Gulf War and Health Volume 6: Physiologic, Psychologic, and Psychosocial Effects of Deployment-Related Stress (2008) / Chapter Skim
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7 PSYCHOSOCIAL EFFECTS
7 PSYCHOSOCIAL EFFECTS
Pages 283-316
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From page 283... ...
, anxiety, and depression, might find reintegration into family, social, and occupational settings difficult. Given the complexity of the psychosocial factors in the lives of veterans and their families, the committee addresses the following issues in this chapter: connections between deployment to a war zone and marital and family conflict, including intimate partner violence and adverse effects on children; employment; incarceration; and homelessness.
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From page 284... ...
have been used by several researchers assessing impact of serving in Vietnam on the veterans' marital and family status and intimate partner violence. In the NVVRS, male Vietnam-theater veterans with PTSD were compared with theater veterans without PTSD.
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Of the 1200 theater veterans who were interviewed, 862 were selected for followup on the basis of PTSD classification. The followup group also contained an oversampling of veterans without PTSD who indicated they had had high combat exposure or high levels of nonspecific psychological distress.
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Several studies that assessed the relationship between PTSD and marital conflict in veteran populations are also briefly discussed. Finally, the committee reviewed four additional secondary studies that reported positive findings that specifically address the role of deployment-related marital and family conflict in psychosocial effects on children.
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(2004) , who assessed a sample of 250 male Vietnam veterans, part of the NVVRS cohort, for depression, intimate partner violence, PTSD, and parenting satisfaction.
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(1992) selected all households of theater veterans who appeared to have PTSD and the households of a subset of veterans who did not appear to have PTSD to determine the effects of PTSD on family adjustment and marital conflict, including intimate partner violence.
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The modeling showed that there were four direct influences on intimate partner violence in male Vietnam veterans: a poor relationship with mother, combat exposure, perceived threat in the war zone, and PTSD symptom severity. All the influences resulted in more intimate partner violence except for combat exposure.
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Secondary Studies In addition to the primary studies that support the association between deployment and intimate partner violence after deployment, there are numerous supportive secondary studies. Studies that assess deployed vs nondeployed veterans are discussed first, followed by studies of intimate partner violence in veterans with and without PTSD.
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From page 291... ...
Symptom severity and, to a lesser degree, substance abuse were correlated with violence among the PTSD inpatients. It should be noted that this study did not include intimate partner violence as a violence endpoint.
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From page 292... ...
Families were divided into those with a soldier-parent who was deployed to the Gulf War and those with a soldier-parent who was not deployed and remained on the military base. The researchers also compared the results of the assessments with an assessment of some of the same families a year earlier, before deployment.
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From page 293... ...
Although this study suffers from the absence of a representative sample, the findings highlight the disruptive effects of PTSD on all members of a family. Summary and Conclusions The collective findings of the primary and secondary studies of marital and family conflict, including intimate partner violence, indicate that many veterans and their families will experience significant stress after the return of the veterans from deployment.
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From page 294... ...
Three other studies, all of which used data from a survey of spouses and partners of Vietnam veterans who participated in the NVVRS, found an association between combat-related PTSD and increased intimate partner violence. Four secondary studies lend additional support to the findings of primary studies.
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From page 295... ...
Measures included nondeployed 252 spouses or -Mississippi Scale for Partners and spouses of theater status partners of veterans Combat-Related PTSD, veterans with PTSD were -plethora of without PTSD vs DIS-PTSD module, and significantly more likely to report measures and 122 spouses of detailed assessment of lower levels of happiness and life interview veterans with PTSD exposure to traumatic satisfaction and to have higher -long-term events demoralization scores than effects -Parental Problems Index spouses or partners of theater -Level of Functioning veterans without PTSD Limitations: Index -study was -Family-Violence subscale Children of veterans with PTSD conducted 15 of CTS were substantially more likely to years after -Index of Subjective Well- have a problem score in the Vietnam War Being clinical range than children of ended -PERI Demoralization veterans without PTSD -no adjustments Scale -Social Isolation Index -alcohol problems -nervous breakdown -Child Behavior Checklist McCarroll et Cross-sectional Randomized sample Probability of spousal Probability of severe aggression in Age, race, sex, Causal al. 2000 survey in 1990- of 11,541 GW- aggression in association preceding year significantly rank, and number relationship 1994 deployed vs 15,294 with deployment greater in deployed (4.25%- of children living between nondeployed 4.95%)
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From page 296... ...
