Returning Home from Iraq and Afghanistan Assessment of Readjustment Needs of Veterans, Service Members, and Their Families (2013) / Chapter Skim
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6 Military Families
6 Military Families
Pages 257-330
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From page 257... ...
With that priority, various challenges arise. Throughout this chapter, the committee presents evidence that military family members have to deal with additional relationship problems, impairments in psychologic and physical well-being, responsibilities as caregivers of children or wounded service members, and overwhelming household duties.
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However, little research has examined family issues as they relate to single service members. Demographic Characteristics of Military Families This section describes the demographic characteristics of families of active-duty forces and selected reserve components.
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d Of these, 76.1% are enlisted members, and 23.9% are officers. NOTE: Data are derived from a variety of sources, including the Active Duty Military Personnel Master File, the Active Duty Military Family File, the Reserve Components Common Personnel Data System, the Reserve Components Family File, and the Defense Enrollment and Eligibility Reporting System (DEERS)
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examined military personnel records to track the marital status of service members over a 10-year period (1996 to 2005) and found that rates of marital dissolution for female service members were more than double those of their male counterparts.
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. Approximately half to two-thirds of enlisted members of the selected reserve across reserve components have family responsibilities, the exception being Marine reserve families, in which just over a quarter (27.1%)
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In 2008, the Military Family Life project included two items related to marital transitions in a survey of a probability sample of 28,500 military spouses. The first item asked respondents, all of whom were married or separated, if they were currently living in a stepfamily; 20% indicated that they were.
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From page 263... ...
. The high proportion of military women in dual-service marriages, when combined with the high rates of marital dissolution among military women, raises questions about the severity of the unique challenges faced by dual-military families in coordinating leaves between parents, arranging child care, and other challenges posed by dual commitments to military service (Bethea, 2007)
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. Many studies focus on negative consequences, especially posttraumatic stress disorder (PTSD)
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Measures include physical health, behavioral health, marital relationship, parenting, use of services, career intentions, and deployment experience (RAND Center for Military Health Policy, 2012)
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For length of deployment, but not for frequency, the connection to relationship quality was mediated by psychologic symptoms. These findings probably underestimate the impact of the frequency of deployment because most studies exclude deployments lasting less than 30 days or deployments not in support of war operations.
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, and families who experience the injury or death of service members are almost certain to experience at least some negative consequences. Deployment and Married Couples The health of marriages is typically assessed in research by two key indicators: marital quality and marital dissolution, which refers to the end of the marital relationship, typically via divorce (Karney and Bradbury, 1995)
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From page 268... ...
. Researchers have articulated several concepts evident throughout the deployment cycle -- ambiguity and uncertainty, relationship connection, and communication -- that characterize the nature of the relationship between military service members and their spouses and that influence their experiences (Sahlstein et al., 2009; Wiens and Boss, 2006)
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(2009) surveyed 522 service members in the Army National Guard about 1 month before deployment, comparing responses of soldiers who had or had not been previously deployed for OIF or OEF.
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observed in a study of 129 Army spouses that a substantial proportion developed heightened rejection sensitivity partway through deployment, fearful that their deployed partners had decided to leave the marriage. These fears were significantly and negatively related to relationship adjustment, even though participants could identify no precipitating reason for their fear; fears also appeared to increase with cumulative months of separation.
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More than half also used video instant messaging once per month. Results showed that service members reported lower levels of PTSD symptoms following deployment when they had communicated more frequently with their spouses during deployment but only when marital satisfaction was high and only when delayed forms of communication, such as letters, emails, and care packages, were used.
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For example, caregivers in both National Guard and reserve families reported significantly greater household and relationship hassles, and caregivers in National Guard families reported poorer emotional well-being. Allen et al.
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. Studies conducted after return from deployment emphasize the implications of psychologic symptoms of service members, but many other aspects of the reintegration experience may be consequential for adults and children.
