Transcript The Impact of Deployment on Service Members and their

The Impact of Deployment
on Service Members
and their Families
Presented by:
Jim Messina, Ph.D.
Licensed Psychologist
Lead Trainer: Florida ARCCoping with Deployment PFA for Military Families
Lead Disaster Mental Health Services
Tampa Bay Chapter of American Red Cross
Psychologist with: St. Joseph’s Hospital, Vericare, Argosy University
Presentation Available on: www.jamesjmessina.com
Most current statistics on
make up of Deployed Military
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Men = 90%
Women = 10%
Married = 53%
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Single = 47%
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with children = 68%
without children = 32%
with children = 13%
without children = 87%
CTS Deployment File Baseline Report, Defense Manpower Data
Center, Aug 31, 2007
Major Stressors for Military
Families
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Frequent moves and separations
Individual augmentees
Risk of injury and death
Expectations
Long and unpredictable Foreign residence
Risk Factors for Military
Families
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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
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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
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Power of attorney/Will/Financial plan
Location of important papers
Emergency contact procedures
Child care arrangements
Emotional preparation
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Prepared to cope with unexpected problems
Trust service member will be protected
Support mission
Pre-Deployment Stressors
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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
Children
PRE-DEPLOYMENT
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Confusion
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Regression
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Anger Outbursts
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Sadness
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Surprise
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Guilt
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Behavioral problems
DURING DEPLOYMENT
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At higher risk for problems
than the national norm.
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Parenting stress during
deployment is more than the
national norm.
 Boys and younger children
may experience more
symptoms than girls.
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Internalizing symptoms may
be more common than
externalizing symptoms
Pre-Deployment Stressors on
Adolescents
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“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
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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
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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
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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
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WRAIR Land Combat Study Team
Challenges of Operation Iraqi Freedom (OIF)
& Operation Enduring Freedom (OEF)
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No “front line”
Highly ambiguous environment
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Complex and changing missions – combat, peacekeeping,
humanitarian
Long deployments
Repeated deployments
Environment is very harsh – extreme heat
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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
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Fear and anxiety
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Intrusive thoughts about the trauma
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Nightmares of the trauma
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Sleep disturbance
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Feeling jumpy and on guard
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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
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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
Social
Support
Trauma
Initial
Reactions
PTSD
Symptoms
The Role of Families
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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)
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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)
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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)
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Data from phone survey of
approximately 2000 OIF & OEF veterans
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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)
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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 Findings
Invisible Wounds of War
Rand Corporation (2008)
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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
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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
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29% of spouses report trouble paying bills
1/2 reporting difficulties are from junior enlisted grades
Increased expenses– Supplies for deployed service
member
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Shipping costs
Communication
Additional childcare costs
Stressors in the Deployment
Cycle
Typical Course of Reintegration
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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
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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
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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
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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
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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
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Adapted from briefing by COL Kevin Gerdes, May 2008
Mindset of Returned Service
Members at Home
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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
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Adapted from briefing by COL Kevin Gerdes, May 2008
Reserve Components Stress
after Deployment
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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
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FAMILY HAS
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New routines
New responsibilities
More independence and confidence
Made many sacrifices
Worried, felt lonely
Gone through milestones that were missed
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Adapted from briefing by COL Kevin Gerdes,
May 2008
Impact of Returning Home
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VETERAN’S RETURN CAN
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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
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Afraid of returning parent /Avoiding
 Wants attention
 Clingy
 Anger
 Needs reassurance
 Attempts to split parents
 Desires recognition
 Joy
 Excitement
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Briefing by Doug Lehman, May 2008
Post-Deployment Stressors of
Adolescents
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Spending more time with friends
School problems
Behavioral problems
Relief
Defiance
Resentment
Avoidance
Withdrawal
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Briefing by Doug Lehman, May 2008
Tips for both spouses during
reintegration
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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
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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
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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
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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
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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
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Armstrong, K., Best, S., & Domenici, P. (2006), Courage After
Fire
References
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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
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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