Female Veterans: Navigating Two Identities

Female veterans differ from their male veteran counterparts in terms of ratio of men to women, minority status, economic status, and age. In 2014, female veterans totaled over 2 million; roughly 10% of the veteran population. In addition to balancing personal and professional responsibilities, many female veterans also have to adjust to and cope with the physical and/or mental health conditions they experience post-deployment. The extent to which female veterans succeed in transitioning back to civilian life post-deployment may be determined by biological, psychological, and social factors within their home and community. Circumstances that can support or hinder female veterans’ reintegration process include: (a) availability of gender-specific Veterans Affairs policies and services; (b) access to education and employment; (c) supports specific to mental health and/or military sexual trauma; and (d) social stigmas associated with being a female veteran. Along with other healthcare professionals, social workers have an obligation to promote social justice, and to empower underprivileged populations, including female veterans, whose needs may differ from male veterans and require specific expertise and knowledge.     

Experiences of student veterans with social anxiety and avoidance: A qualitative study

Eight-to-ten percent of returning combat veterans report symptoms of Posttraumatic Stress Disorder (PTSD), of which 7–13% also report symptoms of Social Anxiety Disorder. Both disorders are characterized by maladaptive patterns of social functioning, which can have significant effects on the lives of returning combat veterans and increase suicidal risk. The objective of the present study was to identify elements of the lived experience of college student veterans experiencing social anxiety and avoidance. Twelve student veterans with post-9/11 active duty service were interviewed about their lived experiences with social anxiety/avoidance within the framework of phenomenological theory. Data was analyzed using multilevel coding and theme analysis. Analysis of interview themes (n = 12) clarified university campus environments that induce social anxiety/avoidance and the impact on personal and professional relationships, learning, and navigation of physical space. Implications of this study include addressing student veterans’ needs through clinical intervention and further representative research on prevalence rates of these risk factors in various university and community college settings.     

Traumatic Stress and Affect Management in Military Families

The war-time deployment of a service member creates significant stress for the family system that supports that person’s transition into combat, combat duty, and readjustment into civilian and family life upon return. The stressors associated with the deployment cycle are significant and can lead to depression, anxiety, and behavioral concerns for all family members including the children and partners. A family’s adaptation to these stressors can also impact the functioning of the service member during the phases of mobilization, deployment, sustainment, and reintegration. Social work interventions that offer support to the military family can reduce levels of distress within and between the members and improve overall family functioning. A case vignette will be presented that highlights some of the salient interpersonal challenges that can develop in a military family when a veteran returns home with posttraumatic stress that is left untreated. Recommendations for interventions will be considered through the application of psychoeducational approaches for managing traumatic stress in families.     

Diagnosing and treating traumatic brain injury among veterans of the Afghanistan and Iraq wars: implications for social work

Traumatic brain injury (TBI) is a serious condition affecting many American veterans who have served in Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF). Using a biopsychosocial perspective, the authors delineate and discuss the challenges of diagnosing and treating this neurological disability among soldiers who have returned to the United States from combat theaters in the Middle East. They explain recent changes including the Veterans Affairs Polytrauma System of Care, as well as social work's role on the interdisciplinary team who promote rehabilitation and community reentry for OEF/OIF veterans with TBI.     

Veterans-by-proxy: A conceptual framework of ambiguous loss among children of combat veterans

There are tens of millions of children (youth and adult) of parents who are veterans. These individuals can experience traumatic injury alongside the parent who is a combat veteran. It is a parallel process called “veterans-by-proxy.” A proxy is an individual that acts on behalf of another individual. The proxy witnesses how combat traumatizes their parent and vicariously experience the trauma themselves. When a proxy suffers secondary trauma, ambiguous loss, and insecure attachment, one or more ego functions fail to adequately develop. This article proposes a conceptual framework of the proxy’s loss as it relates to the parent’s trauma and discusses research-based resiliency-focused interventions critical to healing the relationship between the proxy and the parent who is a combat veteran.     

Can Anyone Here Know Who I Am? Co-constructing Meaningful Narratives With Combat Veterans

The discourse on psychosocial reintegration of combat veterans in the United States has largely been confined to discussions of the best treatment for those diagnosed with psychiatric disorders. Yet analysis of the data indicates that all combat veterans are changed by their experience. It also indicates that the current medical model of treatment is insufficient. The author suggests that another model is called for; one that benefits from psychoanalytic insights on war and violence. A model that supports veterans’ experience of changed consciousness might best help them form a coherent narrative that connects their past lives and combat experience to their lives going forward. She argues that this approach may not have been taken because the same mental processes that cause combat veterans to split off their experiences also cause society as a whole to distance itself from them. Clinicians can be most effective when they create a link to the veteran by acknowledging the veteran as part of society, not a split off aberration, and recognizing the universal role of aggression within and without in creating the war that the veterans fought, and shaping the social response to their return. Literature drawn from psychoanalysis, cognitive neuroscience, and clinicians from the global south is combined with that of military psychiatry and global relief and development to support these positions.     