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, and may dissipate as families move through the deployment cycle (for example, worries about a service member's safety during deployment may lessen upon returning home)
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More recently, a large representative survey of military members (59,631) showed that deployment to Operation Desert Storm was associated with a statistically significant increase, by 4.2 percentage points, in later divorce rates of female service members (Angrist and Johnson, 2000)
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Spousal Abuse Family violence, which includes spousal abuse1 as well as child maltreatment, has become a focus of concern in the military. This section covers spousal violence in terms of prevalence, types of abuse, risk factors, health consequences of abuse, and treatment.
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From page 277... ...
. In the only study on spousal abuse specifically in OIF and OEF service members, experiential avoidance -- a coping strategy that seeks to avoid emotionally painful events -- was associated with physical aggression perpetration and victimization in a study of 49 male National Guard members who returned from deployment to Iraq (Reddy et al., 2011)
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The committee found little information about treatment of spousal abuse, which is a service provided by the FAP itself or in conjunction with local treatment providers. In 2010, the Government Accountability Office (GAO)
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Few programs were available to educate or support parents in their efforts to assist their adult children. Psychologic Health of Family Members Among service members whose deployment experiences result in personality changes or psychologic symptoms and diagnosis, particularly PTSD, there are consequences for marital quality as well as specific psychologic effects on spouses and children.
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Across studies, most military spouses who reported psychologic symptoms also reported seeking care (Eaton et al., 2008; Gorman et al., 2011; Warner et al., 2009) , but most encountered barriers to care, including difficulty in getting time off from work, arranging child care, difficulty getting an appointment, and cost.
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Spousal Physical and Psychologic Health During Pregnancy A small number of studies have investigated the possible impact of deployment on the health of military spouses during pregnancy. To date, few differences in physical health have been found.
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. Consequences of Service Members' Psychologic Symptoms for Marital Quality The largest area of research related to deployment and families pertains to the implications of service members' combat- or deployment-related psychologic symptoms and diagnoses, particularly PTSD, for the quality and stability of relationships with intimate partners and children.
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A group of studies using data from the Readiness and Resilience in National Guard Soldiers (RINGS) study documented interpersonal dynamics surrounding service members' PTSD symptoms.
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observed similar patterns in a sample of 272 members of the National Guard and reserves, averaging 34 years of age, in that the group who experienced high exposure to combat and high levels of PTSD symptoms also reported the most problems in psychologic and social functioning, while the group of service members who experienced high exposure to combat but reported low levels of PTSD symptoms were significantly more likely than others to report receiving support and understanding from their families and to perceive a sense of purpose and control. Erbes (2011)
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From page 285... ...
Military families have access to child care and health services that are often far superior to those available to civilian families at similar income levels. Housing is related to family size, and military installations tend to have good schools, good sports, and recreation facilities, and a system of support services, including ones targeted for the families of deployed or injured personnel.
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Parental Mental Illness and Substance Abuse The number of children in either military or civilian families who live with a parent with a mental disorder is unknown. However, mental illness clearly occurs in both military and civilian families.
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Like military deaths, civilian deaths may be sudden, such as in the case of a suicide or a car accident, or may follow long drawn-out illness or be the eventual consequence of a serious injury. Again, like military children, civilian children lose more fathers than mothers.
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From page 288... ...
In multivariate analyses, mood and behavioral symptoms were higher in children whose military parent was deployed for longer periods and for whom either parent reported higher levels of psychologic symptoms; the effects of long parental deployment were seen even after the parent returned. Using input from parents and child care providers, a study of 169 preschoolers in child development centers at a large Marine Corps installation compared children of parents deployed in OIF or OEF with other military children and with national norms and found that children of deployed parents had significantly higher scores on both internalizing (mood)
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From page 289... ...
