Strong Military Families Intervention Enhances Parenting Reflectivity And Representations In Families With Young Children

Military families face many challenges due to deployment and parental separation, and this can be especially difficult for families with young children. The Strong Military Families (SMF) intervention is for military families with young children, and consists of two versions: the Multifamily Group, and a Home‐based psychoeducational written materials program. The Multifamily Group was designed to enhance positive parenting through both educational components and in vivo feedback and support during separations and reunions between parents and children (n = 78 parents). In the present study, we examine parenting reflectivity and mental representations in mothers versus fathers in military families, service members versus civilian spouses/parenting partners, and before versus after participation in the SMF Multifamily Group and Home‐based interventions. Parenting reflectivity and mental representations were coded from the Working Model of the Child Interview (WMCI; C.H. Zeanah & D. Benoit, 1995). Results suggest that neither parenting reflectivity nor WMCI typology differs between mothers and fathers in military families, or between service members and civilian parenting partners. Furthermore, there was substantial stability in parenting reflectivity and WMCI typology from baseline to posttest, but participation in the Multifamily Group, relative to Home‐based, was associated with improvements in both parenting reflectivity and WMCI ratings from baseline to postintervention.RESUMENLas familias militares enfrentan muchos retos debido a las distantes asignaciones de servicio y la separación de los padres, lo cual puede ser específicamente difícil para familias con niños pequeños. La intervención Familias Militares Fuertes (SMF) es para familias militares con niños pequeños y consta de dos versiones: un Grupo Múltiple de Familias y un programa sicoeducativo de materiales escritos con base en casa. El Grupo Múltiple de Familias se diseñó para mejorar la crianza positiva tanto a través de componentes educativos como de reacciones y apoyo en vivo durante las separaciones y reuniones entre padres y niños (n = 78 padres). En el presente estudio, examinamos el poder de reflexión sobre la crianza y las representaciones mentales en mamás vs. papás en familias militares, miembros del servicio militar vs. cónyuges civiles/parejas conyugales en la crianza, y antes vs. después de la participación en el Grupo Múltiple de Familias SMF y en las intervenciones con base en casa. El poder de reflexión sobre la crianza y las representaciones mentales se codificaron usando el Modelo de Trabajo de la Entrevista del Niño –WMCI‐ (Zeanah y Benoit, 1995). Los resultados sugieren que ni el poder de reflexión ni la tipología del WMCI difieren entre mamás y papás en familias militares, o entre miembros del servicio militar y sus parejas conyugales civiles en la crianza. Es más, se dio una estabilidad de importancia en el poder de reflexión y la tipología WMCI entre el punto de referencia y la examinación posterior, pero la participación en el Grupo Múltiple de Familias, en relación con la intervención en casa, se asoció con mejoras