The relationships between posttraumatic stress symptom clusters and marital intimacy among war veterans

This study examined (a) the relationships between posttraumatic stress disorder (PTSD) symptom clusters and marital intimacy among Israeli war veterans and (b) the role of self-disclosure and verbal violence in mediating the effects of PTSD avoidance and hyperarousal symptoms on marital intimacy. The sample consisted of 219 participants divided into 2 groups: ex-prisoners of war (ex-POWs; N = 125) and a comparison group of veterans who fought in the same war but were not held in captivity (N = 94). Ex-POWs displayed higher levels of PTSD symptoms and verbal violence and lower levels of self-disclosure than did controls. Although ex-POWs and controls did not differ in level of marital intimacy, they did, however, present a different pattern of relationships between PTSD clusters and intimacy. In ex-POWs, self-disclosure mediated the relations between PTSD avoidance and marital intimacy. Verbal aggression was also found via indirect effect of hyperarousal on marital intimacy. The results point to the importance of self-disclosure and verbal violence as interpersonal mechanisms for the relations between posttraumatic symptoms on marital intimacy of ex-POWs.     

The relationship between posttraumatic stress disorder symptoms and paternal parenting of adult children among ex-prisoners of war: a longitudinal study

The aversive impact of combat and combat-induced posttraumatic stress disorder (PTSD) on parenting of young children has been examined in a few studies. Nevertheless, the toll of war captivity on parenting and the long-term relations between posttraumatic symptoms and paternal parenting of adult children remains unknown. This longitudinal study examined paternal parenting of adult children among war veterans, some of whom were held in captivity. Furthermore, we examined the mediating role of PTSD symptoms in the association between captivity and parenting. The sample included two groups of male Israeli veterans from the 1973 Yom Kippur War: ex-prisoners of war (ex-POWs) and comparable veterans who had not been held captive. Both groups were assessed via self-report measures of PTSD at three time points: Time 1 (18 after the war), Time 2 (30 after the war), and Time 3 (35 after the war) years after the war. Results shows that ex-POWs reported lower levels of positive parenting compared to comparison group veterans at Time 3. Furthermore, PTSD symptoms at Time 1, Time 2, and Time 3 mediated the association between captivity experience and parenting at Time 3. In addition, it was found that increases in the levels of PTSD symptom clusters over time were associated with lower levels of positive parenting at Time 3.     

Posttraumatic Stress Disorder and Marital Adjustment: The Mediating Role of Forgiveness

The study assessed the effects of war captivity on posttraumatic stress symptoms and marital adjustment among Prisoners of War (POWs) from the Yom Kippur War. It was hypothesized that men's perception of level of forgiveness mediates the relation between posttraumatic symptoms and marital adjustment. The sample consisted of 157 Israeli veterans divided into 3 groups: 21 POWs with Posttraumatic Stress Disorder (PTSD), 58 former POWs without PTSD, and 70 control veterans. The findings indicated that former POWs with PTSD reported lower levels of marital satisfaction and forgiveness than veterans in the other 2 groups. In addition, men's perception of level of forgiveness mediated the relationship between their posttraumatic symptoms and their marital adjustment. The theoretical and clinical implications of these results are discussed.     

From front line to home front: a study of secondary traumatization.

While the long-term effects of combat trauma on veterans have been studied extensively, its impact on veterans' wives has yet to be investigated. This study examined the implications of combat-induced psychopathology--wartime combat stress reaction (CSR) and current posttraumatic stress disorder (PTSD)--in a sample of 205 wives of Israeli combat veterans of the 1982 Lebanon war. Results show that both CSR and PTSD were associated with increased psychiatric symptoms in the wives. In addition, current PTSD was particularly found to contribute to impaired social relations among veterans' wives in a broad range of contexts, from inner feelings of loneliness, through impaired marital and family relations, and extending to the wider social network. Implications of these findings for treatment and further research are discussed.     