disorder, major depressive Inability to episode, alcohol determine dependence, drug causality dependence Call and Cohort; Career 2,901 white men Association between Young men in military service Education, birth, Limited Teachman Development who graduated from combat service and marital during Vietnam War were most military life- generalizability 1991 Study Washington state status likely to marry history data high schools in 1966 and 1967, 627 Original data collected by No long-term evidence of Vietnam combat questionnaire in 1965-1966 destructive effect of combat veterans, 586 in high schools; in 1979- service on life-course sequencing noncombat Vietnam 1980, telephone interview or veterans' first marriages veterans, 1688 yielded event history data civilians on 88.8 % of original 1966 panel members
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behavior and stress, which then affect marital stability and quality 297
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Children's Manifest pathologic symptoms in otherwise Anxiety Scale healthy children Inability to determine causality NOTE: CES = Combat Exposure Scale, CTS = Conflict Tactics Scale, DIS = Diagnostic Interview Schedule, GW = Gulf War, IPV = intimate partner violence, NSVG = National Survey of the Vietnam Generation, NVVRS = National Vietnam Veterans Readjustment Study, PTSD = posttraumatic stress disorder.
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From page 299... ...
Rosenheck and Fontana (1994) reanalyzed data from the NVVRS on 1460 male Vietnam veterans to model the risk of homelessness on the basis of premilitary personal experiences, exposure to war-zone stress, current PTSD, other psychiatric disorders, and substance abuse.
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From page 300... ...
Most of the veterans 45-54 years old had served between the Korean War and the Vietnam War, and 17% of them had seen combat; among veterans who served during the Vietnam War era, 40% reported combat exposure. The much higher prevalence of psychiatric illness, substance abuse, and antisocial personality disorder among white veterans 20-34 years old seemed to be a more likely contributor to the greater vulnerability of this group than combat exposure.
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The other two studies were equivocal. The secondary studies were also mixed and in general showed that homelessness was related more to the presence of psychiatric disorders than to combat exposure itself.
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302 GULF WAR AND HEALTH The committee concludes that there is inadequate/insufficient evidence to determine whether an association exists between deployment to a war zone and homelessness.
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2.64 1994) Age 35-44: OR 3.17, 95% CI 2.69 3.73 Age 45-54: OR 1.39, 95% CI 1.14 1.71 NOTE: CI = confidence interval, CPS = Current Population Survey, DIS = Diagnostic Interview Schedule, NSVG = National Survey of the Vietnam Generation, NVVRS = National Vietnam Veterans Readjustment Study, OR = odds ratio, PTSD = posttraumatic stress disorder.
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The primary studies involved a population-based survey of military personnel who had listed Iowa as their place of residence at enlistment for the Gulf War (Black et al.
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From page 305... ...
Of the 319 Vietnam theater veterans with current PTSD, 45.7% had been arrested or jailed more than once in their lives compared with 11.6% of the 871 theater veterans without PTSD; 11.5% of the veterans with PTSD had been convicted of a felony. PTSD symptom level at the time of the interview was assessed with the Mississippi Scale for Combat-Related PTSD; a study cutoff score of 94 was used as a threshold for an assessment of current PTSD.
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From page 306... ...
Summary and Conclusions The two primary studies, one of Gulf War veterans and one of Vietnam veterans, found that exposure to heavy combat increased the likelihood of being incarcerated after release from military service. However, veterans who were deployed but did not experience heavy combat were less likely to be incarcerated than those exposed to heavy combat and were not any more likely to be incarcerated than nondeployed veterans.
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From page 307... ...
Incarceration prevalence Prevalence of being between Vietnam arrested after discharge: theater and era -heavy combat exposed, veterans 19.6% nonviolent offenses, 4.9% violent offenses -moderate combat exposure, 17.7% and 2.1%, respectively -light combat exposure, 5.7% and 0.6%, respectively NOTE: CI = confidence interval, OR = odds ratio.
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From page 308... ...
The two that were designated as primary studies used data from the NVVRS, a nationally representative sample of male Vietnam veterans. Of the three secondary studies, two were based on data from the National Comorbidity Survey (NCS)
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The secondary studies also indicated that veterans with combat exposure had poorer employment outcomes than those who experienced other or no traumas, particularly if they had PTSD.
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310 GULF WAR AND HEALTH The committee concludes that there is inadequate/insufficient evidence to determine whether an association exists between deployment to a war zone and adverse employment outcomes.
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white veterans with higher wages (NS) disorders, no history of difficulty of job psychiatric disorders PTSD: 50% lower and deployed chance of elsewhere employment; 16% lower wages NOTE: CI = confidence interval, NS = nonsignificant, NVVRS = National Vietnam Veterans Readjustment Study, OR = odds ratio, PTSD = posttraumatic stress disorder.
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2006. Intimate partner violence in the U.S.
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1999. Analysis of violent behavior in Vietnam combat veteran psychiatric inpatients with posttraumatic stress disorder.
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2005. Risk factors for partner violence among a national sample of combat veterans.
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From page 315... ...
1997a. Posttraumatic stress disorder and functioning and quality of life outcomes in a nationally representative sample of male Vietnam veterans.
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