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This study explored the roles of spiritual distress and negative communication in relationship satisfaction among couples that include a veteran managing posttraumatic stress disorder (PTSD). Fifty-eight veterans managing PTSD and 42 of their partners responded to mailed surveys assessing PTSD symptoms, relationship satisfaction, negative communication, spiritual distress, and demographics. Among veterans, spiritual distress predicted relationship satisfaction, and the effect was mediated by negative communication. Among partners, negative communication, but not spiritual distress, predicted relationship satisfaction. Clinical implications and future directions for spiritually-integrated care are discussed.