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

多家庭团体致力于减少 mTBI 退伍军人的婚姻冲突和残疾

• 批准号: 8596550
• 负责人: AMY L DRAPALSKI
• 金额: --
• 依托单位: JAMES J PETERS VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-02-01 至 2018-01-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8596550
• 关键词: Address; Adoption; Affect; Afghanistan; Aftercare; Brain Concussion; Caregiver Burden; Caregivers; Clinical; Cognitive; Cognitive deficits; Communication; Community Integration; Comorbidity; Conflict (Psychology); Couples; Data; Diagnosis; Distress; Education; Educational workshop; Effectiveness; Emotional; Emotions; Empathy; Environment; Evidence based treatment; Family; Freedom; Group Meetings; Health education; Healthcare; Healthcare Systems; Household; Impaired cognition; Impairment; Incidence; Individual; Injury; Intervention; Interview; Iraq; Knowledge; Learning; Mediating; Memory; Mental Depression; Mental Health; Methods; Military Personnel; Modeling; Neurocognitive; Outcome; Paired Comparison; Participant; Post-Concussion Syndrome; Post-Traumatic Stress Disorders; Problem Solving; Process; Randomized; Randomized Clinical Trials; Recovery; Rehabilitation therapy; Relative (related person); Reporting; Research; Role; Services; Social support; Soldier; Specific qualifier value; Spouses; Symptoms; Therapeutic; Training; Traumatic Brain Injury; Unconscious State; Veterans; anger management; base; cognitive function; cohort; combat; community living; depressive symptoms; disability; emotion regulation; evidence base; improved; injured; intimate behavior; intimate partner violence; mental state; novel; operation; primary outcome; psychoeducation; psychoeducational; public health relevance; satisfaction; secondary outcome; service intervention; skills; skills training; therapy design

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.

描述（由申请人提供）： 轻度创伤性脑损伤 (mTBI) 是一种与短暂意识丧失或精神状态改变相关的损伤或脑震荡，影响了最近在伊拉克和阿富汗军事行动中受伤的士兵的 35%。高达 30% 的伤者报告有持续的躯体、情绪和认知脑震荡后症状 (PCS)，这可能会对家庭生活和重新融入社区产生不利影响。 54% 的 OEF/OIF 夫妇报告称，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。造成婚姻冲突的一个重要因素是 缺乏对退伍军人状况的了解以及帮助他弥补记忆和计划方面的常见缺陷所需的技能，这给家庭管理带来了挑战。尽管夫妻治疗 PTSD 的证据基础不断增加，但目前还没有针对患有 mTBI 的 OEF/OIF 退伍军人建立基于家庭的治疗方法，从而造成了严重的研究和服务差距。拟议的研究旨在通过评估一种新颖的多家庭团体治疗形式来填补这一空白，该治疗旨在通过培训配偶/伴侣帮助康复和雇用残疾人来改善患有 mTBI 的已婚/同居 OEF/OIF 退伍军人的社区融合（CI）。调整沟通和解决问题的技巧，以减少婚姻冲突并提高婚姻满意度。在 OEF/OIF 时代持续进行 mTBI DVBIC 筛查呈阳性并经 VA 鉴定临床访谈和蒙特利尔认知评估 (MoCA) 评分 e 19 确认的退伍军人 (N=180) 将被随机分配接受以下任一组： 1) 多家庭组夫妻 TBI (MFG-mTBI-C)，一项心理教育、康复和技能培养干预措施，包括 2 节多家庭教育讲习班，提供有关 TBI 和每两个月举行 12 次多家庭小组会议，提供与认知/情绪缺陷相关的问题解决和沟通技能培训；或 2) 每两个月举行 14 次多家庭小组会议，提供无技能的健康教育 训练。两种治疗之前都会进行 2-3 次单独的夫妇治疗。参与者将在治疗前、治疗后以及治疗后 6 个月接受评估。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）结果变量进行配对比较。假设：1）与健康教育组相比，接受 MFG-mTBI-C 治疗的退伍军人将表现出 CI、愤怒管理和社会支持使用方面的改善，并且配偶/伴侣的负担将减轻； 2) CI 的改善将通过婚姻满意度、退伍军人愤怒管理和社会支持的改善来调节； 3) 基线认知功能更完整的退伍军人在 CI、愤怒管理、社会支持和婚姻满意度方面将表现出更大的改善。如果有效，MFG-mTBI-C 有潜力帮助患有 mTBI 的退伍军人及其整个 VA 医疗保健系统的合作伙伴。