The Effect of 21st Century Military Service on Civilian Labor and Educational Outcomes

I estimate the effect of military service during the Afghanistan and Iraq wars on civilian labor and educational outcomes using several empirical methodologies including sibling fixed effects and propensity score matching. Since military occupations and training have changed significantly in the past few decades, these effects may be different than those found in previous studies on veterans of earlier theaters. I find that veteran status increases civilian wages by approximately ten percent for minorities but has little or no effect on whites in this regard. Veterans of all demographic groups are found to be equally employable and equally as satisfied with their civilian occupation as non-veterans. For females and minorities, veteran status substantially increases the likelihood one attempts college. These veterans are found to be more apt to pursue and obtain a two year (associate’s) degree instead of a four year (bachelor’s) degree. Lastly, I find mixed evidence that veteran status increases the likelihood of public sector employment.     

“I'm Still Fighting for the Two of Us”: How Partners of UK Veterans Construct Their Experience of Living with Combat‐Related Trauma

There has been little qualitative research into the experiences of UK partners of veterans with PTSD. This study therefore aimed to explore how partners constructed their experiences of living with the condition. Fifteen female partners of male UK veterans were recruited and interviewed. Using a social constructionist thematic analysis, five themes were constructed: the women's need to subdue own emotional and behavioral responses; dilemmas about whether the veteran was unwell or ‘bad’; attempts at negotiating multiple roles; challenging the narrative of veterans as heroes; and the relational struggle with the transition to nonmilitary life. This study highlighted the importance of considering the veteran as existing within a relational and cultural context, and the need to include partners in therapeutic interventions.     

Differential association between unemployment status and mental health among veterans and civilians

This study aims to examine the negative effect of unemployment on mental health among 2,762 veterans and 45,095 civilians aged 18 to 50 years. The data were from the 2012 Behavioral Risk Factor Surveillance System (BRFSS) survey. We used ordinary least squares regression to test the interaction association between employment status and veteran/civilian status with mental health status. Findings revealed that long-term unemployed veterans had a significantly greater number of days with poor mental health than long-term unemployed civilians. The study highlights the need for future research concerning the negative effects of long-term unemployment on veterans’ mental health as well as the reciprocal relationships between mental health and occupational functioning for veterans. The findings challenge researchers to question the meanings that are associated with employment status for veterans as compared to those of their civilian peers. In addition to this, the study raises the need for further exploration into the topics of identity, self-perception, and the notion often present in the military/veteran culture that there is “dignity in labor.”     

Alcohol Use after Combat-Acquired Traumatic Brain Injury: What We Know and Don't Know

Military personnel engage in unhealthy alcohol use at rates higher than their same age, civilian peers, resulting in negative consequences for the individual and jeopardized force readiness for the armed services. Among those returning from combat deployment, unhealthy drinking may be exacerbated by acute stress reactions and injury, including traumatic brain injury (TBI). Combat-acquired TBI is common among personnel in the current conflicts. Although research suggests that impairments due to TBI leads to an increased risk for unhealthy drinking and consequences among civilians, there has been little research to examine whether TBI influences drinking behaviors among military personnel. This article examines TBI and drinking in both civilian and military populations and discusses implications for clinical care and policy.     

UNDERSTANDING AND TREATING POST-TRAUMATIC STRESS DISORDER SYMPTOMS IN FEMALE PARTNERS OF VETERANS WITH PTSD

Studies of post-traumatic stress disorder have focused primarily on veterans, generally ignoring their female partners (wives or girlfriends). recently, clinicians have begun to identify PTSD-like symptoms in these female partners, but the literature describing this phenomenon has been limited. This paper addresses the fact that women in long-term relationships with veterans suffering from PTSD commonly experience PTSD-like psychiatric symptoms themseoves. These wonem's symptoms and issues they face in their relationships with their veteran partners are described. Conceptual explanations of and causal factors for these women's symptoms are presented, followed by discussion of treatment approaches and issues.     

