The Impact of Deployment on Service Members and their Families

Presented by:Jim Messina, Ph.D.

Licensed PsychologistLead Trainer: Florida ARC-

Coping with Deployment PFA for Military FamiliesLead Disaster Mental Health Services

Tampa Bay Chapter of American Red CrossPsychologist with: St. Joseph’s Hospital, Vericare, Argosy University

Presentation Available on: www.jamesjmessina.com

Most current statistics on make up of Deployed Military Men = 90% Women = 10% Married = 53%

with children = 68% without children = 32%

Single = 47% with children = 13% without children = 87%

CTS Deployment File Baseline Report, Defense Manpower Data Center, Aug 31, 2007

Major Stressors for Military Families

Frequent moves and separations Individual augmentees Risk of injury and death Expectations Long and unpredictable Foreign

residence

Risk Factors for Military Families Younger spouses Younger children Socially isolated and dependent families Families undergoing major transitions Families with multiple needs and

problems before deployment Children with school history of special

education How well children show coping skills

prior to deployment

Risk Factors for Military Families Family history of mental health issues Families of junior enlisted Single parents Foreign-born spouses Pregnant spouses Prior deployments Dual military Newly married

Stressors in the Deployment Cycle

Pre-Deployment Stressors

Preparedness – Practical preparation

Power of attorney/Will/Financial plan Location of important papers Emergency contact procedures Child care arrangements

Emotional preparation Prepared to cope with unexpected problems Trust service member will be protected Support mission

Pre-Deployment Stressors Lack of Preparation Time Unit Preparation vs. Family Preparation Shifting expectations Length of upcoming deployment Open-ended deployments Deployment date Clarifying changes in family dynamics Anticipation of threats to service member Perception of mission purpose Lack of information Rumors

Deployment Stressors on Spouses

PRE-DEPLOYMENT Confusion Denial Resentment Arguing Worrying Planning

DURING DEPLOYMENT Busier than usual Crying Loss of sleep, appetite Engrossed in war news Self-growth Independence Decision maker Less angry, but

lonelier

Deployment Stressors on ChildrenPRE-DEPLOYMENT Confusion Regression Anger Outbursts Sadness Surprise Guilt Behavioral problems

DURING DEPLOYMENT At higher risk for

problems than the national norm.

Parenting stress during deployment is more than the national norm.

Boys and younger children may experience more symptoms than girls.

Internalizing symptoms may be more common than externalizing symptoms

Pre-Deployment Stressors on Adolescents

“I don’t care” Fear of rejection Denial of feelings Anger Higher value on friends

Children’s Reaction to Deployment

Stressors in the Deployment Cycle

Deployment Stressors for Service Members

Operational-heat, dehydration, lack of comforts, desert, noises, fumes

Cognitive-boredom, monotony, unclear role or mission, experiences that defy beliefs, info overload

Emotional-fear of failure, guilt, horror, fear, anxiety, feeling devalued

Social-separation from loved ones, lack of privacy, public opinion and media

Spiritual-change in faith, inability to forgive, loss of trust

Charles Figley and William Nash, Combat Stress Injury (2007)

Trauma descriptions offered by Soldiers and Marines

Friends burned to death, one killed in blast

A friend was liquefied in the driver’s position on a tank

A huge bomb blew my friends’ head off like 50 meters from me

Marines being buried alive Seeing, smelling, touching, dead, blown-

up people

Tough Realities about Combat

Fear in combat is ubiquitous Unit members will be injured and killed There will be communication breakdowns Leadership failures will be perceived Combat impacts every soldier mentally and

emotionally Combat has lasting mental health effects Soldiers are afraid to admit that they have a mental

health problem Deployments place a tremendous strain upon

families Combat environment is harsh and demanding Combat poses moral/ethical challenges

WRAIR Land Combat Study Team

Challenges of Operation Iraqi Freedom (OIF) & Operation Enduring Freedom (OEF)

No “front line” Highly ambiguous environment

Complex and changing missions – combat, peacekeeping, humanitarian

Long deployments Repeated deployments Environment is very harsh – extreme heat

24 hour operations constant movement by ground or air limited down time crowded uncomfortable living conditions difficult communications

Combat Exposure in Iraq

Common Reactions to Trauma Fear and anxiety Intrusive thoughts about the

trauma Nightmares of the trauma Sleep disturbance Feeling jumpy and on guard Concentration difficulties

