Exploring the Efficacy of an Anger Management Programme for Veterans with Post-Traumatic Stress Disorder
Abstract: Objective: This study assessed the efficacy of a two-week residential treatment programme to support anger difficulties in veterans diagnosed with PTSD. Methods: 172 participants with a diagnosis of PTSD and co-morbid difficulties with anger completed a standardised two-week residential treatment based upon cognitive behaviour therapy and Dialectical Behaviour Therapy principles. The intervention consisted of a mixture of group sessions and individual therapy. Participants were asked to complete a range of health outcomes pre- and post-treatment and three months later. 85 participants (49.4%) were followed up three months after treatment. Primary outcomes were measures of anger and aggression and secondary outcomes included other mental health difficulties. Results: No differences in terms of baseline health outcomes and demographic characteristics were evident between those followed up and participants lost to follow-up. Significant reductions on the primary outcome measures of anger and aggressive behaviour were observed post-treatment. Examination of mean scores on the DAR-5 suggested anger difficulties was at subthreshold levels following treatment. Significant, but more modest reductions were observed for symptoms of PTSD, depression and anxiety. Individuals who were unemployed, not in relationships or being defined as being early service leavers from the military had poorer treatment outcomes. In addition, higher rates of pre-treatment depression were associated with lower treatment efficacy. Conclusions: Whilst limitations exist, findings from the study suggest cautious optimism for the treatment of anger in veterans with co-morbid PTSD.
Abstract: Introduction: Persistent inequities exist in obstetric and neonatal outcomes in military families despite universal health care coverage. Though the exact underlying cause has not been identified, social determinants of health may uniquely impact military families. The purpose of this study was to qualitatively investigate the potential impact of social determinants of health and the lived experiences of military individuals seeking maternity care in the Military Health System. Materials and methods: This was an Institutional Review Board-approved protocol. Nine providers conducted 31 semi-structured interviews with individuals who delivered within the last 5 years in the direct or purchased care market. Participants were recruited through social media blasts and clinic flyers with both maximum variation and homogenous sampling to ensure participation of diverse individuals. Data were coded and themes were identified using inductive qualitative research methods. Results: Three main themes were identified: Requirements of Military Life (with subthemes of pregnancy notification and privacy during care, role of pregnancy instructions and policies, and role of command support), Sociocultural Aspects of the Military Experience (with subthemes of pregnancy as a burden on colleagues and a career detractor, postpartum adjustment, balancing personal and professional requirements, pregnancy timing and parenting challenges, and importance of friendship and camaraderie in pregnancy), and Navigating the Healthcare Experience (including subthemes of transfer between military and civilian care and TRICARE challenges, perception of military care as inferior to civilian, and remote duty stations and international care). Conclusions: The unique stressors of military life act synergistically with the existing health care challenges, presenting opportunities for improvements in care. Such opportunities may include increased consistency of policies across services and commands. Increased access to group prenatal care and support groups, and increased assistance with navigating the health care system to improve care transitions were frequently requested changes by participants.