Another analysis of the psychosocial effects of deployment on military children found that families experiencing deployment identified one-third of the children at "high risk" for psychosocial morbidity and that parental stress was the most significant predictor of children's psychosocial functioning (Flake et al., 2009)
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A case series of substantiated child maltreatment by parents in 1,771 families of enlisted Army soldiers who were deployed at least once from September 2001 to December 2004 found that child maltreatment was more frequent during the times when the military parent was deployed than at other times, the most common perpetrators being civilian mothers (Gibbs et al., 2007)
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. The committee was unable to find any information about the treatments rendered for child maltreatment victims by DOD's Family Advocacy Program.
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(2010) used data on almost 170,000 children under the age of 2 enrolled in TRICARE and deployment data from the Defense Manpower Data Center to determine whether parental deployment influenced the rate at which parents used health care for their young children within the military health system.
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(2010) used data on over 600,000 children ages 3 to 8 enrolled in TRICARE; these data were merged with deployment data from the Defense Manpower Data Center to determine whether parental deployment influenced the rate at which parents used either medical or mental-health care for their children within the military health system.
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Treating distressed parents might be as important to child mental health as treating the children themselves. It is important to understand more about how parental characteristics that predict selection for deployment also predict children's response to parental deployment and parental reaction to returning home.
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Nature of Service Members' Injuries In 2010, the National Alliance for Caregiving (NAC) reported findings from an online survey of 562 self-identified family caregivers, ages 19 or older, who provided care to a veteran whose injury, illness, or condition was related to military service.
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. Characterizing the level of burden experienced by caregivers on the basis of the number of ADLs and IADLs performed and the number of hours of care given, the NAC survey found that 65% of the veteran caregivers have a high burden of care, 15% have a medium burden, and 21% have a low burden (National Alliance for Caregiving, 2010)
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. Impact of Caregiving on Family Caregivers Numerous studies of civilian populations have documented evidence that caregiving can have profound negative consequences for family caregivers in terms of burden, psychologic and physical health, emotional well-being, quality of life, employment, and financial status (for example, see Kreutzer et al., 2009; Pinquart and Sörensen, 2003; Schulz and Martire, 2004; Stenberg et al., 2010; van der Voort et al., 2007; Vitaliano et al., 2003; and Zarit, 2006)
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Respondents in the NAC survey of caregivers of veterans conveyed that providing care to their veteran took a toll on their psychologic and emotional health. Stress or anxiety was reported as the most prevalent health problem of caregivers (88%)
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This percentage is a much higher proportion than the 13% of family caregivers nationwide reporting the same level of financial hardship (National Alliance for Caregiving, 2010)
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. Ethnicity also plays a role; minority caregivers reported worse physical health than white caregivers, but findings were mixed for psychologic health (Pinquart and Sörensen, 2005)
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Programs and Services Child Care DOD has provided child care services to more than 200,000 military children from birth to age 12 at more than 900 child-development centers in over 300 locations worldwide and at 5,000 Family Child Care homes (DOD, 2012b)
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Regarding deployment-specific problems, in a 2009 survey of 802 spouses of active-duty Air Force airmen, the majority of respondents reported that their child care problems worsened following their spouses' deployment. Parents who lived within 30 minutes of the base reported more problems finding child care than those who lived more than 30 minutes away, as did parents who were part of a dual-military family as compared with parents who were civilians.
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In response to problems with interstate school transfers, DOD developed the "Interstate Compact on Educational Opportunity for Military Children." States that adopt the compact agree to provide uniform eligibility, enrollment, placement, and graduation policies with regard to military children. As of 2012, 40 states have adopted the compact, eliminating many of the problems associated with transferring from one state to another for 93% of all military children (DOD Education Activity, 2012)
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(Medical counseling, on the other hand, is designed to address long-term, medically diagnosable issues, such as substance abuse, mental illness, or PTSD.) DOD offers confidential, free nonmedical counseling sessions to all activeduty, National Guard, and reserve members and their families.
