Best Practices
Standardizing the Use of Mental Health Screening Instruments in Patients With Pain
Incorporating screening modalities for anxiety and depression during patient visits for pain may reduce disease burden for patients with all 3...
Ryan Holliday is a Clinical Research Psychologist at the Rocky Mountain Regional VA Medical Center, Rocky Mountain Mental Illness Research, Education and Clinical Center (MIRECC) for Suicide Prevention in Aurora, Colorado and Assistant Professor in the Department of Psychiatry at the University of Colorado Anschutz Medical Campus. Nicholas Holder is an Advanced Research Postdoctoral Fellow at the San Francisco Veterans Affairs Health Care System, Sierra Pacific MIRECC, and in the Department of Psychiatry at the University of California, San Francisco School of Medicine. Jessica Wiblin is a VA Advanced Fellow in Women’s Health at the VA Los Angeles HSR&D CSHIIP (Center for the Study of Healthcare Innovation, Implementation, & Policy) in California. Alina Surís is a Clinical Professor in the Department of Psychiatry at the University of Texas Southwestern Medical Center in Dallas, Texas.
Correspondence: Ryan Holliday (ryan.holliday@va.gov)
Author disclosures
The authors report no actual or potential conflicts of interest with regard to this article.
Disclaimer
The opinions expressed herein are those of the authors and do not necessarily reflect those of Federal Practitioner, Frontline Medical Communications Inc., the US Government, or any of its agencies.
Although about 8.3% of the general adult civilian population will be diagnosed with posttraumatic stress disorder (PTSD) in their lifetime, rates of PTSD are even higher in the veteran population.1,2 PTSD is associated with a number of psychosocial consequences in veterans, including decreased intimate partner relationship functioning.3,4 For example, Cloitre and colleagues reported that PTSD is associated with difficulty with socializing, intimacy, responsibility, and control, all of which increase difficulties in intimate partner relationships.5 Similarly, researchers also have noted that traumatic experiences can affect an individual’s attachment style, resulting in progressive avoidance of interpersonal relationships, which can lead to marked difficulties in maintaining and beginning intimate partner relationships.6,7 Despite these known consequences of PTSD, as Dekel and Monson noted in a review,further research is still needed regarding the mechanisms by which trauma and PTSD result in decreased intimate partner relationship functioning among veterans.8 Nonetheless, as positive interpersonal relationships are associated with decreased PTSD symptom severity9,10 and increased engagement in PTSD treatment,11 determining methods of measuring intimate partner relationship functioning in veterans with PTSD is important to inform future research and aid the provision of care.
To date, limited research has examined the valid measurement of intimate partner relationship functioning among veterans with PTSD. Many existing measures that comprehensively assess intimate partner relationship functioning are time and resource intensive. One such measure, the Timberlawn Couple and Family Evaluation Scales (TCFES), comprehensively assesses multiple pertinent domains of intimate partner relationship functioning (ie, structure, autonomy, problem solving, affect regulation, and disagreement/conflict).12 By assessing multiple domains, the TCFES offers a method of understanding the specific components of an individual’s intimate partner relationship in need of increased clinical attention.12 However, the TCFES is a time- and labor-intensive observational measure that requires a couple to interact while a blinded, independent rater observes and rates their interactions using an intricate coding process. This survey structure precludes the ability to quickly and comprehensively assess a veteran’s intimate partner functioning in settings such as mental health outpatient clinics where mental health providers engage in brief, time-limited psychotherapy. As such, brief measures of intimate partner relationship functioning are needed to best inform clinical care among veterans with PTSD.
The primary aim of the current study was to create a psychometrically valid, yet brief, self-report version of the TCFES to assess multiple domains of intimate partner relationship functioning. The psychometric properties of this measure were assessed among a sample of US veterans with PTSD who were in an intimate partner relationship. We specifically examined factor structure, reliability, and associations to established measures of specific domains of relational functioning.
Ninety-four veterans were recruited via posted advertisements, promotion in PTSD therapy groups/staff meetings, and word of mouth at the Dallas Veterans Affairs Medical Center (VAMC). Participants were eligible if they had a documented diagnosis of PTSD as confirmed in the veteran’s electronic medical record and an affirmative response to currently being involved in an intimate partner relationship (ie, legally married, common-law spouse, involved in a relationship/partnership). There were no exclusion criteria.
Incorporating screening modalities for anxiety and depression during patient visits for pain may reduce disease burden for patients with all 3...
A literature review of the stresses of caregivers of active-duty service members and veterans with a traumatic brain injury provides clinicians...
No significant difference was seen in between-class adherence when comparing SSRIs, SNRIs, bupropion, and mirtazapine during a 3-month study of...
SAN FRANCISCO – Veteran survivors of military sexual trauma are often reluctant to report assaults, but some therapies can help.