tanto en el poder de reflexión como en los puntajes WMCI entre el punto de referencia y la intervención posterior.RÉSUMÉLes familles de militaires font face à de nombreux défis du fait des déploiements et de la séparation parentale, et cela peut s’avérer particulièrement difficile pour les familles avec de jeunes enfants. L’intervention Familles Militaires fortes (ici abrégé en français FMF, SMF en anglais, pour Strong Military Families) est destinée aux familles de militaires avec de jeunes enfants et consiste en deux versions: un Groupe Multifamilial, et une intervention à domicile avec programme de matériel psychoéducatif écrit. Le Groupe Multifamilial a été conçu afin de mettre en valeur le parentage positif à travers des composantes éducatives et du feedback in vivo et du soutien durant les séparations et les réunions entre les parents et les enfants (n = 78 parents). Dans cette étude nous examinons la réflectivité de parentage et les représentations mentales chez les mères et les pères de familles de militaires, les membres du service comparés aux épouses civiles et aux partenaires de parentage civils, et avant par rapport à après la participation au Groupe Multifamilial FMF et les interventions à domicile. La réflectivité de parentage et les représentations mentales ont été codées à partir du Modèle de Travail de l’Entretien de l’Enfant (Zeanah & Benoit, 1995). Les résultats suggèrent que ni la réflectivité de parentage ni le Modèle de Travail de l’Entretien de l’Enfant ne diffèrent entre les mères et les pères dans les familles militaires ou entre les membres du service et les partenaires de parentage civils. De plus il y avait une stabilité importante dans la réflectivité de parentage et la typologie du Modèle de Travail de l’Entretien de l’Enfant du niveau de référence jusqu’après le test, mais la participation au Groupe Multifamilial, par rapport à la participation à domicile, était liée à des améliorations dans à la fois la réflectivité de parentage et les scores du Modèle de Travail de l’Entretien de l’Enfant du niveau de référence à après l’intervention.ZUSAMMENFASSUNGMilitärische Familien stehen durch den Einsatz und die Trennung der Eltern vor vielen Herausforderungen, was besonders für Familien mit Kleinkindern schwierig sein kann. Die Intervention „Strong Military Families“ (SMF) richtet sich an Militärfamilien mit Kleinkindern und besteht aus zwei Versionen: Aus einer Mehrfamiliengruppe und einem psychoedukativen schriftlichen Materialprogramm für Zuhause. Die Mehrfamiliengruppe wurde entwickelt, um die positive Elternschaft sowohl durch pädagogische Komponenten als auch durch in vivo Feedback und Unterstützung bei Trennungen und Wiedervereinigungen zwischen Eltern und Kindern (n = 78 Eltern) zu fördern. In der vorliegenden Studie untersuchen wir die Reflektivität und mentalen Repräsentationen von Eltern bei Müttern vs. Vätern in militärischen Familien, Dienstmitgliedern vs. zivilen Ehepartnern/Erziehungspartnern und vor vs. nach der Teilnahme an der SMF Mehrfamiliengruppe und psychoedukativen Intervention Zuhause. Die elterliche Reflektivität und mentalen Repräsentationen wurden aus dem “Working Model of the Child Interview” (WMCI; Zeanah & Benoit, 1995) kodiert. Die Ergebnisse deuten darauf hin, dass sich