for years afterward. Spiritual care for combat trauma is designed to help service members and Veterans find meaning and purpose in their experiences. One such spiritual care program is REBOOT Combat Recovery, a 12-week, Christian-based course led by trained volunteers across the country. An in-depth investigation of the REBOOT program is needed to advance knowledge of spiritual care for combat trauma and to assess the course in attendees' own words. Semi-structured interviews were conducted with 40 course graduates. Experiences of the course were positive. Interviewees identified the program's emphasis on peer fellowship, spirituality, and the roots of distress as reasons for its effectiveness (RQ1). The most helpful aspects of the program involved the hospitality and family focus; targets for improvement included maintaining fidelity to the curriculum and offering opportunities for continuity upon graduation (RQ2). Interviewees described a variety of ways the course affected their view of self, their relationship with God and others, and their perceptions of combat trauma (RQ3). These findings are valuable for enriching spiritual care, in general, and enhancing the REBOOT Combat Recovery program, in particular.

Applying Relational Turbulence Theory to Adult Caregiving Relationships.

Although the quality of the relationship between caregivers and care recipients predicts the well-being of both people, gaps exist in understanding the interpersonal dynamics of adult caregiving. We introduce relational turbulence theory as a conceptual framework for understanding how caregivers and care recipients relate to each other. We searched for research on relational turbulence theory as well as research on the relationships of adult care partners. Then, we integrated the two bodies of work. Our review suggests initial support for the theory's three central tenets: (a) transitions, including the transition to caregiving, are key periods within relationships; (b) relational uncertainty and interdependence are relationship parameters that complicate relating during transitions; and (c) relational turbulence predicts outcomes. Recommendations for practice include (a) helping care partners focus on relationship continuity, (b) gearing clinical services toward both people, (c) educating them about relational uncertainty and interdependence, and (d) teaching them communication strategies for diminishing relational turbulence. Making care partners aware of interpersonal challenges may bolster relationship satisfaction.

Mental health symptoms and the reintegration difficulty of military couples following deployment: A longitudinal application of the relational turbulence model.

OBJECTIVE: Understanding the factors that predict the reintegration difficulty of military couples during the postdeployment transition has important implications for theory, research, and practice. Building on the logic of the relational turbulence model, this paper evaluates the relationship processes of reunion uncertainty and reintegration interference from a partner as mediators of the connection between people's mental health symptoms and their difficulty with reintegration after deployment. METHOD: Dyadic longitudinal data were collected from 555 US military couples once per month for 8 consecutive months. RESULTS: Findings mapped the trajectory of reintegration difficulty and suggested reunion uncertainty and reintegration interference from a partner as mediators of the link between people's depressive and posttraumatic stress symptoms and the magnitude of their reintegration difficulty. CONCLUSION: These results highlight relationship processes as a key domain of intervention to preserve the well-being of military couples during the postdeployment transition.

Communication of military couples during deployment predicting generalized anxiety upon reunion.

This study draws on the emotional cycle of deployment model (Pincus, House, Christenson, & Adler, 2001) to consider how the valence of communication between military personnel and at-home partners during deployment predicts their generalized anxiety upon reunion. Online survey data were collected from 555 military couples (N = 1,110 individuals) once per month for 8 consecutive months beginning at homecoming. Dyadic growth curve modeling results indicated that people's anxiety declined across the transition. For at-home partners, constructive communication during deployment predicted a steeper decline in anxiety over time. For both returning service members and at-home partners, destructive communication during deployment predicted more anxiety upon reunion but a steeper decline in anxiety over time. Results were robust beyond the frequency of communication during deployment and a host of individual, relational, and military variables. These findings advance the emotional cycle of deployment model, highlight the importance of the valence of communication during deployment, and illuminate how the effects of communication during deployment can endure after military couples are reunited. (PsycINFO Database Record

Military children's difficulty with reintegration after deployment: A relational turbulence model perspective.

