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: 9188775
• 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: 2014-03-01 至 2019-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9188775
• 关键词: Address; Adoption; Affect; Afghanistan; Aftercare; Brain Concussion; Caregiver Burden; Clinical; Cognitive; Cognitive deficits; Communication; Communities; Community Integration; Comorbidity; Conflict (Psychology); Couples; Custom; Data; Diagnosis; Distress; Education; Educational workshop; Effectiveness; Emotional; Emotions; Empathy; Evidence based treatment; Family; Freedom; Group Meetings; Health education; Healthcare; Healthcare Systems; Household; Impaired cognition; Impairment; Incidence; Individual; Injury; Intervention; Interview; Iraq; Knowledge; Learning; Life; Mediating; Memory; Mental Health; Methods; Military Personnel; Modeling; Neurocognitive; Outcome; Paired Comparison; Participant; Post-Concussion Syndrome; Post-Traumatic Stress Disorders; Problem Solving; Randomized; Randomized Clinical Trials; Recovery; Rehabilitation therapy; Reporting; Research; Role; Services; Social support; Soldier; Specific qualifier value; Spouses; Symptoms; Therapeutic; Training; Unconscious State; Veterans; anger management; base; cognitive function; cognitive testing; cohort; collaborative environment; combat; comorbid depression; depressive symptoms; disability; emotion regulation; evidence base; improved; injured; intimate behavior; intimate partner violence; mental state; mild traumatic brain injury; novel; operation; primary caregiver; primary outcome; psychoeducation; psychoeducational; public health relevance; satisfaction; secondary outcome; service intervention; skills; skills training; therapy design; treatment group

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）是与短暂的意识或精神状态改变有关的伤害或脑震荡，在最近在伊拉克和阿富汗的军事行动中，多达35％的士兵受伤了35％。在受伤的报告中，多达30％的报告持续的躯体，情感和认知后 - 脑震荡症状（PC）可能会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和延迟康复。造成婚姻冲突的关键因素是 缺乏有关退伍军人状况的知识以及帮助他弥补记忆和计划中常见缺陷所需的技能，这在家庭管理中带来了挑战。尽管对PTSD的夫妻治疗越来越多的证据基础，但尚无对MTBI的OEF/OIF退伍军人的建立基于家庭的治疗，从而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型的多家族小组治疗形式来填补这一空白，旨在通过培训配偶/合作伙伴来帮助康复和采用残障适应的沟通和解决越来越多的竞争性冲突并改善玛利亚冲突并改善婚姻满意度，旨在改善已婚/同居的已婚/同居OEF/OIF/OIF退伍军人与MTBI的社区融合（CI）。 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一项两项课程的多户教育研讨会，提供有关TBI和12个双月多户家庭小组会议的信息，提供与认知/情感缺陷有关的问题解决和沟通的技能培训；或2）14个两个月的多户会议，提供没有技能的健康教育 训练。两种治疗方法都将在2-3对夫妻会议之前。参与者将在治疗前和治疗后6个月进行评估。将使用意图对治疗分析对数据进行分析，并使用混合效应回归模型对初级治疗组（资深CI，看护人负担）和次级（愤怒管理，使用社会支持）进行配对的比较。假设：1）接受MFG-MTBI-C治疗的退伍军人将显示出改善的CI，愤怒管理和对社会支持的使用，与健康教育小组中治疗的退伍军人相比，配偶/伴侣的负担会减轻负担； 2）CI的改善将通过改善婚姻满意度以及退伍军人的愤怒管理和社会支持来调节； 3）在基线时具有更完整的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有所改善。如果有效的话，MFG-MTBI-C有可能在整个VA医疗保健系统中与MTBI及其合作伙伴协助退伍军人。