Coping with war captivity: The role of sensation seeking

This study examines the implication of both sensation seeking and the subjective appraisal of captivity in the long-term adjustment of ex-prisoners of war (ex-POWs). 164 Israeli ex-POWs and 184 comparable controls were studied, 18 years after their participation in the Yom Kippur War. The findings indicate that high-sensation seekers adjusted better than low-sensation seekers to the stresses of captivity. Low-sensation-seeking ex-POWs reported more PTSD symptoms, more severe psychiatric symptomatology, and more intense intrusive and avoidance tendencies. High- and low-sensation-seeking POWs differed also in feelings when taken prisoner, subjective assessment of suffering in prison, ways of coping with prison, and emotional states during captivity. The present study supports the postulation that sensation seeking is an important stress-buffering personal resource. The role of coping styles in long-term adjustment following war captivity is discussed.     

PTSD Symptom Severity and Family Adjustment Among Female Vietnam Veterans

This study examined relations between posttraumatic stress disorder (PTSD) symptom severity and several family adjustment variables among a sample of 89 female Vietnam veterans and their male relationship partners. Findings revealed associations between PTSD symptom severity and measures of marital adjustment, family adaptability, family cohesion, parenting satisfaction, and psychological abuse. Results suggest that the presence of PTSD symptomatology may have important implications with regard to the family life of female Vietnam veterans.     

Veterans’ Offspring’s Personality Traits and the Intergenerational Transmission of Posttraumatic Stress Symptoms

Following war and war captivity, many combat veterans and former prisoners of war (ex-POWs) may suffer from posttraumatic psychopathologies, and these may be transmitted to their offspring. Though there are considerable individual differences between offspring in this respect, the mechanisms underlying such differences remain unclear. The current longitudinal study examined the role that veterans’ offspring’s Big Five personality traits may play within this intergenerational transmission. One hundred and twenty-three dyads consisting of veterans (79 ex-POWs and 44 combat veterans) and their adult offspring were examined. Fathers’ posttraumatic stress symptoms (PTSS) and global psychiatric distress (GD) were assessed 30 and 35 years after the war, and offspring’s PTSS, GD, and Big Five personality traits were assessed 40 years after the war. Findings indicate that veterans’ psychopathologies were associated with those of their offspring. Furthermore, analyses revealed significant positive associations between offspring’s psychopathologies and their Neuroticism, and negative associations with their Agreeableness and Conscientiousness. Finally, a mediation effect was found wherein the fathers’ PTSS and GD were related to their offspring’s Neuroticism levels, and the offspring’s Neuroticism was related to their PTSS and GD levels. These findings suggest that offspring’s personality traits may indeed play a role in the transmission of posttraumatic psychopathologies from veterans to their offspring, and may explain individual differences in this respect. Specifically, high levels of Neuroticism may place offspring at risk for secondary traumatization. Possible explanations and limitations are discussed, and future research directions are suggested.     

World assumptions and combat-related posttraumatic stress disorder

The authors examined the association between (a) personal world assumptions and (b) combat stress reactions (CSRs), posttraumatic stress disorder (PTSD), and PTSD's course among three groups of Israeli veterans: 109 veterans who suffered from CSR on the battlefield, 98 decorated veterans, and 189 control participants. Participants completed standardized questionnaires that measured PTSD and world assumption. Both CSR and chronic PTSD were associated with lower levels of self-worth and beliefs about the benevolence of people. In addition, the authors found a linear association between self-worth perceptions and levels of mental status. The authors examined the results of the study considering the extraordinary characteristics and meaning of war.     

