Long-Term Trajectories and Service Needs for Military Families

The deployment of US military personnel to recent conflicts has been a significant stressor for their families; yet, we know relatively little about the long-term family effects of these deployments. Using data from prior military service eras, we review our current understanding of the long-term functioning and needs of military families. These data suggest that overseas deployment, exposure to combat, experiencing or participating in violence during war deployment, service member injury or disability, and combat-related post-traumatic stress disorder (PTSD) all have profound impacts on the functioning of military families. We offer several recommendations to address these impacts such as the provision of family-centered, trauma-informed resources to families of veterans with PTSD and veterans who experienced high levels of combat and war violence. Recent efforts to address the needs of caregivers of veterans should be evaluated and expanded, as necessary. We should also help military families plan for predictable life events likely to challenge their resilience and coping capacities. Future research should focus on the following: factors that mediate the relationship between PTSD, war atrocities, caregiver burden, and family dysfunction; effective family-centered interventions that can be scaled-up to meet the needs of a dispersed population; and system-level innovations necessary to ensure adequate access to these interventions.     

Mental Health Risk and Social Ecological Variables Associated with Educational Attainment for Gulf War Veterans: Implications for Veterans Returning to Civilian Life

This study examines how post-secondary educational attainment among young veterans of the first gulf war affects their mental health status. The all-volunteer military attracts recruits by offering them veterans’ educational benefits. Education should help veterans adjust to civilian life. Few studies have shown whether education following military service helps improve veterans’ mental health, however. Viewing resiliency, life span and life course, and social geography theories through the lens of social ecology, it is hypothesized that selected contextual factors in the personal, interpersonal, and organizational domains could mediate or moderate the relationship between education and veterans’ mental health. Informational social networks showed an association with obtaining mental illness treatment. Recent treatment for post-traumatic stress disorder (PTSD) showed an association with use of veterans’ educational benefits. Residing with a small nuclear family in conjunction with having higher levels of health and educational benefits and a higher family income was associated with higher educational attainment.     

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.     

Healing from Moral Injury: A Qualitative Evaluation of the Impact of Killing Treatment for Combat Veterans

This paper evaluates the Impact of Killing (IOK) treatment—a psychological intervention designed to address moral injury and trauma associated with killing in war. Using qualitative data from interviews with 28 combat veterans, we examine IOK’s impact, how it differs from other trauma-focused treatments, and how it can be improved to better meet veterans’ needs. We found that many veterans processed their killing experiences for the first time in IOK, even though all had previously completed evidence-based treatments for posttraumatic stress disorder. Several described killing in war as the most distressing and transformative trauma of their lives, and all affirmed the value of an intervention focused directly and explicitly on moral injury and killing. IOK helped veterans to acknowledge their grief, shame, and distress; gently but critically examine their thoughts and beliefs about killing in war; and make strides toward acceptance, reconciliation, and forgiveness.     

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.     

Being Hopeful and Continuing to Move Ahead: Religious Coping in Iranian Chemical Warfare Poisoned Veterans,a Qualitative Study

There is a substantial number of Iranian war veterans, exposed to sulfur mustard, who suffer from serious long term progressive health problems involving their respiratory organs, eyes, and skin. Little is known, however, about these casualties’ experiences of living with the consequences of sulfur mustard poisoning. This qualitative study aims to provide greater insight into how war veterans live with the consequences of the poisoning and involved 17 Iranian war veterans who had been poisoned by sulfur mustard during the Iran–Iraq conflict. Each participant was interviewed using a semi-structured interview schedule and the data generated through this process was analyzed using constant comparative data analysis technique. Data analysis resulted in “religious beliefs and practices” as a main category, which included two sub-categories: religious value centered life and religious support. Findings suggest that religious belief assists veterans to accept the impact of poisoning on their lives and adapt their lifestyles accordingly, to participate in religious social activities and feel socially supported, and to be hopeful about the future and live their lives as fully as possible.     

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.     

Zwischen Anerkennung und Zur��ckweisung

The paper deals with the question of to what extent the development and application of medical nosologies are dependent upon social, political and economic conditions and which (often utilitarian) considerations decide on the fitness for use of a clinical picture and a diagnosis. The context and the framework of the construct are crucial to understanding, recognition and finally to compensation procedures. With reference to historical and current material supplied by war veterans, processes of recognition and rejection of entitlements to benefits will be illustrated; the significance of psychoanalytical concepts in this process will be reflected.     

