Publication year
2015
Citation Title
Exploration of individual and family factors related to community reintegration in veterans with traumatic brain injury
Journal Name
Journal of the American Psychiatric Nurses Association
Journal Volume
21
Issue Number
3
Page Numbers
195-211
DOI
10.1177/1078390315590315591879
Summary
This study explored the effect of community reintegration among Veterans who have a traumatic brain injury (TBI) diagnosis. Semi-structured interviews with Veterans and a family member as well as survey instruments assessed community reintegration, depressive symptoms, physical health, and relationship quality. Findings revealed that depression had a significant effect on how well Veterans reintegrated into their communities.
Key Findings
The quality of participants’ relationships did not have a significant influence on how well Veterans were able to reintegrate into their communities.
Veterans who reported more depressive symptoms tended to have less community reintegration.
Participants with less physical functioning engaged with their community less often than participants who had more physical functioning.
Implications for Program Leaders
Offer support groups for family members of Service members with a TBI to promote healthy coping and family well-being
Provide outreach services that increase awareness of available supports to families and Service members with a TBI
Develop workshops for Service members and their families on effective ways to allow for a smooth reintegration transition
Implications for Policy Makers
Recommend that all Service members with a TBI and their families be offered continual consultations with a mental health professional during the transition to civilian life
Recommend that programs for Service members leaving the military provide information about Veteran Affairs (VA) benefits, especially benefits pertaining to Service members with a TBI and their families
Recommend professional education on improving diagnosis of depression among Service members and their families
Methods
Participants were recruited from the Philadelphia VA Medical Center via letter in the mail.
Veterans and family members participated in separate semi-structured interviews that were conducted in their home exploring their experiences with a TBI and community reintegration.
Data was also collected from the VA Patient Record System, including Veteran measures of community reintegration, depressive symptoms, relationship quality, physical functioning, body pain, PTSD, and family member depressive symptoms.
Participants
Veterans (N = 83) with a TBI diagnosis and one family member of their choice participated in this study
Average Veteran age was 40 years (SD = 13.0) and average family member age was 42 years (SD =1 2.5); a majority of family members were spouses of Veterans (n=59).
The race of the participants was predominantly White (Veterans = 58%; family members = 60%), followed by Black (Veterans = 35%; family members = 31%), Native American (Veterans = 2%), Asian-Americans (Veterans = 1%; family members = 4%), and other (Veterans = 4%; family members = 5%).
Limitations
The study findings cannot be generalized to civilians with a TBI or Veterans who do not use VA services.
Due to the cross-sectional design of this study, data were not applicable to the long-term effects of community reintegration on Veterans with a TBI.
The study findings are of Veterans who had family members within close proximity, thus limiting the generalizability to Veterans who may be more isolated or have lower community reintegration.
Avenues for Future Research
Utilize a larger sample of participants that includes both Service members and non-Service members with a TBI
Collect longitudinal data to examine the effects of community reintegration on participants with a TBI over a longer period of time
Evaluate the effects of community reintegration in Service members who are more isolated from their families
Focus
Multiple Branches
Target Population
Population Focus
Military Branch
Military Component
Abstract
Objective: This study evaluates the longitudinal outcomes of Families OverComing Under Stress (FOCUS), a family-centered preventive intervention implemented to enhance resilience and to reduce psychological health risk in military families and children who have high levels of stress related to parental wartime military service. Method: We performed a secondary analysis of evaluation data from a large-scale service implementation of the FOCUS intervention collected between July 2008 and December 2013 at 15 military installations in the United States and Japan. We present data for 2,615 unique families (3,499 parents and 3,810 children) with completed intake and at least 1 postintervention assessment. Longitudinal regression models with family-level random effects were used to assess the patterns of change in child and parent (civilian and military) psychological health outcomes over time. Results: Improvement in psychological health outcomes occurred in both service member and civilian parents. Relative to intake, parental anxiety and depression symptoms were significantly reduced postintervention, and these reductions were maintained at 2 subsequent follow-up assessments. In addition, we identified an improvement over time in emotional and behavioral symptoms and in prosocial behaviors for both boys and girls. We observed reductions in the prevalence of unhealthy family functioning and child anxiety symptoms, as well as parental depression, anxiety, and posttraumatic stress symptoms from intake to follow-up. Conclusion: Longitudinal program evaluation data show sustained trajectories of reduced psychological health risk symptoms and improved indices of resilience in children, civilian, and active duty military parents participating in a strength-based, family-centered preventive intervention.
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