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Evaluation ViewAttendees 3

Couples / Close Relationships
Symposia

Symposium 73 - Learning from Risk Studies in Military and Veteran Couples: Embracing Complexity Across Levels of Care

Saturday, November 16, 2024
10:30 AM – 11:30 AM EST
Location: Grand Ballroom K/L, Level 5, Downtown Marriott
CE: 1

Keywords: Couples / Close Relationships, Military, Veterans
Level of Familiarity: Basic to moderate
Recommended Readings: Karney, B. R., & Crown, J. S. (2007). Families under stress: An assessment of data, theory, and research on marriage and divorce in the military (Vol. 599). Rand Corporation.,   Curry, S. J., Krist, A. H., Owens, D. K., Barry, M. J., Caughey, A. B., Davidson, K. W., ... & US Preventive Services Task Force. (2018). Screening for intimate partner violence, elder abuse, and abuse of vulnerable adults: US Preventive Services Task Force final recommendation statement. Journal of the American Medical Association, 320(16), 1678-1687. https://doi.org/10.1001/jama.2018.14741,   Baucom, D. H., Whisman, M. A., & Paprocki, C. (2012). Couple‐based interventions for psychopathology. Journal of Family Therapy, 34(3), 250-270.  https://doi.org/10.1111/j.1467-6427.2012.00600.x,   Joiner, T. (2005). Why people die by suicide. Harvard University Press.,  

Relationship health has strong bidirectional links to mental health concerns such as posttraumatic stress disorder, substance use disorders, and suicidal thoughts, and these patterns have been replicated in U.S. military couples (Whisman et al., 2020, 2021). Unfortunately, private couple therapists and community clinics frequently redirect “complex couples” to individual mental health treatment. While some reasons are structural (e.g., insurance), another barrier may be the clinician’s own concerns about understanding and monitoring risk in a couple therapy context. Ultimately, this results in a status quo where the ability to pursue fulfilling relationships becomes a privilege of mental wellness. In contrast, the U.S. Department of Defense (DoD) and the Department of Veterans Affairs (VA), have broad directives to both offer relationship services to individuals with mental health concerns and to include concerned significant others in mental health treatment whenever appropriate and desired. This has led to multiple relationship health initiatives and trials of conjoint approaches to mental health treatment in both systems. This symposium features studies examining the relationships of individuals presenting to these treatment across a range of clinical severity, from couples presenting to an upstream relationship education program to couples where one partner has been psychiatrically hospitalized for suicide risk. By examining clinical characteristics when couples present to care, these studies aim to develop generalizable insights about risk management that have relevance beyond the treatments studied. The first half of our symposium uses large samples to predict negative relationship outcomes and support risk identification. Our first speaker focuses on a sample of 608 U.S. Army couples (n=1,216 individuals) enrolled in a DoD RCT of relationship education. By examining divorce outcomes over an eight-year period, the results will provide insights on how and when to best help distressed couples. Our second speaker uses VA medical record data from 275,305 Relationship Health and Safety screens given in 2019. Analyses identify predictors of intimate partner aggression (IPA) broadly and specific high-risk IPA behaviors to identify opportunities for selective prevention. The second half of our symposium uses data from smaller trials of higher-risk couples to provide guidance for risk management. The third speaker looks at screening data for 31 couples (n=62 individuals) referred by a VA provider to an RCT of adjunctive relationship consultations. The authors note high rates of mental health concerns among partners, challenging the “identified patient” model used in disorder-specific couple therapies. Our final speaker presents baseline data from a DoD RCT of 91 psychiatrically hospitalized service members and their partners (n=182 individuals). Results indicate partners have moderate understanding of the service member's past-risk and low agreement on future risk, suggesting they need support discussing suicidal thoughts and behaviors. Finally, our discussant will draw on decades of experience supporting couple therapy trials in both civilian and military samples to integrate these talks.

Learning Objectives:

At the end of this session, the learner will be able to:
  1. Summarize risk and protective factors intimate partner violence and divorce.
  2. Distinguish the models of an "identified patient" vs. "mutual support."
  3. Consider strategies to address suicidal thoughts/behaviors in couple therapies.
  4. Long-term goal: We intend to help clinicians attend to risk for negative relationship outcomes in their work (esp. with military/veteran couples).
  5. Long-term goal: We hope to increase clinicians' motivation and comfort taking on and managing higher-risk couples in clinical care.

Presentations:

  • 10:30 AM – 11:30 AM EST
    (SYM 73) Risk of Divorce Among a Sample of U.S. Army Couples: Examining Marital Processes, SM Mental Health, and Military Experiences over Time

    Speaker: Mollie E. Shin, M.A. (she/her/hers) – University of Colorado Denver

    Co-author: Elizabeth Allen, Ph.D. – University of Colorado Denver

    Co-author: Howard Markman, Ph.D. – University of Denver

    Co-author: Galena Rhoades, Ph.D. (she/her/hers) – University of Denver

    Co-author: Scott M. Stanley, Ph.D. (he/him/his) – University of Denver

  • 10:30 AM – 11:30 AM EST
    (SYM 73) Factors Associated with Risk of Intimate Partner Aggression in a Large National Sample of Veterans

    Speaker: Hajra Usman, B.A. (she/her/hers) – San Francisco VA Health Care System

    Co-author: Dev Crasta, Ph.D. – VISN 2 Center of Excellence for Suicide Prevention

    Co-author: Grace McKee, Ph.D. – San Francisco VA Medical Center

    Co-author: Scott McDonald, Ph.D. – Central Virginia VA Medical Center

  • 10:30 AM – 11:30 AM EST
    (SYM 73) Exploring the Mental Health Concerns of Couples Presenting for Relationship Consultations: The Challenge of Picking a Focal Diagnosis When Treating a Trandiagnostic Problem

    Speaker: Dev Crasta, Ph.D. – VISN 2 Center of Excellence for Suicide Prevention

    Co-author: Peter Britton, Ph.D. (he/him/his) – Center of Excellence for Suicide Prevention, VA Finger Lakes Healthcare System

    Co-author: Stephen Maisto, PhD – Department of Clinical Psychology, Syracuse University; Center of Integrated Healthcare, Syracuse VA Medical Center

  • 10:30 AM – 11:30 AM EST
    (SYM 73) Accuracy and Predictors of Partner Knowledge of Suicidal Individuals' Suicide History and Future Risk: An Investigation in a Hospitalized Military Sample

    Speaker: Alexis M. May, Ph.D. – Wesleyan University

    Co-author: Julia Gillotti, B.A. – Wesleyan University

    Co-author: Ben Porter, Ph.D. (he/him/his) – Mississippi State University