Secondary traumatization among former prisoners of wars' adult children: the mediating role of parental bonding

Background and Objectives: The aversive impact of combat and parents' combat-induced posttraumatic stress disorder (PTSD) on young children has been examined in a few studies. However, the long-term toll of war captivity on secondary traumatization (ST) and the parental bonding of adult children remain unknown. This study examined ST symptoms and parental bonding among adult children of former prisoners of war (ex-POWs' children) that were compared to adult children of comparable veterans (controls' children). Furthermore, we examined the mediating role of parental bonding and exposure to stress in the association between group and ST symptoms. Design: A correlative, cross-sectional study. Methods: Participants were Israeli ex-POWs' children (N = 98) and controls' children (N = 90), whose fathers fought in the 1973 Yom Kippur War. All participants completed a battery of self-reported questionnaires. Results: Ex-POWs' children reported a higher number of ST symptoms and lower levels of fathers' care, as compared to controls' children. Importantly, exposure to stress stemming from fathers' behaviors and fathers' care was found to mediate the association between research group and ST. Conclusions: Forty years after the war ended, the experience of living with ex-POWs is associated with ex-POWs' children psychological outcome.     

The Role of Fathers’ Posttraumatic Stress Symptoms and Dyadic Adjustment in the Intergeneration Transmission of Captivity Trauma

This study aimed to assess the longitudinal associations between the 1973 Israeli-Arab War ex-prisoners of war’s (ex-POWs) posttraumatic stress disorder symptoms (PTSS) and dyadic adjustment (DAS) and their adult offspring’s secondary PTSS and DAS. A sample of 124 Israeli father–child dyads has been examined (fathers at 2003 and 2008; offspring at 2013–2014). Results show that fathers’ PTSS and DAS mediated the link between war captivity and offspring’s secondary PTSS and DAS, respectively. The intergenerational transmission of captivity trauma is indirectly explained by the long-term effects of the fathers’ PTSS on their offspring’s secondary PTSS and DAS.     

Marital intimacy,family support,and secondary traumatization: A study of wives of veterans with combat stress reaction

Abstract

The main aim of the study was to assess the role of family variables in the process of secondary traumatization among wives of post-traumatic veterans. We compared a sample of 49 wives of Israeli veterans with combat stress reaction (CSR) from the 1982 Lebanon War with a sample of 31 wives of Israeli veterans who fought in the war without developing CSR. We assessed their psychological reactions to the war, their health status six years later, and their reported levels of marital intimacy and family support after the war. When compared with controls, wives of veterans with CSR reported more negative emotions and lower perceived intimacy after the war, and greater severity of psychiatric and somatic symptoms six years later. Results also indicate that the greater the perceived marital intimacy, the less the negative emotions wives of veterans with CSR felt after the war and the better their health status six years later. In addition, wives of veterans with CSR who reported having received more support from their families after the war reported more anxiety and hostility than wives who received less support. The roles of marital intimacy and family support in the process of secondary traumatization were discussed.     

Long-Term Guilt and Hostility Underlying Posttraumatic Stress Symptoms in War Combatants and Ex-Prisoners of War

The link between posttraumatic guilt and posttraumatic stress disorder has gained recognition over the past decades and was recently expressed in the modifications made to the diagnostic criteria for the disorder under the DSM-V. Yet, the psychological dynamics underlying this relation are still not fully understood. The present study introduces a model whereby different dynamics between guilt and hostility are related to posttraumatic stress disorder symptoms (PTSS), following different traumatic war experiences. One hundred and forty-four former prisoners of war (ex-POWs) and 143 comparable combatants participated in the study, 30 years after the war, reporting on their PTSS, guilt, and hostility. Moderation analyses revealed a three-way interaction, where high hostility buffered the effect of guilt on PTSS only among ex-POWs. This finding suggests a distinctive dynamic among guilt, hostility, and PTSS following diverse traumatic events. Specifically, it appears that hostility can have a mitigating effect on the negative outcomes of guilt for ex-POWs following trauma, but not for non-POW veterans. The theoretical reasoning and the clinical implications of these findings are discussed.     