weder die elterliche Reflektivität noch die Typologie der WMCI zwischen Müttern und Vätern in Militärfamilien oder zwischen Dienstmitgliedern und zivilen Ehepartnern unterscheiden. Außerdem gab es eine beträchtliche Stabilität in der elterlichen Reflektivität und WMCI‐Typologie vom Beginn der Untersuchungen bis zum Post‐Test, aber die Teilnahme an der Mehrfamiliengruppe, im Vergleich zur psychoedukativen Intervention Zuhause, war mit Verbesserungen sowohl in der elterlichen Reflektivität als auch in der WMCI‐Bewertung vom Untersuchungsbeginn zur Post‐Intervention verbunden.抄録強い軍人家族介入 The Strong Military Families が、 幼い子どものいる家族における育児の内省性 Reflectivity と表象を増強する軍人家族は配属や親との分離のために多くの困難に直面する。そしてこれは幼い子どものいる家族には特に困難になり得る。強い軍人家族The Strong Military Families (SMF)介入は、幼い子どものいる軍人家族のためのもので、2つの型がある。それらは、複数家族グループと資料を用いて家庭で行う心理教育的プログラムである。複数家族グループは、教育的な要素および親子の分離と再会のその場でのフィードバックと支援の両者を通して、ポジティブな育児を増強するようにデザインされた(n = 78人の親)。この研究では、私たちは、軍人家族の母親対父親、軍人対民間人の配偶者/養育パートナー、そしてSMF複数家族グループと家庭での介入に参加前対参加後において、育児の内省性と心的表象を調査した。育児の内省性と心的表象は、the Working Model of the Child Interview (Zeanah & Benoit, 1995) によってコード化された。結果から、軍人家族の母親と父親、あるいは軍人と民間人の養育パートナーの間に、育児の内省性あるいはWMCIタイプについて違いは示されなかった。さらに、基準線からテスト後にかけて、育児の内省性およびWMCIタイプにかなりの安定性があったが、家庭におけるプログラムに比べて、複数家族グループに参加することは、育児の内省性およびWMCI評価の両者の基準線から介入後への改善と関連していた。摘要強大軍人家庭干預增強在有子女家庭中的育兒反思能力和表現由於軍事部署和父母在不同地方居住, 軍人家庭面臨許多挑戰, 這些挑戰對於有小孩的家庭尤其嚴重。強大軍人家庭干預 (SMF) 是為有小孩的軍人家庭進行的干預, 包括兩個版本: 一個多家庭小組和一個家庭式的心理教育書面材料計劃。多家庭小組旨在通過教育丶反饋和支持, 在父母與子女 (78名父母) 的分離和團聚期間, 加強積極的父母教養。在本研究中, 我們考察在軍人家庭丶服務人員與平民配偶/養育夥伴的父母, 以及參與 SMF 多家庭小組和家庭式干預前後的父母反思和心理表徵。我們以兒童訪談的工作模式 (Zeanah&Benoit, 1995), 編碼父母反思能力和心理表徵。結果表明, 在軍人家庭父母之間, 或服務人員和平民養育夥伴之間, 父母反思能力和WMCI類型學並無不同。此外, 從基線到測試後, 父母反思能力和WMCI類型相當穩定, 但和家庭式干預相比, 多家庭小組的參與, 與從基線到干預後的父母反思能力和WMCI評分之改善相關。ملخصالتدخل القوى عند العائلات العسكرية يعزز الأداء التأملي الوالدي والتمثيلات الذهنية في الرعاية الوالدية للعائلات تجاه أطفالهم الصغارالعائلات العسكرية تواجه كثيرا من التحديات بسبب حركات التنقل العسكري والانفصال بين الوالدين وهذا يكون أشد صعوبة بالنسبة للعائلات ذوي الأطفال الصغار. التدخل القوي للعائلات العسكرية (SMF) هو برنامج يتكون من جانبين: مجموعة متعددة الأسر وبرنامج منزلي للمواد التعليمية النفسية المكتوبة. تم تشكيل المجموعة متعددة الأسر لتعزيز الرعاية الوالدية الإيجابية من خلال مكونات تعليمية وتغذية مرتدة ودعم أثناء فترات انفصال الأسر ولم الشمل بين الوالدين والأطفال (n = 78). في الدراسة الحالية نستخدم الأداء التأملي الوالدي والتمثيلات الذهنية عند الأمهات مقابل الآباء في الأسر العسكرية وأفراد الخدمة بالمقارنة مع الأزواج والوالدين المدنيين وكذلك المقارنة بين قبل وبعد المشاركة في برنامج (SMF). تم ترميز الأداء التأملي الوالدي والتمثيلات الذهنية من خلال النموذج العامل للمقابلة الشخصية مع الطفل (زينة وبينوا 1995). تشير النتائج إلى عدم اختلاف الأداء التأملي الوالدي ونمط النموذج العامل لمقابلة الطفل (WMCI) بين الآباء والأمهات في الأسر العسكرية أو بين أفراد الخدمة والأزواج والآباء المدنيين. بالإضافة إلى ذلك كان هناك استقرار جوهري في الأداء التأملي الوالدي ونمط النموذج العامل بين خط البداية والاختبار البعدي ولكن المشاركة في مجموعة متعددة الأسر بالمقارنة مع البرنامج المنزلي كانت مقترنة بتحسن في كل من الأداء التأملي الوالدي وتقييمات (WMCI) بين خط البداية وتدخل الاختبار البعدي.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/141683/1/imhj21690_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/141683/2/imhj21690.pd