The Political Consequences of Combat: Post‐Traumatic Stress and Political Alienation Among Vietnam Veterans

On average, veterans are more civically and politically engaged than civilians. Previous research on the effects of military service, however, did not account for differences in veterans’ combat experiences. Using survey data from a representative sample of Vietnam veterans, this study presents evidence that veterans who were exposed to severe combat trauma and veterans who exhibited attitudes and fears associated with post‐traumatic stress had significantly lower levels of political efficacy and trust. The negative consequences of combat exposure and post‐traumatic stress are not mitigated when veterans have quality social support or when they seek professional counseling. These findings inform political psychology and hold implications for claims regarding the empowering influence of service in the U.S. military, increased political engagement, in particular. Among Vietnam veterans, exposure to severe combat trauma and post‐traumatic stress were both associated with reduced political efficacy and trust.     

Combat-Related Killing: Expanding Evidence-Based Treatments for PTSD

Despite its prevalence, killing in war is an experience that may not fit neatly into existing models of posttraumatic stress disorder (PTSD) and its treatment. The context in which killing occurred may be complex. Furthermore, while killing may certainly be fear based, an individual may have also killed in response to losing someone close and experiencing sadness and anger, as opposed to fear. While evidence-based treatments for PTSD may be a good starting point for killing-related trauma, we argue that existing treatments need to be expanded. Complex killing-related cognitions that may not be anticipated or identified, moral injury, self-forgiveness, and loss are all important issues that arise that may need to be addressed in greater detail. Consequently, we have developed a 6- to 8-session individual treatment module for those impacted by killing in war, expressly designed for use with existing evidence-based treatments for PTSD, currently being validated for use in clinical practice. We see this module as supplementary, rather than as a replacement, building on the skills that veterans have already learned within these treatments. By expanding the types of treatments we offer those who have killed in war, we can ensure that we are providing veterans with comprehensive treatment that takes the complexities of war and its aftermath into account.     

Post-traumatic stress disorder and hiring: The role of social media disclosures on stigma and hiring assessments of veterans

A significant percentage of veterans suffer from post-traumatic stress disorder (PTSD). Veterans are often directed to social media platforms to seek support during their transition to civilian life. However, social media platforms are increasingly used to aid in hiring decisions, and these platforms may make veterans’ PTSD more discoverable during the hiring process. Based on social identity theory and identity management theory, the integrated suspicion model, and the stigma literature, we conducted four studies that examine veterans’ PTSD disclosures on social media and the consequences in the hiring process. Study 1 suggests that 16%–34% of veterans included cues related to PTSD status on social media. Study 2, based on 290 upper-level business students, shows that veterans with PTSD were more stigmatized than veterans without PTSD, and stigmatization is associated with more suspicion and lower hiring-related ratings (of expected task performance, expected organizational citizenship behaviors (OCB), expected counterproductive work behaviors (CWB), and intention to interview). Study 3, based on 431 working professionals with hiring experience, further supports relationships from Study 2. Study 4, based on 298 working professionals, identifies peril (i.e., perceptions regarding danger) as an additional mediator for the effects of PTSD on hiring-related ratings. In sum, we identify and explore the identity management conundrum that social media disclosure poses for veterans with PTSD in the hiring process and discuss potential remedies and avenues for future research.     

Religious Moral Beliefs Inversely Related to Trauma Experiences Severity and Depression Severity among War Veterans in Bosnia and Herzegovina

The aim of this study is to determine the association of religious moral beliefs and depression severity of war veterans in Bosnia and Herzegovina. The sample consists of male war veterans who were inpatients with clinically presented depression and those who were observed as healthy, regarding results of previous psychological testing (n = 65 both). The Bosnia–Herzegovina versions of Hopkins Symptom Checklist and Harvard Trauma Questionnaire with questionnaire for religious moral beliefs were applied. The religious moral belief index was inversely correlated to depression severity. The religious moral beliefs may help protection of the war veterans’ mental health stability after surviving multiple war traumas.     

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.     

Social Identity,Groups, and Post‐Traumatic Stress Disorder

As with the identification and labelling of many mental health problems, the adoption of PTSD within DSM can be said to arise from contemporaneous social and political contexts: specifically the return to the United States of many war‐affected veterans from Vietnam ( Scott, 1993 ). The specific circumstances of the recognition of PTSD within DSM‐III have led several commentators to discuss it in terms of social construction (e.g., Summerfield, 2001 ). The current review argues that the orientation of theory and research aimed at understanding PTSD has been particularly informed by Western individualistic constructions of social phenomena. Our review calls for a blending of approaches to understanding post‐traumatic stress by considering the social structures and contexts in which it is expressed and in particular by considering how a group‐level analysis can inform incidence, diagnosis, and expression of post‐traumatic symptoms.     

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.     

