Suffering in the Shadows: Interviews with Wives of Combat Veterans Suffering from Post-Traumatic Stress Disorder and/or Traumatic Brain Injury

The body of research examining issues confronting combat veterans of the Afghanistan and Iraq wars continues to grow. However, this research focuses primarily upon veterans with very less attention given to the challenges confronting their spouses. Using a semi-structured interview methodology and a feminist perspective, this study examines what it means to be a wife of a combat veteran who suffers from post-traumatic stress disorder (PTSD) and/or traumatic brain injury (TBI). Our findings indicate these women—who experience tremendous emotional, financial, and social challenges that arise from being the caregiver for their husbands—feel isolated from and abandoned by both the military community and the civilian community. Furthermore, the social and emotional disconnection of these women experience amplify the stresses they confront in daily life—stresses that are unique to their relationship to being with a combat veteran spouse who has PTSD and/or TBI. We argue future research should build upon this exploratory study to better understand how both the military community and the civilian community impact the subjectivity of these women and their efforts to reintegrate themselves and their families into civilian life.     

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.     

“This will help your children”: Service providers’ experiences with military families during cycles of deployment

ABSTRACT

Military families face not only the same challenges as other families, but also unique issues due to their military involvement. Parenting programs for civilian families can be helpful, but they do not generally cover the specific issues faced by military families. The purpose of this qualitative study was to gather information from a focus group of eight service providers about the types of issues that affect military families, such that content and delivery of workshops at a social service agency could be formed to specifically cater to military families. This study utilized a phenomenological approach, and analyses revealed areas for social service involvement around the cycle of deployment. Specifically, social services could be helpful by using psychoeducational and normalization techniques around the five major themes that resulted from this study: (1) the issues of servicemembers psychologically withdrawing before deployment, (2) family cohesion and connectedness during and after deployment, (3) family stability during reintegration of the service member, (4) military families experience many of the same challenges that nonmilitary families do (such as domestic violence and financial issues), and (5) utilizing a military culture framework for all military family programs.     

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.     

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.     

Curriculum Implications for Collaborative Practice From Veterans Health Care Sector Social Workers Serving OIF/OEF Veterans

This study examined veterans health care social workers’ perceptions of collaboration and practice with Operation Iraqi Freedom and Enduring Freedom veterans with the purpose of developing curriculum implications for social work education. Using a mixed-methods design, including surveys (n=21) and interviews (n=13), associations between serving this veterans cohort and the occurrence of collaboration were assessed. Surveys revealed that reflection on collaborative processes increased when serving this cohort. Interviews identified frequent high acuity in behavioral health conditions and emotionally overwhelmed veterans as contributors to this finding. Curriculum recommendations include infusing content on interprofessional collaboration in practice courses, improved instruction on intervening with colleagues to promote effective client processes and outcomes, and education on developing positive interprofessional climates.     

Continuity of Mental Health Care Across Military Transitions

Multiple deployments, a prominent characteristic of operations Enduring Freedom, Iraqi Freedom, and New Dawn, have been linked to increased risk for various mental health conditions. It is also well known that military transitions, such as a change of duty station or discharge, are an inevitable part of military life. While military transitions can be stressful for any service member or veteran, those with mental health conditions face additional challenges. Transition stress can exacerbate a mental health condition that in turn hinders ability to manage the transition, resulting in a cycle of stress. As a result, those receiving mental health care while transitioning often experience difficulty continuing treatment post-transition. This article describes a unique and innovative transition coaching program designed to address this emerging issue.     

Oral health among student veterans: Effects on mental and physical health

Abstract

Objective: The purpose of this study was to explore differences in oral health among students by military service status in postsecondary settings. Participants: Secondary data were obtained from the American College Health Association’s 2011–2014 National College Health Assessment II. Method: Demographic characteristics of the study sample were explored by calculating frequencies and percentages by military service status. Research questions were explored with maximum likelihood multiple logistic regression. Results: Service member and veteran students are at greater risk for neglecting health behaviors associated with positive oral health, including that they were less likely to get dental exams and that those who deployed in the past were the least likely to be practicing good oral health. Conclusions: The results suggest that improving oral health will contribute to improving health and mental health outcomes in this population, and provide important information for health specialists working with service members and veterans on college campuses.     