Psychological symptoms and marital satisfaction in spouses of Operation Iraqi Freedom veterans: relationships with spouses' perceptions of veterans' experiences and symptoms

Much research has shown that spouses of combat veterans with posttraumatic stress disorder (PTSD) have higher rates of psychological and marital distress than do spouses of veterans without PTSD; however, very few studies have examined potential mechanisms of this increased vulnerability. The current study examined spouses of National Guard soldiers recently returned from deployments in Iraq. In addition to documenting elevated levels of psychological symptoms in these spouses, the authors found that spouses experienced greater symptom severity when they perceived high levels of symptoms in soldiers but the soldiers endorsed low levels of symptoms. Furthermore, spouses' marital satisfaction was negatively linked to soldiers' self-reported symptom severity only when spouses perceived that soldiers had experienced low levels of combat activity while deployed. When spouses perceived high levels of such activity, soldiers' self-reported symptoms had no relationship with spouses' marital satisfaction. These findings highlight the importance of interpersonal perceptions in intimate relationships and are consistent with the notion that uncontrollable attributions for a relative's mental health problems may provide a buffer against relationship distress. (PsycINFO Database Record (c) 2008 APA, all rights reserved).     

War exposure and post-traumatic stress as predictors of Portuguese colonial war veterans' physical health

The relationship between war exposure and post-traumatic stress disorder (PTSD) has been largely investigated but the impact of the combat experience on physical health has only recently merited attention. The authors investigated the relationship between war exposure and psychological and physical health among 350 Portuguese colonial war veterans. The role of current PTSD symptoms as a mediator of these relationships was also investigated. The results showed that 39% of the veterans met criteria for current PTSD diagnosis and psychological distress was present in half of the sample. Pain, fatigue, and sleep problems were the most reported physical symptoms and mental health and gastro-intestinal problems, the most reported illnesses. Combat exposure variables were significant predictors of current health. The results indicated that veterans with higher exposure to war trauma maintained higher current levels of psychological distress and presented more physical health problems and physical symptoms than those less exposed. Mediation analyses showed that current PTSD was a full mediator of the relationship between war exposure and physical health outcomes.     

Loneliness and Marital Adjustment of Turkish Couples

The purpose of the present study was to investigate the relationship between loneliness and marital adjustment in Turkish couples. Some demographic correlates of loneliness and marital adjustment such as gender, age, duration of the marriage, type of marriage, and degree of acquaintance before marriage were also examined. The UCLA Loneliness Scale (D. Russell, L. A. Peplau, & C. E. Cutrona, 1980) and the Dyadic Adjustment Scale (G. B. Spanier, 1976) were administered to 58 heterosexual married couples. The results showed that loneliness was significantly and negatively correlated with marital adjustment. For the demographic correlates, significant results were as follows: Self-selected marriages resulted in lower loneliness scores and higher marital adjustment scores than the arranged type of marriage, and marital adjustment increased parallel to an increase in the degree of acquaintance before marriage. The findings and implications are discussed in the context of practice and research.     

Posttraumatic stress disorder, traumatic brain injury, and suicide attempt history among veterans receiving mental health services

History of posttraumatic stress disorder (PTSD) or traumatic brain injury (TBI) has been found to increase risk of suicidal behavior. The association between suicide attempt history among veterans with PTSD and/or TBI was explored. Cases (N = 81) and 2:1 matched controls (N = 160) were randomly selected from a Veterans Affairs Medical Center clinical database. PTSD history was associated with an increased risk for a suicide attempt (OR = 2.8; 95% CI: 1.5, 5.1). This increased risk was present for those with and without a history of TBI. Results support incorporating PTSD history when assessing suicide risk among veterans with and without TBI.     

