Elevated rates of post-traumatic stress disorder (PTSD) and other Axis 1 diagnoses among OEF/OIF veterans have been reported. The Department of Veteran's Affairs (VA) Office of Public Health and Environmental Hazards (OPHEH) reported that PTSD is the most common mental health diagnosis and the second most frequent medical diagnosis among veterans who have used VA health care services. The Veterans' Health Administration (VHA) has responded by placing a high priority on meeting veterans' needs for physical and mental health care. Although the families and communities of the Nation's newest veterans have received significant attention, identifying the impact of veterans' exposure to trauma and subsequent mental health on their families, especially as it relates to PTSD, is a critical gap. Research on Vietnam veterans and their families indicate increased marital and relationship problems and worse mental health outcomes when a veteran has PTSD. Studies of veterans' spouses from other wars indicate severe psychological impairment is associated with caregiving for combat veterans with PTSD. The well-being of caregivers is a key component of the recovery of OEF/OIF veterans, many of whom will need life long care.
The primary objective of this project was to establish a battery of instruments to assess caregiver well-being. To accomplish this, we convened an expert panel to guide the selection and revision of instruments to assess and monitor OEF/OIF caregiver well-being in a variety of domains. We also sought caregivers' assistance in identifying important domains that should be included in the battery and in refining questions on the instruments selected for use. Our long term objective is to analyze the impact of PTSD on family health to inform the development of targeted interventions for families. Research on older adults has shown that caregivers who receive appropriate support are better prepared to assist with care.
Key domains and instruments were identified and reviewed for appropriateness by an expert panel and caregiver focus groups. Focus group interviews were used to facilitate identification of important domains. The battery of candidate instruments was critiqued by the expert panel and their recommendations were incorporated into a draft battery of instruments. The draft battery was then shared with a second round of family caregivers and their feedback was incorporated.
Expert panel methods and focus group interviews yielded valuable input regarding the domains of experience and key questions to be included in the assessment battery. Use of these methods resulted in the selection of valid, reliable assessment tools that can be adapted and included in an assessment battery to be administered in future research examining OEF/OIF caregivers.
By elucidating the special needs and issues affecting OEF/OIF caregivers and using this information and expert guidance to inform the development of an assessment battery, we are positioned to examine the impact of the veteran's trauma on OEF/OIF caregivers, determining caregiver outcomes and unmet need. This information can be used to improve veterans' care and in the development of targeted interventions for OEF/OIF caregivers.
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