Study's focus: Mending hearts broken by deaths of military loved ones

Family members of those serving in the nation's armed forces endure many hardships, including long separations, frequent moves, and limited job opportunities. Some are faced with the most difficult burden of all: the death of their loved one. A groundbreaking study is exploring whether two virtual tools can help military family members move forward after suffering devastating loss.

"Grief is normal, and experiencing considerable emotional pain related to the death of a loved one is also normal," said Dr. Stephen Cozza, a retired Army colonel, psychiatrist, and professor at the Center for the Study of Traumatic Stress at the Uniformed Services University of the Health Sciences in Bethesda, Maryland.

"We should never expect grief to disappear," Cozza said. "But over time, we do expect grief to find its rightful place in someone’s life so that there also can be opportunities for people to live in productive and joyful ways."

Some people, however, may have ongoing difficulty adapting to grief. "People can continue to be so preoccupied with the death that they're unable to find happiness or engage in the world or in social interactions," Cozza said.

This prolonged, life-dominating grief is called complicated grief, and it may cause mental as well as physical health ailments. According to the American Heart Association and numerous studies, chronic stress caused by factors including grief may lead to heart disease and other illnesses.

USU is collaborating with Columbia University in New York on the study, Stepping Forward in Grief, which is funded by the Department of Defense. Cozza's co-lead investigator is Dr. Katherine Shear, a psychiatry professor at Columbia, and founder and director of the Center for Complicated Grief.

USU embarked on this latest study as an outcome of the National Military Family Bereavement Study, which spanned seven years, from 2010 to 2017, and involved 2,000 adult and more than 100 child survivors of military deaths.

"We saw that study as an important opportunity to both understand and describe the experiences of surviving family members," Cozza said. And while the findings showed most were doing well, "there was a small but significant group of individuals who continued to struggle with their grief, sometimes even many years after the death," Cozza said. "Those are the people we're most concerned about."

In an effort to provide better support to all surviving family members, USU and Columbia developed two research-based tools accessible on personal computers and mobile devices. GriefSteps is focused on successful adaptation to loss, while WellnessSteps promotes general health and well-being activities. The Stepping Forward in Grief study is testing the effectiveness of the two programs.

Family members interested in taking part in the study complete a survey and a telephone interview. Then they're randomly selected to download one of the two programs for six months of use. They're also assigned a guide who will answer any questions and provide information through telephone calls as well as a messaging system built into each program.

Cozza said he isn't aware of any studies comparing complicated grief in military family members and their civilian counterparts. However, complicated grief in military family members wouldn't be surprising, he said.

"We know that military deaths are often of young people," Cozza said. "They're untimely deaths. And they're often sudden and violent deaths." Of the 16,000 service members who died while on active duty in the decade after 9/11, he said, 85 percent were sudden and violent losses including by combat, accident, and suicide.

Approximately 250 family members are already in the Stepping Forward in Grief study, Cozza said. The goal is to recruit an additional 280 by the end of June, when the enrollment period ends.

The study initially was limited to immediate family members – parents, spouses, adult children, and adult siblings – of service members who died after 9/11. Cozza said the inclusion criteria recently has broadened to all family members and also close friends of fallen service members. Further, the service members' deaths could have occurred at any time.

"Grief is an experience everybody has at some point in their lives," Cozza said. "It's a very challenging time when it's hard to think about anything other than the person who died. With this study, we hope to find ways to help survivors so that grief can find its rightful place in their lives, allowing room for joy, friendships, and fulfillment.