Common Reactions to Trauma

Avoiding trauma reminders Feeling numb or detached Feeling angry, guilty, or ashamed Grief and depression Negative image of self and world

The world is dangerous I am incompetent People can not be trusted

BATTLEMIND TRAINING

Battlemind skills helped you survive in combat, but may cause you problems if not adapted when you get home

Buddies (cohesion) vs. Withdrawal Accountability vs. Controlling Targeted Aggression vs. Inappropriate Aggression Tactical Awareness vs. Hypervigilance Lethally Armed vs. “Locked and Loaded” at

Home Emotional Control vs. Anger/Detachment Mission OPSEC vs. Secretiveness Individual Responsibility vs. Guilt Non-Defensive Driving vs. Aggressive Driving Discipline and Ordering vs. Conflict

TraumaInitial

Reactions

Social Support

PTSDSymptoms

The Role of Families

In general, families provide a primary source of social support.

Spouses and intimate partners are typically identified as the chief source of social support.

Approximately 50% of service members deployed to OEF/OIF are married at the time of deployment.

Background Invisible Wounds of War

Rand Corporation (2008)

Since October 2001, approximately 1.64 million U.S. troops were deployed to Operation Enduring Freedom (OEF; Afghanistan) and Operation Iraqi Freedom (OIF; Iraq).

Pace of deployments is unprecedented in the history of the all-volunteer force (Belasco, 2007; Bruner, 2006).

Higher proportion of armed forces are being deployed & deployments have been longer, redeployment to combat has been common, and breaks between deployments have been infrequent (Hosek, Kavanagh, and Miller, 2006).

Background Invisible Wounds of War

Rand Corporation (2008)

OEF & OIF have employed smaller forces & produced lower casualty rates of killed or wounded than Vietnam and Korea. More service members are surviving due to advances in medical technology & body armor (Regan, 2004; Warden, 2006).

However, casualties of a different kind have emerged—invisible wounds, such as mental health conditions and cognitive impairments

These deployment experiences may include multiple deployments per individual service member and exposure to difficult threats, such as improvised explosive devices (IEDs).

Invisible Wounds of War Rand Corporation (2008)

Data from phone survey of approximately 2000 OIF & OEF veterans 14% PTSD 14% depression 19% TBI 33% PTSD, depression or TBI 5% symptoms of all 3

Invisible Wounds of War Rand Corporation (2008)

Top 3 barriers to mental health treatment

1. Treatment not confidential; could constrain future job assignments and military career advancement

2. Medications may have unpleasant side effects

3. Even good mental health care is not effective

Invisible Wounds of War Rand Corporation (2008)

Costs of PTSD, depression and TBI–Other psychiatric diagnoses

Risk of attempting suicide Higher rates of unhealthy behaviors

(smoking, overeating, unprotected sex) Higher rates of physical health problems

and mortality Missed more days of work or less

productivity A relationship to being homeless

Invisible Wounds of War Rand Corporation (2008)

Service members not on active duty (Reserve Corps, discharged, retired)

Enlisted personnel Females Hispanics More lengthy deployments More extensive exposure to combat

trauma

Summary of FindingsInvisible Wounds of War

Rand Corporation (2008)

About 10-15% of Soldiers develop PTSD after deployment An additional 10-15% have significant symptoms of

depression, anxiety, or PTSD Alcohol misuse also increases post-deployment Prevalence varies as a function of deployment

experiences MH problems associated with functional impairment,

attrition, and physical health problems One-third of Soldiers use MH services after deployment

(includes screening and prevention services) Perceptions of stigma may be improving. However, many

Soldiers don’t seek help, due to stigma and other barrier

Financial Stressors of Deployment

Most do not experience serious financial difficulties – Potential loss of income offset by supplements

Substantial minority does face financial hardships– 18% of spouses report serious financial difficulties

29% of spouses report trouble paying bills 1/2 reporting difficulties are from junior enlisted grades

Increased expenses– Supplies for deployed service member

Shipping costs Communication Additional childcare costs

Stressors in the Deployment Cycle

Typical Course of Reintegration

Family resilience is the rule, not the exception.

Usually, families return to the normal routine.

Common to incorporate changes without major disruption in family functioning.