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Despite the positive reviews from individuals using available counseling, the 2010 Military Family Life Survey found that many military spouses had concerns that deterred them from seeking counseling. Concerns included the following: "it would be difficult to get time off work or child care for counseling" (47%)
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. In FY 2010, the figure rose to 96% of service members who completed a FAP treatment program and were not reported for spousal abuse within 1 year (DOD, 2011a)
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The RAND Corporation compiled a list of about 200 DOD programs that address psychologic health and traumatic brain injury, of which 120 serve families. RAND likewise
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DOD thus has in place hundreds of programs to support military families that address a wide range of needs -- from child care and financial readiness to counseling and health care services. Despite the growth in programs that serve families, the committee found that DOD does not maintain a complete list of programs, describe their scope, or assess whether they have been evaluated, and if evaluated, by what metrics.
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is similar to SAFE but uses trained family members rather than mental-health professionals as group leaders. FFEP, which was developed by the National Alliance on Mental Illness (NAMI)
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The problem-solving component of this form of MFGT also focuses on the specific PTSD symptoms of avoidance and emotional numbing (Sherman et al., 2012)
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One study found reductions in selfreported, clinician-rated, and partner-rated avoidance, emotional numbing, and overall PTSD symptoms; however, there were no measures for its effect on relationship functioning (Sautter et al., 2009)
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Evaluation of these programs must be multifaceted and multimodal so that not only individual psychopathology and marital relationships are studied but also overall family function, parent–child interactions, and child functioning are studied. CONCLUSIONS Military service members are also members of families, and their families can provide essential support to them as well as -- at times -- be a source of stress and concern.
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Although healthy and stable marital and other romantic partner relationships provide important supports for service members, there are many knowledge gaps regarding how these relationships influence military readiness and how they are affected by deployments. There is evidence, for example, that deployment erodes marital quality, but the factors that moderate these processes are not well understood; therefore, knowledge is insufficient about the best way to prevent such erosion in association with military service.
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Research is needed to improve understanding of which children in military families are at highest risk, whether their mental-health needs are different from those of nonmilitary children, and of effective treatments that work within the context of military life. Despite now representing a significant minority of the armed forces, female military members are understudied.
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The demands placed on military family members call for support in the areas of relationship building, family and individual function, and reduction of risk of psychologic and physical-health problems. The committee found that little information is available on the potential effectiveness of broad-based, universal prevention efforts aimed at military children and their families.
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From page 316... ...
2010. Hitting home: Relationships between recent deployment, posttraumatic stress symptoms, and marital functioning for Army couples.
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2011. Awareness of posttraumatic stress disorder in veterans: A female spouse/intimate partner perspective.
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2010. Stressful experiences, coping strategies, and predictors of health-related outcomes among wives of deployed military servicemen.
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2011. Couple adjustment and posttraumatic stress disorder symptoms in National Guard veterans of the Iraq war.
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1995. Behavioral family therapy for Vietnam combat veterans with posttraumatic stress disorder.
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2010. Returning Home from Iraq and Afghanistan: Preliminary Assessment of Readjustment Needs of Veterans, Service Members, and Their Families.
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2011. Posttraumatic stress, family adjustment, and treatment preferences among National Guard soldiers deployed to OEF/OIF.
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2007. Military service in the life course.
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Operation Iraqi Freedom 06-08: Iraq; Operation Enduring Freedom 8: Afghanistan. Washington, DC: Office of the Surgeon General, United States Army Medical Command, Office of the Surgeon Multinational Force-Iraq.
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2012. The prevalence of mental health disorders in a community sample of female victims of intimate partner violence.
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2009. Impact of prior Operation Enduring Freedom/Operation Iraqi Freedom combat duty on mental health in a predeployment cohort of National Guard soldiers.
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2002. Warfare and welfare: Military service, combat, and marital dissolution.
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From page 328... ...
2011. The role of intimate relationships, appraisals of military service, and gender on the development of posttraumatic stress symptoms following Iraq deployment.
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2011. Programs Addressing Psychological Health and Traumatic Brain Injury Among US Military Servicemembers and Their Families.
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