Traumatization,Marital Adjustment,and Parenting among Veterans and Their Spouses: A Longitudinal Study of Reciprocal Relations

Despite considerable research on secondary traumatization, the ramifications of veterans’ and their wives’ posttraumatic stress symptoms (PTSS) for the family system remain largely uninvestigated. Beginning to fill this gap, the current study aims to investigate the reciprocal relations between both spouses’ PTSS and marital adjustment, and the implications these bear for their parental functioning. Two hundred and twenty‐five Israeli veterans (mean age = 58.62, SD = 7.6) from the 1973 Yom Kippur War and their wives (mean age = 58.28, SD = 5.79) were examined at two points in time: 30 (T1) and 35–37 years after the war (T2). Analysis included longitudinal actor–partner interdependence modeling and sequential mediation analyses. The results show that higher PTSS among the wives at T1 predicted higher PTSS among husbands at T2, and vice versa, and predicted their husbands’ marital adjustment at T2. Moreover, wives’ PTSS at T1 had a significant effect on parental overinvolvement of both parents at T2, but neither their PTSS nor their husbands’ PTSS had an impact on positive parenting. In the intrapersonal domain, better marital adjustment at T1 predicted positive parenting among both spouses in subsequent measurement. Interpersonally, wives’ lower marital adjustment at T1 predicted husbands’ higher parental functioning, but not vice versa. Furthermore, marital adjustment mediated the association between PTSS and positive parenting for both spouses. The results emphasize the detrimental ramifications of war trauma on the interpersonal domains in veterans’ families. Hence, both marital and parental consequences of trauma should be considered in clinical family interventions.     

Coping with war captivity: the role of attachment style

The current study examines the implication of attachment style in both immediate coping and long-term adjustment of prisoners of war (POWs). 164-ex-POWs and 184 matched controls filled out a battery of questionnaires, 18 years after the war. They were questioned about their subjective experience of captivity, current mental health status, and characteristic attachment style. Secure individuals, who reported lower levels of suffering, less helplessness and more active coping during captivity, exhibited better long-term adjustment. Avoidant ex-POWs, who reported helplessness and hostility, and ambivalent individuals, who felt abandoned and vulnerable, reported long-term maladjustment. The role of attachment style as a stress-moderating resource is discussed. © 1998 John Wiley & Sons, Ltd.     

Psychological Functioning of Partners of Australian Combat Veterans: Contribution of Veterans' PTSD Symptoms and Partners' Caregiving Distress

Previous research has found posttraumatic stress disorder (PTSD) symptoms in combat veterans to be associated with impaired psychological functioning in their partners. However, little is known about possible mediators of this association. The present study investigated the mediational properties of six dimensions of the revised Partners of Veterans' Distress Scale (MacDonell, Marsh, Hine, & Bhullar, 2010). Participants were 181 female partners of Australian combat veterans, age ranging from 43 and 83 years (M = 60.47, SD = 4.96), who completed measures assessing their caregiving distress levels, dyadic adjustment, mental health, and satisfaction with life. The combat veterans also completed a scale measuring their PTSD symptoms. Our results indicated that higher scores of veterans' PTSD were associated with lower levels of dyadic adjustment, mental health, and satisfaction with life in their partners. Partners reported that distress related to exhaustion and intimacy problems significantly mediated the relationship between veterans' PTSD symptoms and their partners' satisfaction with life, whereas partners' distress associated with intimacy problems was the sole significant mediator for their dyadic adjustment, and exhaustion was the only significant mediator for partners' mental health. Implications for programmes designed to address the significant needs of the partners of combat veterans are discussed.     

Together in pain: attachment-related dyadic processes and posttraumatic stress disorder

We used actor-partner interdependence modeling to explore associations among attachment-related dyadic processes, posttraumatic stress disorder (PTSD) in war veterans, and secondary traumatic stress (STS) in their wives. A sample of 157 Israeli couples (85 former prisoners of war and their wives and a comparison group of 72 veterans not held captive and their wives) completed self-report scales assessing attachment insecurities (anxiety, avoidance) and PTSD symptoms. For both groups of veterans and their wives, attachment anxiety was associated with the severity of their own and their spouses' PTSD and STS. Avoidant attachment was associated with PTSD and STS only in couples that included a former prisoner of war. A complex pattern of associations involving avoidant attachment was observed in the actor-partner analyses of these couples. The study demonstrates that attachment-related dyadic processes play a role in the development and maintenance of PTSD in traumatized veterans and STS in their wives.