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            "title": "Risk and Resilience in U.S. Military Families",
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            "abstractNote": "War related separations challenge military families in many ways. The worry and uncertainty associated with absent family members exacerbates the challenges of personal, social, and economic resources on the home front. U.S. military operations in Iraq and Afghanistan have sent a million service personnel from the U.S. alone into conflict areas leaving millions of spouses, children and others in stressful circumstances. This is not a new situation for military families, but it has taken a toll of magnified proportions in recent times. In addition, medical advances have prolonged the life of those who might have died of injuries. As a result, more families are caring for those who have experienced amputation, traumatic brain injury, and profound psychological wounds.The Department of Defense has launched unprecedented efforts to support service members and families before, during, and after deployment in all locations of the country as well as in remote locations. Stress in U.S. Military Families brings together an interdisciplinary group of experts from the military to the medical to examine the issues of this critical problem.  Its goal is to review the factors that contribute to stress in military families and to point toward strategies and policies that can help. Covering the major topics of parenting, marital functioning, and the stress of medical care, and including a special chapter on single service members, it serves as a comprehensive guide for those who will intervene in these problems and for those undertaking their research.",
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            "version": 1,
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            "title": "Community re-integration problems and treatment preferences among OIF/OEF Veterans",
            "creators": [
                {
                    "creatorType": "author",
                    "firstName": "Nina A.",
                    "lastName": "Sayer"
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            "abstractNote": "BACKGROUND/RATIONALE:\nNearly 1.7 million US service members have been deployed to Iraq or Afghanistan since the beginning of America's engagement in the Global War on Terror. Service members returning from these deployments carry a high burden of mental disorders. High-profile cases of suicide and homicide among veterans of the wars in Iraq/Afghanistan provide further evidence of the reintegration problems these veterans face. Although Federal and state agencies have implemented programs to assist veterans with readjustment to civilian life, to our knowledge there has been no systematic study of the types of functional problems these new veterans face or the types of interventions they prefer as they reenter their communities. We know even less about the treatment preferences of this new generation of veterans which differs from earlier cohorts of veterans in terms of age, education, and comfort with technology.and community re-integration among new veterans.\n\nOBJECTIVE(S):\nThe primary objectives of this study were to describe the prevalence and types of community re-integration problems faced by Iraq and Afghanistan war veterans and to assess preferences for interventions to promote adaptation to civilian life. Secondarily, we explored variation in community reintegration problems and treatment interests by probable Posttraumatic Stress Disorder (PTSD), race and gender.\n\nMETHODS:\nWe surveyed a national, stratified sample of Iraq/Afghanistan combat veterans enrolled in the Department of Veterans Affairs (VA) health care system. Survey questions assessed reintegration problems, treatment preferences, and physical and mental health using screening measures with strong psychometric properties. Prevalence and proportions were weighted to represent the population of Iraq/Afghanistan combat veterans surveyed. We used stratified logistic regression models to construct odds ratios and 95% confidence intervals for community reintegration problems by probable PTSD status, gender and race adjusting for demographic characteristics that preceded deployment. Stratified Poisson regression was used to determine whether the number of community reintegration problems and the number of services of interest were associated with the presence of probable PTSD, gender or race. All analyses were first performed on responders and then were adjusted for potential non-response bias based on administrative data by constructing response propensities and producing a weighted combination of within-propensity class estimates.\n\nFINDINGS/RESULTS:\nOf 1,226 veterans surveyed, 754 (62%) responded. An estimated 25% to 56% of the population had some to extreme difficulty in social functioning, productivity, community involvement, and self-care domains. At least one third reported divorce, dangerous driving, increased substance use and anger control problems since returning from deployment. Difficulty getting along with one's spouse was more common among nonWhite compared with White veterans. An estimated 41% had probable posttraumatic stress disorder (PTSD) and each type of reintegration problem was more prevalent among veterans with probable PTSD. The vast majority (96%) of Iraq/Afghanistan veterans expressed interest in services to help them readjust to civilian life. The most commonly preferred ways to receive reintegration service or information was at a VA facility, through the mail, and over the internet. Veterans with probable PTSD and female veterans expressed interest in more types of services than other veterans. Interest in self-help techniques and yoga/meditation was particularly common among women.\n\nIMPACT:\nIraq/Afghanistan war veterans reported multiple functional and reintegration problems, which were particularly prevalent among those with probable PTSD. The types of services these veterans most frequently wanted are typically not provided in health care settings. New strategies are needed to deliver readjustment services.\n\nPUBLICATIONS:\n\nJournal Articles\n\n   1. Carlson KF, Gravely AA, Noorbaloochi S, Simon AB, Bangerter AK, Sayer NA. Post-deployment injury among new combat veterans enrolled in Veterans Affairs (VA) healthcare. Injury Prevention : Journal of The International Society For Child and Adolescent Injury Prevention. 2011 Oct 1; 17(5):343-7.