Background: The most challenging community problems faced by senior military leaders are closely linked to the quality of marriage relationships. These include family violence, spouse maltreatment, and suicide. Despite the potential high costs of chronic marital distress, very few couples seek therapy. There is a substantial need in the military for early detection and preventive care for deteriorating couples before irreversible relationship damage has occurred. There are currently no widely available means to fill this need. The Marriage Checkup (MC) addresses this issue by providing a less-threatening option for couples to seek early preventive care. MC's design as a brief "check-up" model for marriage help appears particularly well-suited to primary care. The investigators conducted a pilot study to adapt MC for use in Air Force primary care clinics. The results provided preliminary evidence that a MC delivered in three 30-minute appointments and adapted to a military population can be effectively used by behavioral health consultants (BHCs) working in an integrated primary care clinic.

Objective/Hypothesis: (a) Military couples who participate in the MC for primary care will demonstrate positive relationship health trajectories for intimacy, acceptance, and relationship satisfaction over the course of 6 months when compared to couples in a wait-list control condition. (b) The MC will attract military couples at-risk for marital deterioration who are otherwise not seeking relationship treatment.

Specific Aims: (a) Recruit Service members and their partners who are married or in committed romantic relationships to participate in a MC delivered by BHCs in primary care. (b) Evaluate the efficacy of MC in primary care by comparing couples who received MC to couples in a wait-list control condition on multiple indices of relationship health. (c) Determine the ability of MC to attract military couples across a broad range of relationship functioning by examining standardized measures and other self-report data at baseline. (d) Obtain qualitative data from BHCs and participating couples after conclusion of the intervention portion of the study to better understand factors impacting MC implementation and success.

Study Design: A randomized trial will be conducted at four military primary care clinics. Participants will be active duty or activated reserve members and/or their partners who are currently married or in a committed romantic relationship of 6 months or longer. All participants will complete a baseline assessment prior to randomization and follow-up assessments immediately post-treatment and 1 month and 6 months post-treatment. Participants will be randomly assigned to either receive MC immediately or to a 6-month wait list (WL) condition. At the conclusion of 6 months, the WL participants will be offered the opportunity to receive the MC. To detect the effect size found in the previous randomized trials of the MC with civilian couples, the study will need to achieve a target sample size of 215 couples.

Relevance: The widespread adoption of regular dental health checkups began inside the military when it became obvious that the most effective means of maintaining force readiness in the area of dental health was prevention (i.e., checkups) rather than strictly tertiary treatment (i.e., repairing cavities, root canals, tooth extraction). If the proposed study provides sufficient evidence that a brief MC improves relationship health and attracts couples early in the distress continuum, then it is possible that widespread adoption of MC within the Department of Defense's primary care system could achieve meaningful gains in ability to reach at-risk couples with preventive care.