21st Century American Military Families: A Review in the Context of the Wars in Afghanistan and Iraq

This article has three interrelated objectives designed to highlight military family studies in the context of the wars in Afghanistan and Iraq. Often referred to collectively as “the war on terror,” Operation Enduring Freedom in Afghanistan and Operation Iraqi Freedom represent the most comprehensive wars fought with an all‐volunteer force since the nation's independence. I review the literature on American military families with an emphasis on the challenges facing military families during these operations. First I provide coverage of issues specific to military marriages and then address the research on children of military families. The article ends with an argument for scholars to take a more integrated approach to the study of military families that would help break down the current state of family scholarship and military family scholarship as parallel lines of inquiry.     

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.     

When women veterans return: The role of postsecondary education in transition in their civilian lives

Objective: The purpose of this study was to assess the current state of postsecondary educational settings’ outreach to military women who become students postservice. Participants: Data for the present cross-sectional study were obtained from the American College Health Association’s (ACHA) 2011–2014 National College Health Assessment II (NCHA). Methods: Demographic characteristics of the study sample were explored by calculating frequencies and percentages by military service status. Research questions were explored with Fisher’s exact test, maximum likelihood multiple logistic regression, as appropriate. Results: Women service member and veteran students received health information from their university/college less often than women students with no military experience on the following topics: alcohol and other drug use, depression and anxiety, sexual assault and relationship violence prevention, and stress reduction. Conclusions: The findings of this research identified clear gaps in service provision for women student veterans on college campuses and provided some possible models for intervention development.     

Implications of Posttraumatic Stress Among Military-Affiliated and Civilian Students

Abstract

Objectives: To determine whether posttraumatic stress (PTS) symptoms are associated with problem drinking and alcohol-related consequences, as well as academic correlates among military-affiliated and civilian students. Participants: The final sample (n = 248) included 78 combat-exposed student service members/veterans, 53 non–combat-exposed student service members/ veterans, 38 ROTC (Reserve Officers’ Training Corps) students, and 79 civilian students. Methods: Self-report data were collected spring 2011 via a Web-based survey measuring PTS, problem drinking, alcohol-related consequences, grade point average, educational self-efficacy, academic amotivation, and persistence. Results: Military students exposed to combat-related trauma reported significantly greater PTS symptoms than other military and civilian groups. PTS symptoms were associated with problem drinking and alcohol-related consequences for all groups, yet unrelated to academic correlates among those exposed to combat-related trauma. Conclusion: This study adds to the scant literature base exploring the unique characteristics of student service members/veterans in higher education.     

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.”     

Quality of life among U.S. Army spouses during the Iraq war

ABSTRACT

During the course of previous military conflicts, attention has been focused on separations experienced by service members and their loved ones. This study utilized the ABC-X model of Family Stress and Resiliency Theory to provide information about specific family and parental stressors, family coping, appraisal of stress and coping abilities, and quality of life for spouses at various stages of a recent military deployment. Three groups of spouses differed primarily for levels of family stress and quality of life. In addition to comparative analysis, path analyses were conducted for each group to determine the influence of stressors, coping, wellbeing, and sense of coherence on quality of life. The model for the group of spouses with service members deployed longest accounted for the greatest amount of variability in quality of life. Implications for family counseling, social work practice, and community policy have been provided.     

Military service and marital dissolution: a trajectory analysis

Military service adds additional challenges for married couples. Previous literature on service and marital stability is comprised of mixed results and has often ignored the timing of these effects. This timing is important as it helps disclose the nature of causality and has implications for both military and social security policies. Using a trajectory specification, I estimate the effect of military service on the likelihood of divorce during the volunteer’s period of service and the years following. Two veteran cohorts are examined, those who served during the early twenty-first century wars and those who served during the early 1980s. Among my results, the former cohort is shown to have had their divorce probability increased in the first 2 years post-service, while the opposite effect is found for the latter cohort. Unlike many previous studies of military service and marital stability, I find that effects are not overly dissimilar across racial groups.     

Navigating the “Sea of Goodwill”: Lessons from Regional Veterans Collaboratives

ABSTRACT

Veterans and military families face a complex set of challenges transitioning to civilian life. Following in a tradition of community collaboration and collective impact, we believe that a coordinated community-based approach can help ease this transition. Our comparative case study suggests that veteran collaborative efforts should be based on best principles including a neutral and natural convening organization; the presence of credibility, respect, and trust; resources to administer and facilitate; and using data for planning and implementation. Looking forward, these collaboratives need to address issues of scale, formalizing and broadening their scope to identify and achieve and evaluate their impact.