\n   2. Bangerter A, Gravely A, Cutting A, Clothier B, Spoont M, Sayer N. Brief report: Comparison of methods to identify Iraq and Afghanistan war veterans using Department of Veterans Affairs administrative data. Journal of rehabilitation research and development. 2010 Jan 1; 47(8):815-21.\n\nConference Presentations\n\n   1. Sayer NA, Frazier P, Orazem R, Murdoch M, Abel MD, Carlson KF, Gravely AA, Noorbaloochi S. Psychometric Properties of a Measure of Post-Deployment Community Reintegration Difficulty. Paper presented at: VA HSR&D National Meeting; 2011 Feb 17; National Harbor, MD.\n   2. Sayer NA. Reintegration problems and treatment preferences among Veterans returning from Iraq and Afghanistan with and without probable PTSD. Paper presented at: Trauma Spectrum Disorders Annual Conference; 2010 Dec 7; Bethesda, MD.\n   3. Carlson KF, Sayer NA, Gravely AA, Noorbaloochi S. Risk of medically-treated injuries among Iraq and Afghanistan combat Veterans. Paper presented at: American Public Health Association Annual Meeting and Exposition; 2009 Nov 9; Philadelphia, PA.\n   4. Sayer NA, Noorbaloochi S, Frazier P, Carlson KF, Gravely A, Murdoch M. Reintegration Problems and Treatment Preferences among Recent Veterans - New Directions for Trauma Research. Paper presented at: American Psychological Association Annual Convention; 2009 Aug 7; Toronto, Canada.\n   5. Carlson KF, Sayer NA, Gravely AA, Noorbaloochi S. Potential Risk Factors for Post-Deployment Injury among Combat Veterans. Poster session presented at: Society for Epidemiologic Research Annual Meeting; 2009 Jun 25; Anaheim, CA.\n   6. Sayer NA, Noorbaloochi S, Frazier P, Murdoch M, Carlson K, Gravely A, Baines A. Reintegration Problems and Treatment Preferences among Veterans Returning from Iraq and Afghanistan with and without Probable PTSD. Paper presented at: VA HSR&D National Meeting; 2009 Feb 12; Baltimore, MD.\n\n\n\nDRA: Military and Environmental Exposures\nDRE: Treatment - Observational, Prevention\nKeywords: Caregivers – not professionals, Patient preferences, PTSD\nMeSH Terms: none",
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            "title": "Re-integration stress for Desert Storm families: Wartime deployments and family trauma",
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                    "firstName": "J H",
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            "abstractNote": "Because the war was relatively brief, casualties relatively light, and the Nation sanctioned the war socially, veterans of Desert Shield/Storm and their families were not anticipated to suffer symptoms of trauma or re-entry stress beyond that expected in routine peacetime military deployments. However, the authors argue that the stress imposed on families by Desert Shield/Storm was not analogous to that of routine deployments. The call to duty was unexpected, disruptive, and \"hazardous\" (i.e., highly dangerous) which places it in the category of a \"catastrophic\" stressor as defined by McCubbin and Figley (1983). The deployment was a call to war, which creates unique stress beyond those experienced during peacetime deployments. The deployment also carried with it prolonged \"anticipation of trauma.\" For these reasons, the authors argue, the deployment to Desert Shield/Storm created a situation of \"family trauma\" for veterans and their families. Suggestions are offered for education, prevention and treatment for families undergoing unexpected wartime military deployments.",
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            "abstractNote": "The requirements of an effective and modern military force frequently result in military personnel being separated from their families for extended periods of time. Today's specialized work force and dual income family structures also demand family separations. Such separations change family dynamics and functions. Although stressed, most families eventually adjust, only to face even more challenges once the family reunites. Experiencing such new stressors can create negative effects for the family in their long term functioning and reintegration. In turn, such difficulties present obstacles to corporate and military retention, readiness, and performance rates.\n     Set within the framework of Hamilton McCubbin's Double ABCX Family Stress Theory, this study replicated earlier findings that stressors, resources and family appraisal interacted to determine the family outcome of reintegration. These findings were based on the analysis of 85 written surveys and six in-depth interviews. Instruments of measurement included the Family Satisfaction Scale which assessed family functioning and the dependent variable reintegration; the Family Changes and Strains Scale which measured stressors; and the Family Cop8ing Scale and a resources scale which measured support. Using correlation co-efficient and regression",
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                    "firstName": "Gert J",
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            "abstractNote": "Objective: To examine the effects of a residential community reintegration programme for patients with psychosocial problems due to acquired chronic brain injury on caregivers' emotional burden and family functioning. Design: A prospective cohort study with waiting list control and 1-year follow-up. Subjects: Forty-one caregivers of which 28 female. Mean age was 48 ± 8.3 years and 33 caregivers were parents. Intervention: A structured residential treatment programme was offered to the patients directed at domestic life, work, leisure time and social interactions. Measures: The Involvement Evaluation Questionnaire for Brain Injury (IEQ-BI) for emotional burden, the General Health Questionnaire (GHQ) for psychological health and the Family Assessment Device (FAD) for family functioning were used. Results: There was an overall significant effect of Time for all outcome measures (MANOVA T(2 )= 9.1, F(15,317) = 64.1, p = 0.000). The effect sizes were moderate for three IEQ-BI sub-scales (partial η(2 )= 0.12-0.17) and small for two sub-scales (partial η(2 )= 0.05-0.09). The effect size for GHQ was moderate (partial η(2 )= 0.11). As for FAD no significant time effects were present (partial η(2 )= 0.00-0.04). Conclusions: Emotional burden and psychological health of the caregivers improved significantly when patients with acquired brain injury and psychosocial problems followed a residential community reintegration programme. Family dynamics remained stable.",
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