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IIR 08-308
Complicated Family Reintegration in OEF-OIF Veterans
Steven L. Sayers, PhD Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA Philadelphia, PA Funding Period: June 2010 - September 2015 |
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BACKGROUND/RATIONALE:
There is extensive evidence that PTSD, Depression, and other psychiatric complications of combat trauma can have a negative impact on marital and family functioning. It is not clear, however, the pathway or mechanism by which the sequelae of combat exert this impact. Most of the existing models of trauma applied to the understanding of combat veterans and their family members do not take into account the family reintegration processes that these families experience. OBJECTIVE(S): The purpose of this research project was to understand better how war-related psychiatric symptoms of OEF/OIF veterans may interfere with family reintegration and negatively affect family functioning. This study sought to test whether difficulties with family reintegration account for the impact of psychiatric symptoms on overall family functioning over time. METHODS: The study planned a sequential mixed methods design with the qualitative aspect secondary to the quantitative aspect. The quantitative aspect of the study was planned as a non-treatment two-wave (Baseline and 12-month follow-up) clinical assessment of military veterans with a target N=220 and their family members recruited within 2 years of their return from OEF-OIF deployments. We hypothesized that psychiatric symptoms, namely, depressive mood, trauma-related avoidance, and emotional numbing will be associated with reintegration problems. The qualitative aspect of the study consisted of semi-structured interviews, administered separately to each spouse. Qualitative interviews were conducted after entry into the study with a purposive-subsample of veterans and their spouses (target N= 40 dyads). Interview data were generated from open-ended and interviewer follow-up questions, with data analysis following the grounded theory approach. Recruitment was through evaluation referrals, primary care, and the Women's Clinic providers, and in addition, area military reserve and National Guard units were sought to participate in recruitment. Assessments were conducted with the veteran, his/her spouse by interview at the VA Medical Center, or by telephone using a structured set of interview assessments, conducted separately for each spouse. Due to the difficulty in recruiting OEF-OIF veterans who were married/partnered, returned from deployment within the last two years, we expanded the study entry criteria tied to military discharge within 3 years prior to study entry, and we recognized were unlikely to obtain an adequate sample to evaluate the quantitative goals of the study. The interviews assessed anxiety, depressive and other psychiatric symptoms, family reintegration, overall family functioning, and a range of demographic and military service covariates. Baseline interview took approximately 55 - 65 minutes for each member of the couple and the qualitative interviews extended for 45-75 minutes. Each spouse was paid from $60 to $80 for each interview for their participation. Follow-up interviews were conducted with a portion of the sample FINDINGS/RESULTS: Qualitative data analyses have been conducted on interviews of Veterans (N=30) and non Veteran spouses (N=24), including a same-sex, dual-career, and female Veteran couples. A minority of Veterans (40%) and their spouses (30%) were maritally dissatisfied, and 47% of Veterans had clinically significant PTSD. There was an insufficient sample to evaluate the quantitative hypotheses planned for the study. The findings indicated that the degree and type of relationship commitment emerged as an important factor in relationship success and satisfaction after deployment. Spouses who made an 'a priori' commitment to relationship success appeared to be significantly strengthened in the post-deployment period, whereas those with tentative and 'wishful' thoughts about relationship commitment were less successful and satisfied. Those most satisfied and committed also were able to gain greater post-deployment relationship growth, confidence and meaning after the trauma of combat deployment. Finally, regarding divisions of labor, nondeployed spouses relinquished household responsibilities to returning combat Veterans reluctantly, especially for those Veterans with PTSD. Additional analyses demonstrated that communication during a combat deployment is important tool for helping couples manage stress and maintaining their relationship, with several caveats. First, deployment communication can be highly unpredictable, within and across deployments. Deployment conditions and thus communication with spouses are highly variable and communication blackouts lead to increased unpredictability and anxiety. Second, the content and depth of what couples discuss both influence the impact of the communications. Deployed service members likely withhold information to protect their spouses from unneeded anxiety and themselves from emotional vulnerability--spouses often sense the service members' emotional unavailability. When everyday family problems are discussed electronically, this can be stressful for deployed service members, particularly for unhappy couples. Yet it may be difficult for couples to avoid discussing important family issues when the spouse is experiencing critical situations at home. Planning for the desired degree and type of deployment communication prior to the deployment was accomplished by a few couples and likely led to better outcomes. IMPACT: These findings suggest that couples who plan deliberately in advance of a combat deployment for changes they may experience, and discuss their preferences for deployment communication, may fare better following the deployment. In addition, the findings suggest that there are the following opportunities for intervention development with couples following deployment: 1) helping couples renew or reconsider factors in their relationship following deployment, rather than trying to return to the status quo from prior to the deployment, and 2) helping couples in which the Veteran has significant PTSD or other injury with reintegration so that the Veteran's couple and family role can be maximized, rather than minimized, which is likely the more common tendency. External Links for this ProjectNIH ReporterGrant Number: I01HX000225-01A1Link: https://reporter.nih.gov/project-details/7872227 Dimensions for VA Dimensions for VA is a web-based tool available to VA staff that enables detailed searches of published research and research projects. Learn more about Dimensions for VA. VA staff not currently on the VA network can access Dimensions by registering for an account using their VA email address. Search Dimensions for this project PUBLICATIONS:Journal Articles
DRA:
Military and Environmental Exposures, Mental, Cognitive and Behavioral Disorders
DRE: Treatment - Observational Keywords: Deployment, Operation Enduring Freedom, Operation Iraqi Freedom MeSH Terms: none |
