A number of psychotherapies have shown efficacy for the treatment of adult depression in civilian populations (Hollon & Ponniah, 2010
). However, given the unique context and challenges presented by current operations, any evidence-based treatment needs to be adapted and tested for effectiveness in military populations prior to dissemination. When adapting interventions, both content issues (e.g., psychosocial stressors unique to the military context) and logistical considerations (e.g., availability and acceptability of services) need to be elucidated and factored into treatment design.
When adapting treatment content, a host of military-specific complexities which may contribute to depression need to be addressed. For example, reintegration following deployment may elicit complex attitudes and motivations. Spouses may feel overwhelmed by returning service members who are exhibiting aggression, irritability, and heightened arousal symptoms (Solursh, 1989
), and who may be abusing substances in an attempt to cope (Dao, 2011
). For service members, especially those suffering from posttraumatic stress, combat operations may have taken on an “addictive” quality (Galovski & Lyons, 2004
) and they might feel under-stimulated and unfulfilled upon their return to civilian life. Differences within military populations should also be taken into account when adapting treatments. For example, Westhuis and colleagues (2006)
found that the effect of age, marital satisfaction, and financial problems on coping is moderated by different cultural values among Caucasians, African American, and Hispanic military spouses. Other variables such as rank may also moderate the impact of deployment on spousal depression.
Treatment adaptation should also address local logistical factors which limit access to care. Practical considerations such as transportation to sessions, scheduling difficulties, and arranging child care may all limit treatment accessibility (APA, 2007
; Gorman et al., 2011
), and thus require attention. Issues surrounding mental health stigma (Hoge et al., 2004
) and treatment confidentiality (APA, 2007
) can also impact treatment, and need to be understood within the local context. For example, how are mental disorders and psychotherapy viewed by people around the base? What are the disclosure policies in the military heath care system? How does this influence people's help-seeking?
The collection of qualitative data is an important first step in treatment adaptation; even when a treatment need is well-established by empirical data, qualitative assessment informs the what (i.e., content) and how (i.e., logistics) of the treatment. Focus groups, key informant interviews, surveys, and direct observation, all provide an efficient, practical means of collecting such data. Whatever the method, assessment should involve multiple stakeholders to gain a range of perspectives on spouses' unique mental health needs, psychosocial stressors, currently available resources, access to care, and treatment acceptability.
Following treatment adaptation, the next step is to test the intervention for feasibility, acceptability, and effectiveness in a clinical trial. Testing should be conducted with an eye towards dissemination, ensuring that the treatment can be embedded in the usual care of military families and delivered by the clinicians who routinely treat spouses.