HOWEVER…

Reunions can be stressful Changed roles/responsibilities New independence of spouse Lack of time Tug on loyalties Extended family Health/Mental health problems Unresolved marital issues haven’t

vanished

Most frequently identified stressors following soldiers’ return

Readjustment to marital and family relationships

Lack of time for family reintegration Couple jealousy and suspicions Ongoing military stressors Uncertainty about future retention

Teitelbaum (WRAIR,1992) conducted a study with the Army after ODS

Post Deployment Stressors of Service Members

Physical: traffic, crowds, unarmed, access to alcohol

Cognitive: loyalty issues to family vs unit, secrecy vs disclosure, boredom, regrets, thoughts of losses

Emotional: grief, anger, feeling unsafe, guilt, withdrawal from war “rush,” numbness

Social: separated from buddies, overwhelmed or misunderstood by family, feelings of alienation

Spiritual: asking why buddies died, lack of purpose, changed faith, conflicting values

Charles Figley and William Nash, Combat Stress Injury (2007)

Service Mindset when Deployed Stay focused on mission /nothing else matters Truly life or death / always on the edge Constant adrenaline “rush” Black or white / all or nothing Sense of purpose, invincibility Only trust battle buddies /others are threat Need to control environment Real problems and needs exist in Iraq

Adapted from briefing by COL Kevin Gerdes, May 2008

Mindset of Returned Service Members at Home Life is now unfocused and complex No longer on the verge of life or death What can replace the “high” of war? Things aren’t clear cut No sense of purpose, nothing matters Can’t trust anybody Can’t be in control of surroundings Problems at home pale in comparison to those in

Iraq

Adapted from briefing by COL Kevin Gerdes, May 2008

Reserve Components Stress after Deployment Return to civilian life Job may no longer be available May experience a reduction in income Transition of health care or loss of

health coverage Loss of unit/military support system for

the family Lack of follow up/observation by unit

commanders to assess needs

Changes in Family faced by returning Service Members FAMILY HAS

New routines New responsibilities More independence and confidence Made many sacrifices Worried, felt lonely Gone through milestones that were

missed Adapted from briefing by COL Kevin Gerdes,

May 2008

Impact of Returning Home VETERAN’S RETURN CAN

Interrupt routine Disrupt space Throw off decision making Cause family to walk on tip toes Not make everything perfect Not replace the sacrifices and missed milestones

Adapted from briefing by COL Kevin Gerdes, May 2008

Post Deployment Stressors for Spouses

Post Deployment Stressors for Children Afraid of returning parent /Avoiding

Wants attention Clingy Anger Needs reassurance Attempts to split parents Desires recognition Joy Excitement

Briefing by Doug Lehman, May 2008

Post-Deployment Stressors of Adolescents

Spending more time with friends School problems Behavioral problems Relief Defiance Resentment Avoidance Withdrawal

Briefing by Doug Lehman, May 2008

Tips for both spouses during reintegration Recognize that readjustment stress is

common Listen to each other’s stories and be

curious Recognize that experiences have changed

both partners Discover new family strengths Negotiate a new balance, roles, and routine Make sure each spouse has space

Tips for both spouses during reintegration Don’t play “one-up” games about

deployment Build common interests again Go slow Don’t drill the other if there are concerns

regarding an affair Don’t plan sudden romantic getaways Both spouses may feel unneeded,

unwanted - discuss changes and gradually develop solutions

Tips for both spouses during reintegration Expect children to test limits Be flexible and patient Communicate respect Plan for future together Compliment each other more Be willing to apologize Take time outs when things feel out of

control

Tips for Both Parents during Reintegration Spend one-on-one time with each child Be giving of time and energy Allow child to also have space Listen and accept child’s feelings Be realistic and flexible Avoid excess gift giving Don’t get upset if child has reactions to you Don’t give into demands of guilt

Tips for Both Parents during Reintegration Express specific concerns and offer to help but

don’t push Become an expert in available resources Have honest discussion about financial situation Use connections made during deployment to

develop strategies to help transition Give your child a chance to talk about war

experiences Have a battle buddy talk to your child

Armstrong, K., Best, S., & Domenici, P. (2006), Courage After Fire

References The Center for Deployment Psychology

http://www.deploymentpsych.org/

Mission of CDP: To train military and civilian psychologists and other mental health professionals to provide high quality deployment-related behavioral health services to military personnel and their families.

CDP's Course Resources: http://www.deploymentpsych.org/courseres.html

Introduction to the CDP (powerpoint)   PTSD and Domestic Violence (powerpoint)   Families in the Wake of Trauma (powerpoint)

CDP's Links : http://www.deploymentpsych.org/links.html