Adapting group interpersonal psychotherapy (IPT-G) for treating depression among military spouses at Naval Medical Center Portsmouth (NMCP): Formative qualitative phase

Abstract

Introduction: Operation Enduring Freedom (OEF) in Afghanistan and Operation Iraqi Freedom (OIF) in Iraq have resulted in the deployment of nearly 2,000,000 troops, of which nearly 60% were married, and nearly half had dependent children. While great attention is being paid to the mental health of returning Veterans, we cannot neglect the mental health of this substantial population of military family members. Studies have found that spouses exhibit similar rates of mental health problems as soldiers returning from combat. Whereas rates of anxiety have been shown to drop significantly post-deployment, depression in military spouses appears to persist following deployment. Although a number of psychosocial interventions tailored to military families have been developed, to the knowledge of the authors, no evidence-based interventions have been adapted to specifically target clinical depression in military spouses. Methods: This case study is part of a larger pilot study that sought to adapt, test, and evaluate Group Interpersonal Therapy (IPT-G), an evidence-based treatment for depression, for depressed military spouses. A formative qualitative assessment is crucial to the intervention’s long-term effectiveness, dissemination, and sustainability. This study aimed to understand military spouses’ unique mental health needs and their experience with mental health services. Three focus groups were conducted – two groups of military spouses and a group of mental health care providers – and transcripts were generated using verbatim note-taking. Five independent coders then coded the transcripts for themes that emerged as most salient using an inductive thematic analysis approach. Results: The results identified were clustered under three main themes: (1) psychosocial stressors for depressed military spouses; (2) barriers to mental health care for military spouses; and (3) proposed services. Discussion: When implementing an intervention for a specific population, optimization of its fit to the needs, priorities, and help-seeking patterns of the population should take place to ensure that it is meaningful, ecologically valid, and sensitive to context and culture. Our analysis showed that the military culture presents unique psychosocial stressors, barriers, demands, and needs to mental health provision that should be accounted for in the adaptation of evidence-based mental health intervention. The interpersonal nature of many of the challenges faced by military spouses lend themselves readily to the problem areas that are treatment targets of IPT, therefore increasing the patients’ potential for engagement and sense of compatibility with the treatment.