The Together Programme: Supporting Caregiving Partners of veterans
Abstract: In a recent analysis conducted by Combat Stress of UK, partners living alongside veterans with mental health difficulties, rates for depression and PTSD were higher compared to the external population (depression 39% Vs 20%, PTSD 17% Vs 3%. (Murphy, Palmer & Busuttil, 2016). As such this suggests the high burden of need within this group. The support currently available here in the UK mainly comprises of peer based support. Whilst research indicates the positive impact peer led groups can have, the clinical severity of partners symptoms implies a need for more structured, bespoke and evidence based intervention. To this end, a bid for funding to support the development of an evidence based intervention ‘The Together Programme’ for UK veterans partners was made and kindly awarded by The Royal British Legion in 2016. Based on review findings, two US psychoeducational programmes, SAFE and Homefront Strong (see glossary) which have been found to be effective and well accepted within the US military population were selected as the most appropriate base to devloop a UK specific injtervention to support military partners.
Abstract: Background: Exposure to potentially morally injurious events (PMIEs) during military service can lead to moral injury (MI) outcomes and posttraumatic stress symptoms (PTSS). This longitudinal study examined the relationships between PMIE exposure, MI outcomes, and PTSS among Israeli combat veterans, and the potential protective role of dispositional forgiveness in these associations. Method: Participants were 169 Israeli combat veterans who participated in a six-year longitudinal study with four measurement points (T1: 12 months before enlistment, T2: Six months following enlistment- pre-deployment, T3: 18 months following enlistment- post-deployment, and T4: 28 months following discharge). Participants’ characteristics were assessed via semi-structured interviews (T1) and validated self-report measures (T2-T4) between 2019-2024. Results: Approximately 36% of participants reported exposure to PMIEs during service, with 13% exceeding the clinical threshold for probable PTSD at T4. PMIE-Betrayal at T3 was positively associated with MI outcomes of shame and trust violation at T4. The indirect effect of PMIEs on PTSS through MI outcome-Shame depended on forgiveness levels. Among veterans with low forgiveness, higher exposure to PMIE-Betrayal was associated with increased MI shame, which was linked to more severe PTSS. Conversely, for those with high forgiveness, exposure to PMIE-Self and Other was associated with decreased MI shame and subsequently reduced PTSS. Conclusion: Dispositional forgiveness moderates the relationship between PMIE exposure and MI outcomes, particularly shame, which mediates the development of PTSS. These findings highlight forgiveness as a potential target for intervention in treating moral injury and preventing PTSS among combat veterans.