Effect of a Behavioral Intervention on Outcomes for Caregivers of Veterans with PTSD
Abstract: Caregivers of the approximately 9 million individuals in the US with Posttraumatic Stress Disorder (PTSD) face burdens that may seem overwhelming. In 2017, VA implemented the first national clinical program for caregivers of veterans with PTSD. Previous interventions have focused on caregivers more as adjuncts of persons with PTSD or included PTSD caregivers with other types of military/veteran caregivers. The REACH VA behavioral intervention, 4 one-hour sessions during 2 to 3 months, focusing on caregiver coping and managing PTSD-related concerns, was delivered centrally by telephone. In a pre/post intervention design, the 161 caregivers experienced statistically significant improvement in burden, depression, anxiety, frustrations, general stress, time providing care, number of and bother about troubling behaviors, and safety risks. Pre and post intervention improvements in burden and anxiety were also clinically significant. Reducing caregivers’ psychological distress can improve ability to provide care and positively affect health and safety of persons with PTSD. With REACH, VA has made major steps to support caregivers of veterans. The positive results of this implementation may also serve as a model to support PTSD caregivers in the general population.
Abstract: U.S. Air Force remotely piloted aircraft (USAF RPA) personnel face diverse stressors negatively affecting psychological health and military readiness. Prior research in diverse populations supports predictable impact of the COVID-19 pandemic on occupational stressors, burnout, and more distal outcomes. Extending earlier studies linking broad variables (e.g., COVID-19 threat → work stress → burnout), the current study tests and refines an expanded mediation model based on multiple distinct pandemic concerns, occupational stressors, and burnout facets as antecedents of psychological distress mid-pandemic in RPA personnel (N = 496). Differential representation of demands, resources, and rewards evident across distinct occupational stressors in light of job demands/resources theory guided specification of mediated pathways. SEM analysis yielded moderate fit. Following removal of non-significant paths and addition of two interpretable direct paths, fit was improved, yielding seven dominant pandemic concern → occupational stressor → burnout → psychological distress pathways. In support of domain specification, five 'hub' variables (pandemic-driven change, personal stressors, workload, leader communication, and exhaustion) emerged as key intervention targets in mitigating distress in the USAF RPA community and similar populations during future pandemic-related crises.