The association between anger experiences and expression and veteran suicidal thoughts in intimate couple relationships

Wilks, Chelsey R.; Khalifian, Chandra E.; Glynn, Shirley M.; Morland, Leslie A.

doi:10.1002/jclp.22960

Cited by 6 publications

(3 citation statements)

References 41 publications

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“…Additional policy implications regard programs addressing anger and hostility in veterans. Stressors—for example, personal, housing, social, economic, etc.—for veterans in the period immediately following separation are well documented (Elbogen, Johnson, Newton, et al, 2014; Wilks et al, 2020). Speculatively, anger and hostility in these early periods may be manifestations of stress with subsequent decreases over time mediated by decreases in these emotions as veterans adjust to civilian life.…”

Section: Discussionmentioning

confidence: 99%

Anger and suicidality in veterans: Impact of postseparation time and combat.

Wagner,

Lanier,

Molloy

et al. 2023

Psychological Trauma: Theory, Research, Practice, and

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Objective: The study investigated the association over time between the rates of anger/hostility and suicidality in post-9/11 veterans as a function of time following separation from the military and combat exposure. Method: Structured clinical interviews were conducted with N = 2,580 Iraq/Afghanistan-era U.S. military veterans serving since 9/11/01. For each participant, a postseparation interval was calculated as the time between military separation and the clinical interview, with a range of up to 9 years. Combat exposure was assessed using a three-level categorical proxy derived from the Combat Exposure Scale indexing levels of none, below, and above median exposure. Three separate estimates measuring anger/hostility and three separate measures of suicidality were modeled variously across separation intervals and levels of combat exposure. Results: In bivariate analyses, higher levels of combat exposure were associated with overall significantly higher levels of both anger/hostility and suicidality. Based on multivariable analyses, rates in measures indexing suicidality among veterans did not decrease as a function of the number of years postseparation. In contrast, rates in measures indexing anger/hostility among veterans endorsing above-median levels of combat exposure decreased significantly with increasing time since separation. Nonetheless, even at longer time points, both suicidality and anger/hostility remained elevated among respondents endorsing above-median combat exposure. Conclusions: These findings illustrate the importance of implementing suicide prevention and anger management programs for postseparation adjustment as well as for the period beyond the immediate postseparation, with particular attention paid to the level of combat exposure experienced. Clinical Impact StatementUsing multiple indices in a post-9/11 cohort, we observed that anger/hostility and suicidality were elevated among veterans endorsing high levels of combat exposure. Examining time since separation after military service, we found that measures indexing anger and hostility were decreased in cohorts sampled at longer postseparation intervals. In contrast, suicidality did not diminish among veterans at longer postseparation intervals. Results suggest treatment for anger/hostility and suicidality is critical for postseparation adjustment and emotional well-being and that efforts should extend beyond the immediate postseparation period.

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Section: Discussionmentioning

confidence: 99%

Anger and suicidality in veterans: Impact of postseparation time and combat.

Wagner,

Lanier,

Molloy

et al. 2023

Psychological Trauma: Theory, Research, Practice, and

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“…Veterans are also at increased risk of posttraumatic stress disorder (PTSD) and other mental health concerns following military service, which can damage relationship functioning (Cigrang et al, 2014). As a result, veterans may experience a variety of relationship problems, including relationship distress and conflict (Wilks et al, 2020), sexual dysfunction (Khalifian et al, 2020), intimate partner violence (Kar & O'Leary, 2010), and separation or divorce (Foran et al, 2013). This relationship distress can cause substantial harm, exacerbating mental health symptoms (Whisman, 2007), and precipitating suicide attempts (Martin et al, 2013).…”

mentioning

confidence: 99%

Veteran and partner interest in addressing suicidality from a couple-based treatment approach.

Khalifian¹,

Chalker²,

Leifker³

et al. 2022

Couple and Family Psychology: Research and Practice

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Theories of suicide highlight the importance of healthy interpersonal connection and research has found that relationship problems are the most frequently endorsed stressor preceding attempts. However, established suicide interventions are individually focused and do not directly address the relational context. Additionally, it is unclear whether a couple-based suicide intervention would be acceptable to veterans and their partners. Utilizing two different treatment-seeking samples (N = 91), we examined veterans' and partners' desire for and willingness to engage in a couple-based suicide intervention and whether interest in such an intervention correlated with demographics or clinical symptom severity. Findings suggested that veterans and their partners have talked about suicidal thoughts with one another to some extent (77.7%-86.8%), are interested in a couple-based suicide intervention (55.3%-61.5%) or willing to learn more (23.1%-33.3%), and think their partners would be interested (47.4%-61.5%) or willing to learn more (26.9%-42.1%). There were few predictors of differences in interest. Overall, a couple-based suicide intervention appears to be acceptable and desirable by veterans in crisis and their partners.

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“…Relationship distress is associated with a host of negative outcomes for physical health, mental health, and quality of life (Kiecolt-Glaser & Wilson, 2017; Whisman, 2007). Veteran couples and families experience unique challenges (Palmer, 2008), leading to relationship problems such as conflict (Wilks et al, 2020), violence (Kar & O’Leary, 2013), and divorce (Foran et al, 2013). Relationship problems are common among military couples, impacting as many as 75% of veterans seeking mental health services (Sayers et al, 2009).…”

mentioning

confidence: 99%

Pilot open trial of the OurRelationship online couples’ program in a Veterans Affairs Medical Center.

Knopp¹,

Rashkovsky²,

Khalifian³

et al. 2022

Couple and Family Psychology: Research and Practice

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Military-related stressors place veterans at increased risk of intimate relationship problems, which are detrimental to physical health, mental health, and well-being. Couple and family interventions for veterans are effective, and veteran access to family-based care is mandated by law. However, many veteran couples experience barriers to accessing care. OurRelationship is a coached online relationship program that may help meet veterans' needs for accessible couples' interventions. Although OurRelationship is effective with community couples, it has not been implemented or evaluated in a Veterans Affairs (VA) Medical Center setting. The present study piloted the OurRelationship program at a VA site in the southwestern United States to examine feasibility, acceptability, and preliminary effects of the program. Thirteen veterans and their partners enrolled in an open trial and provided baseline and postprogram data on relationship and individual functioning as well as qualitative feedback about their program experiences. Feasibility was supported by meeting recruitment goals, implementing all parts of the online program and coaching sessions, and a completion rate of 85%. Couples reported moderate to high satisfaction with the existing program but also suggested veteran-specific adaptations, including more attention to cognitive and mental health challenges. Veterans and partners exhibited small improvements in relationship satisfaction, distress, depression, and quality of life, with partners showing larger improvements in relationship conflict and quality of life. These results suggest OurRelationship can help expand access to family care for veterans; however, a randomized trial to evaluate the efficacy of a version of the OurRelationship program tailored to veterans is needed.

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The association between anger experiences and expression and veteran suicidal thoughts in intimate couple relationships

Cited by 6 publications

References 41 publications

Anger and suicidality in veterans: Impact of postseparation time and combat.

Anger and suicidality in veterans: Impact of postseparation time and combat.

Veteran and partner interest in addressing suicidality from a couple-based treatment approach.

Pilot open trial of the OurRelationship online couples’ program in a Veterans Affairs Medical Center.

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