Treatment‐Resistant Depression and Risk of Suicide

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/99660/1/sltb12022.pd

Determinants of National Guard Mental Health Service Utilization in VA versus Non‐VA Settings

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/134155/1/hesr12446.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/134155/2/hesr12446-sup-0001-AppendixSA1.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/134155/3/hesr12446_am.pd

Re-engagement in Psychotherapy for PTSD in Veterans

This infographic summarizes the findings of: Buchholz, K.R., Bohnert, K.M., Pfeiffer, P.N., Valenstein, M., Ganoczy, D., Anderson, R.E., & Sripada, R.K. (2017). Reengagement in PTSD psychotherapy: A case-control study. General Hospital Psychiatry, 48, 20-24. doi: 10.1016/j.genhosppsych.2017.06.009https://commons.und.edu/psych-pp/1000/thumbnail.jp

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. This manuscript describes training approaches, preliminary results, and explores future national dissemination.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/79148/1/j.1749-6632.2010.05719.x.pd

Validation of key behaviourally based mental health diagnoses in administrative data: suicide attempt, alcohol abuse, illicit drug abuse and tobacco use

<p>Abstract</p> <p>Background</p> <p>Observational research frequently uses administrative codes for mental health or substance use diagnoses and for important behaviours such as suicide attempts. We sought to validate codes (<it>International Classification of Diseases, 9^thedition, clinical modification </it>diagnostic and E-codes) entered in Veterans Health Administration administrative data for patients with depression versus a gold standard of electronic medical record text ("chart notation").</p> <p>Methods</p> <p>Three random samples of patients were selected, each stratified by geographic region, gender, and year of cohort entry, from a VHA depression treatment cohort from April 1, 1999 to September 30, 2004. The first sample was selected from patients who died by suicide, the second from patients who remained alive on the date of death of suicide cases, and the third from patients with a new start of a commonly used antidepressant medication. Four variables were assessed using administrative codes in the year prior to the index date: suicide attempt, alcohol abuse/dependence, drug abuse/dependence and tobacco use.</p> <p>Results</p> <p>Specificity was high (≥ 90%) for all four administrative codes, regardless of the sample. Sensitivity was ≤75% and was particularly low for suicide attempt (≤ 17%). Positive predictive values for alcohol dependence/abuse and tobacco use were high, but barely better than flipping a coin for illicit drug abuse/dependence. Sensitivity differed across the three samples, but was highest in the suicide death sample.</p> <p>Conclusions</p> <p>Administrative data-based diagnoses among VHA records have high specificity, but low sensitivity. The accuracy level varies by different diagnosis and by different patient subgroup.</p

Isolated hepatic actinomycosis: a case report

<p>Abstract</p> <p>Introduction</p> <p>Actinomyces are slow growing, non-spore forming, gram-positive, branching bacilli that thrive in anaerobic and microareophilic conditions. Actinomyces are more commonly associated with oral and cervicofacial infections. Hepatic involvement in infections of the abdomen (known as isolated hepatic actinomycosis) is rare, accounting for only 5% of all cases of actinomycosis.</p> <p>Case presentation</p> <p>We present the case of a 75-year-old Caucasian woman with a 3-month history of night sweats, fever, chills, abdominal bloating, anorexia, weight-loss, and early satiety. The patient was found to have isolated hepatic actinomycosis infection after undergoing a laparotomy with a biopsy of the liver. The patient has now recovered.</p> <p>Conclusion</p> <p>Isolated hepatic actinomycosis is a rare and often overlooked etiology for a liver mass. Given its subacute presentation and nondescript symptomatology, physicians should be aware of this differential and the potential pitfalls in diagnosis and management.</p

Lateral hypothalamic stimulation: Stimulus-bound eating and self-deprivation

Research was undertaken in an attempt to clarify the relationship between stimulus-bound eating and self-deprivation produced by electrical stimulation of the lateral hypothalamus. It was hypothesized that if these two phenomena are mediated through a common population of feeding-related neurons, a significant correlation should be observed between these two behaviors. No significant relationship was discovered among the rats tested for both stimulus-bound eating and self-deprivation. Although this finding by itself does not rule out some role for feeding-related neural elements in stimulus-bound eating and self-deprivation, the present results provide no support for this view and suggest alternative explanations should be sought.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/23928/1/0000174.pd

Effect of Race and Sex on Primary Care Physicians' Diagnosis and Treatment of Late-Life Depression

To examine primary care physician (PCP) contributions toward racial and sex differences in the diagnosis and treatment of late-life depression. Design : Survey using a computerized instrument incorporating video interviews and text, with volunteer PCPs randomly assigned to one of four standardized video vignettes of an elderly patient depicting late-life depression. Vignettes differed only in the patient/actor's race (white/African-American) or sex. Setting : American Academy of Family Physicians meeting, San Diego, California, 2002. Participants : One hundred seventy-eight U.S.-practicing postresidency PCPs who were asked to participate in a clinical decision-making study. Measurements : The computerized survey instrument assessed PCPs' diagnoses, first-line treatment and management recommendations, and judgment of personal characteristics/behaviors for the patients in the vignettes. Results : Eighty-five percent of all PCPs correctly diagnosed the elderly patient(s) with major depression. There were no significant differences in the diagnosis of depression, treatment recommendations, or PCP assessment of most patient characteristics by the race or sex of the patient/actor in the vignette, but PCP characteristics, most notably the location of medical school training (U.S. vs international), affected the likelihood of a depression diagnosis and treatment recommendations. Conclusion : Given standardized symptom-pictures, PCPs are just as likely to diagnose and treat depression in African-American as in white older people, suggesting that bias based simply on apparent patient race is not a likely explanation for the lower rates of depression diagnosis and treatment in older African Americans. PCPs who have trained at international medical schools may benefit from targeted training initiatives on the diagnosis and treatment of late-life depression.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/65962/1/j.1532-5415.2005.53255.x.pd

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

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/108379/1/jts21942.pd