Sleep disturbances and suicide—New battles for veterans of U.S. wars in Afghanistan and Iraq: A retrospective review

In this article, we systematically reviewed 116 veterans’ medical records to explore the mitigating factors in sleep disturbance, polytrauma clinical triad (PCT), and suicide. We discovered that a particular nonaction (i.e., no standardized completion of sleep-disturbance screenings) had strong implications for resulting suicides among veterans with reported sleep disturbances, PCT, and suicidal ideations. This study provides strong propositions for the further study of this veteran cohort—Operations Enduring Freedom (OEF), Iraqi Freedom (OIF), and New Dawn (OND)—with regard to the impact of sleep disturbance on PCT and its relationship with suicide symptoms, ideation, and completion. The purpose of this study was to examine the outcomes of sleep disturbances on complex relationships among the three primary diagnoses—posttraumatic stress disorder (PTSD), traumatic brain injury (TBI), and chronic pain—that establish the PCT cluster. We identified that those diagnosed with sleep disturbances had increased suicidal ideations and rates of completed suicides. We analyzed these factors in veterans returning from the current wars in Afghanistan and Iraq. We hypothesized that (a) clinicians were not completing sleep-disturbance screenings as a standard practice for the OEF/OIF/OND veterans diagnosed with PCT who reported sleep disturbance concerns within the U.S. Department of Veterans Affairs; (b) if no sleep-disturbance screening instruments were used by clinicians, veterans would be at a greater risk of suicide completion.     

Domestic violence in veterans with posttraumatic stress disorder who seek couples therapy

Domestic violence rates among veterans with posttraumatic stress disorder (PTSD) are higher than those of the general population. Individuals who have been diagnosed with PTSD who seek couples therapy with their partners constitute an understudied population. Self-report measures of domestic violence, relationship satisfaction, and intimacy were administered at intake to 179 couples seeking relationship therapy at a Veterans Affairs clinic. Couples in which the veteran was diagnosed with combat-related PTSD were compared with two other groups based on the veteran's primary diagnosis (depression, adjustment disorder/V-code). Both the PTSD- and depression-diagnosed veterans perpetrated more violence than did those with adjustment/V-code diagnoses. Domestic violence rates among depressed and PTSD-diagnosed veterans were much higher than those found in previous research. Implications for assessment and treatment are discussed.     

Toward an Integrated Theoretical Model of Risk Factors for Post-Deployment PTSD and its Implications for Justice-Involved Veterans

At present, very little knowledge exists about individual differences in susceptibility to posttraumatic stress disorder (PTSD) after combat trauma. Two differing perspectives have emerged. Some researchers maintain that a distinct linear dose-response relationship exists between the severity of combat trauma and the later development of PTSD. Conversely, others have questioned whether differential exposure to combat alone is sufficient to explain differences in the prevalence of post-deployment PTSD. This debate has implications for military veteran offenders who suffer from PTSD. In this paper, I propose a cumulative stress model that posits that it is the particular combination of psychosocial factors and combat exposure that interact to predict the likelihood of developing and maintaining PTSD after deployment. Therefore, PTSD influences post-deployment offending and antisocial behavior through this mechanism. Finally, this paper will discuss implications for criminal justice policy and practice.     

Violence and hostility among families of Vietnam veterans with combat-related posttraumatic stress disorder

The current study provides a portrait of emotional-behavioral functioning within a small sample of Vietnam veterans with combat-related posttraumatic stress disorder (PTSD), their partners, and older adolescent and adult children. Veterans, their partners and children reported moderate-low to moderate-high levels of violent behavior. In addition, partner and veteran hostility scores were elevated relative to gender and age matched norms. Partners also reported heightened levels of psychological maltreatment by veterans. Veterans' combat exposure was positively correlated with hostility and violent behavior among children but unrelated to partner variables. Veterans' reports of PTSD symptoms were positively associated with reports of hostility and violence among children, and hostility and general psychological distress among partners. Veterans' violent behavior was also positively correlated with children's violent behavior, but did not yield significant correlations with other child or partner variables. Findings are discussed in relation to prior work and directions for future research are addressed.     

Entrance and Exit from the Military

Abstract

The literature that addresses the reasons for entering military service is limited and generally does not report on the experiences of ethnic minority populations. This article reports on findings from a qualitative research study that examined health utilization and health status for a sample of 86 American Indian and Alaska Native veterans. The study generated data that provide interesting insights about the reasons for entering military service and experiences post discharge for this population. The data indicate that cultural material plays a significant role in the decision to enter the military and in the reentry experience of the veterans who participated in this research study. The analysis supports the proposition that despite the diversity that characterizes the American Indian and Alaska Native experience, there are overarching values and belief systems that are held in common across tribal communities which influence the social construction of life and the interpretation of life events.