This study drew on the relational turbulence model to investigate how the interpersonal dynamics of military couples predict parents' reports of the reintegration difficulty of military children upon homecoming after deployment. Longitudinal data were collected from 118 military couples once per month for 3 consecutive months after reunion. Military couples reported on their depressive symptoms, characteristics of their romantic relationship, and the reintegration difficulty of their oldest child. Results of dyadic growth curve models indicated that the mean levels of parents' depressive symptoms (H1), relationship uncertainty (H2), and interference from a partner (H3) were positively associated with parents' reports of military children's reintegration difficulty. These findings suggest that the relational turbulence model has utility for illuminating the reintegration difficulty of military children during the postdeployment transition. (PsycINFO Database Record

Depressive symptoms, relational turbulence, and the reintegration difficulty of military couples following wartime deployment.

During reunion following wartime deployment, military couples are at risk for both depression and relationship distress (Bowling & Sherman, 2008). This article applies the relational turbulence model ( Knobloch & Theiss, 2011a ; Solomon & Theiss, 2011 ) to understand the difficulty military couples may experience upon homecoming. One hundred and eighteen military couples completed an online questionnaire once per month for the first 3 months upon reunion following wartime deployment. Multilevel modeling results indicated that people's depressive symptoms (H1), relational uncertainty (H2), and interference from partners (H3) predicted their difficulty with reintegration. A few partner effects were apparent as well. These findings illuminate the dynamics of the reunion period, extend the relational turbulence model, and suggest guidelines for helping military couples preserve well-being during reintegration following wartime deployment.

Comparing the interpersonal behavior of distressed couples with and without depression.

OBJECTIVE: This study compared the interpersonal behavior of distressed couples with depression in one partner (n = 23) to distressed couples without depression in either partner (n = 38). METHOD: Participants (mean age = 44 years old) were recruited at an urban outpatient mental health center. Couples discussed the three best things in their relationship, and their interactions were coded using Structural Analysis of Social Behavior (Benjamin, 1987). RESULTS: Self- and partner-focused hostility were associated with actors' and partners' relationship distress. Actors' hostility towards partners was positively associated with partners' depression status, but negatively associated with partners' depression symptoms. Actors' control behavior was positively associated with their relationship distress. Whereas the behavior of depressed individuals did not differ from a control sample of nondepressed individuals, partners of depressed individuals displayed more partner-focused hostility and submissiveness than controls. CONCLUSIONS: Results underscore the importance of considering partner effects when conceptualizing depression within distressed relationships.

Themes of relational uncertainty and interference from partners in depression.

This article draws on the relational turbulence model to illuminate the dynamics of depression in romantic relationships using a thematic analysis of online discourse. Three content areas of relational uncertainty were apparent: (a) depression uncertainty (questions about physical harm, source of depression, and understanding), (b) self and partner uncertainty (questions about helplessness and identity), and (c) relationship uncertainty (questions about physical intimacy, relationship satisfaction, and the future of the relationship). Three content areas of interference from partners also emerged: (a) daily routines (disruptions to household tasks; finances, work, and school; children and parenting; and family and social life), (b) personal well-being (disruptions to health and safety as well as treatment), and (c) the relationship (disruptions to sexual activity, emotional intimacy, and openness). Relational uncertainty and interference from partners coincided in people's experiences in seven ways. The article concludes by discussing the conceptual, empirical, and pragmatic implications of the findings.

Depressive symptoms and mechanisms of relational turbulence as predictors of relationship satisfaction among returning service members.

In contrast to romanticized portrayals of reunion after deployment, U.S. military personnel may contend with the harsh reality of both depressive symptoms and upheaval in their romantic relationships during the postdeployment transition. This study employed the relational turbulence model to evaluate mechanisms linking depressive symptoms with relationship satisfaction. Cross-sectional, self-report data were collected from 220 service members living in 27 states who had returned home from deployment within the past six months. As hypothesized, the negative association between depressive symptoms and relationship satisfaction was mediated by relational uncertainty and interference from partners. These findings advance scholarship on depressive symptoms and relational turbulence, and they also suggest guidelines for helping service members with depressive symptoms maintain satisfying romantic relationships upon reentry.