War stress and late-life mortality in World War II male civilian resistance veterans

The mental and physical health of 146 Dutch males exposed to severe war stress during their young adulthood were examined in 1986-1987 when they were at ages 61 to 66 years. The veterans' data were compared with a randomly selected population-based sample of same-aged males. In 2005, 70% of the war stress veterans had died, and only 35% of the comparison group. The baseline quality of life was significantly poorer in the war stress veterans than in the comparison group. Baseline variables explained 42% of the increased risk of mortality among war stress veterans. Smoking was the largest single contributor to mortality.     

Faces in the face of death: Effects of exposure to life-threatening events and mortality salience on facial expression recognition in combat and noncombat military veterans

Soldiers in war zones often experience life-threatening events that put their lives at stake. The present study examined how these exposures shape soldiers' social behavior, manifested by recognition of facial expressions. In addition, we investigated how explicit awareness of one's eventual death affects sensitivity to facial expressions. Veterans of elite military combat units were exposed to conditions of mortality or pain salience and later requested to label the emotions depicted in threatening and nonthreatening faces. Combat veterans were more accurate than noncombat veterans in identifying threatening expressions, both in mortality or pain salience induction (Experiment 1) or under no induction at all (Experiment 2). In addition, noncombat veterans primed with mortality salience identified fear expressions more accurately than those primed with pain salience. Finally, mortality salience improved accuracy for nonthreatening expressions for all veterans. The present results demonstrate that fear of death, resulting from exposure to concrete life-endangering perils or from thoughts on human's inevitable death, influences perception of facial expressions, which is critical for successful interpersonal communication. (PsycINFO Database Record (c) 2012 APA, all rights reserved).     

Informing Evidence-Based Assessment of ADHD in Veterans and Service Members

Attention-deficit/hyperactivity disorder (ADHD) is diagnosed in approximately 2.5% to 5% of the population, and though epidemiological studies of ADHD in veterans and service members are lacking, available evidence suggests that there may be a higher prevalence of ADHD in service members than in the general population. Assessment of ADHD in military populations is complicated by the higher prevalence rates of many other disorders with symptoms that overlap those of ADHD (e.g., posttraumatic stress disorder), making differential diagnosis an important aspect of the evaluation of ADHD. Although the diagnostic interview remains the gold standard for the evaluation and diagnosis of ADHD with adults, several different types of psychological measures have been developed and validated that can aid the evaluation. Future epidemiological research focused on prevalence and comorbidity rates in military samples is warranted to better understand the scope and complexity of the diagnosis. In addition, continued study of diagnostic assessment techniques, including validity testing and neurocognitive performance of veterans and service members with ADHD, particularly postdeployed veterans pursuing higher education, is warranted. This article reviews relevant findings and identifies initial recommendations for clinicians and researchers.     

The role of religious beliefs and thoughts of holy defence veterans in accepting the difficulties of imposed war

This study has surveyed the physical, emotional, psychological, educational, vocational, family, social and economic problems of 100 veterans of Iraq's imposed war on Iran. It has examined veterans’ reasons for the acceptance or non acceptance of the difficulties of being a veteran. It has also sought their opinions as to the necessity and usefulness of an active counseling center for facilitating veterans’ problems. One of the most important findings is that 82% of the veterans have easily accepted the problems associated with being a veteran. The most significant factor helping them to accept their various problems has been their religious beliefs. Fifty percent of them did not even know whether the Veterans’ Foundation had a counseling center or not. Sixty four percent of them have considered an active counseling center as necessary and useful, provided that the center (clinic) is independent and not related to the Veterans’ Foundation.     

Influence of adjuvant mindfulness-based cognitive therapy (MBCT) on symptoms of post-traumatic stress disorder (PTSD) in veterans – results from a randomized control study

Even 30 or more years after the end of a war, veterans can suffer from post-traumatic stress disorder (PTSD). In the present study, we explored the influence on symptoms of PTSD among Iranian veterans of the Iran–Iraq war of mindfulness-based cognitive therapy (MBCT) as add-on to a standard treatment with citalopram. Forty-eight male veterans with PTSD (mean age: 52.97 years) took part in this eight-week intervention study. Standard treatment for all patients consisted of citalopram (30–50 mg/day at therapeutic dosages). Patients were randomly assigned either to the treatment or to the control condition. Treatment involved MBCT delivered in group sessions once a week. Patients in the control condition met at the hospital with the same frequency and duration for socio-therapeutic events. At baseline and at study completion, patients completed questionnaires covering symptoms of PTSD, depression, anxiety, and stress. At study completion after eight weeks, scores for PTSD (re-experiencing events, avoidance, negative mood and cognition, hyperarousal), depression, anxiety, and stress were lower, but more so in the intervention than the control group. Data suggest that, as adjuvant to standard SSRI medication, MBCT is an effective intervention to significantly reduce symptoms of PTSD, depression, anxiety, and stress among veterans.