Developmental impact of combat exposure: Comparison of adolescent and adult Vietnam veterans∗

Abstract

This study was undertaken to find whether differences existed between two age groups of Vietnam veterans with PTSD, in terms of their social readjustment. A group of 57 men were divided by two age ranges to reflect two distinct periods of identity formation‐adolescence and early adulthood. The social readjustment measures which were examined included: (1) Substance abuse history; (2) history of legal infractions; (3) work history; (4) interpersonal relationships; and (5) peer relationships.

It was found that the younger soldiers have had a more difficult post‐Vietnam readjustment than their older cohorts. The results lend support to the idea that unsuccessful completion of Erikson's developmental phase of identity vs. role confusion may create problems with one's capacity for love, work and relationships. Specifically, when developmental tasks of late adolescence are not completed because of events such as war, one may suffer difficulties in handling adult responsibilities later in life.     

Rising to the Challenge of Treating OEF/OIF Veterans with Co‐occurring PTSD and Substance Abuse

This article reviews data on the relatively high incidence of Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF) veterans reporting mental health and substance abuse problems, and some perceived barriers that may account for low rates of their engaging in treatment. Treatment outcomes for veterans with co‐occurring posttraumatic stress disorder (PTSD) and substance use disorder (SUD) are generally poorer than for those with PTSD or substance abuse alone. Several evidence‐based individual therapy approaches offered by VA Medical Centers are described along with how they conceptualize the relationship of substance abuse to PTSD. Problems with sequential treatment for persons with PTSD and substance abuse in specialized programs are discussed, including notably the practice of requiring veterans to be completely drug and alcohol free for a month or longer prior to entering PTSD treatment. Several integrated treatment programs are described along with a brief summary of evidence supporting their effectiveness. Some recent policy changes from the Department of Veterans Affairs that bode well for the future of PTSD/SUD treatment are described. Differences between younger and older veterans were cited along with their implications for treatment. Recommendations regarding how to better engage and retain OEF/OIF veterans with PTSD/SUD in treatment are presented together with examples of their implementation. The author concludes that to rise to the challenge of treating this difficult population it is necessary to adapt treatment to meet their needs rather than requiring them to adapt to therapies that may not be a good fit.     

The VA Caregiver Support Line: A Gateway of Support for Caregivers of Veterans

In passing the Caregivers and Veterans Omnibus Health Services Act of 2010, Congress created a legislative mandate for the Veterans Administration (VA) to strengthen its program of support services for caregivers of veterans. As part of this expansion, the VA implemented a nationwide toll-free telephone Caregiver Support Line (CSL). The CSL is a single point of entry system to link caregivers to national and local services to support care of a veteran. This article describes the CSL and its role in supporting aging veterans and their caregivers, discusses social workers’ contributions to its development and implementation, and reports utilization data.     

Korean Survivors of the Japanese “Comfort Women” System: Understanding the Lifelong Consequences of Early Life Trauma

Prior to and during World War II, thousands of girls and young women were abducted from Korea and forced into sexual slavery by the Japanese government. Termed comfort women, these girls and young women suffered extreme sexual, physical, and emotional abuse and trauma. Research on this group is not well-developed and people know little of the impact of this early life trauma on the lives of these women who are now in later life. Using snowball sampling, 16 older adult survivors of the comfort women system participated in semistructured qualitative interviews. Thematic analysis was conducted to gain an understanding of the trauma that these women suffered and how it impacted their lives. Results revealed the depths of the abuse these women suffered, including repeated rapes, physical beatings, humiliation, forced surgery and sterilization, and social exclusion. These early traumatic experiences appeared to reverberate throughout their lives in their family relations, their inability to marry and to conceive children, and their emotional and physical well-being throughout the life course and into later life. The experiences of these survivors illustrate the lasting impact of early-life trauma and can guide interventions with current survivors of sexual abuse or trafficking.     

Traumatic Stress Symptoms in Children Exposed to Intimate Partner Violence: The Role of Parent Emotion Socialization and Children's Emotion Regulation Abilities

Exposure to intimate partner violence (IPV) is a traumatic life event. Almost 50 percent of IPV‐exposed children show subsequent post‐traumatic stress symptoms (PTSS), and they are at increased risk for depression. We examined maternal emotion socialization and children's emotion regulation as a pathway that may protect IPV‐exposed children from developing PTSS and depression. Fifty‐eight female survivors of IPV and their 6‐ to 12‐year‐old children participated. Results showed no direct relations between maternal emotion socialization and child adjustment. However, several indirect effects were observed. Higher mother awareness and acceptance of sadness and awareness of fear predicted better child sadness and fear regulation, respectively, which in turn was related to fewer child PTSS. Similar indirect pathways were found with child depression. In addition, mothers’ acceptance and coaching of anger was associated with better child anger regulation, which related to fewer depression symptoms. Implications for prevention and intervention with high‐risk families are discussed.     

Surviving Critical Illness: New Insights From Mixed-Methods Research

Current advanced medical technology allows survival of critical illness. However, the patient's psychological response to survival is relatively unexplored. Interviews with 32 older adult survivors, using the Hospital Anxiety and Depression Scale (HADS) and the Experience after Treatment in Intensive Care (ETIC-7) scale, Miller's Q-sort, and social work clinical wisdom, yielded unique and unexpected research results. Four response types were identified: avoiding, depressed, denial, and coping. Psychological agency during illness was found to be important. Participants did not reveal posttraumatic stress disorder–related phenomena predicted in previous literature but instead experienced posttraumatic growth. Hallucinatory experiences during illness were not traumatic, whereas social support emerged as a complicated concept. Participants unexpectedly revealed that childhood trauma was an important factor. Implications for clinical social work practice and research are outlined following the discussion of findings.     

Secondary Trauma and Military Veteran Caregivers

The article focuses on the secondary trauma stressors experienced by those who care for members of the military with special attention to the caregivers of war fighters seeking help from combat stress. Consistent with the theme of the special issue of understanding and preparing for the challenges of combat stress, the authors suggest that military caregiver stress and resilience require attention. The article calls for more attention to this area by researchers, practitioners, and policy makers given the growing combat stress injuries due, in large part, to recent multiple and lengthy deployments. The first section of the article describes secondary traumatic stress (STS) conceptually by identifying and defining STS and related constructs and the relevant theories and the prevalence estimates. The middle section of the article discusses the risk and protective factors for STS. The latter section provides an overview of very underdeveloped literature on military veteran caregivers by first describing this population, the most promising approaches to mitigating and preventing STS, and several model programs that may be useful for units of military caregivers.     

Sleep among youths in foster care: Associations with potentially traumatic events,PTSD and mental health

Among maltreated youth in foster care, little is known about frequency of sleep problems and its association to potential traumatic events (PTEs) and mental health. Among youths in foster care, we examined: (1) sleep patterns, difficulties initiating and maintaining sleep (DIMS) and related functional impairment; (2) whether exposure to PTEs, symptoms of post‐traumatic stress disorder (PTSD) and general mental health problems are associated with DIMS and related functional impairment, controlling for age, gender and time in foster care; and (3) whether PTSD and general mental health problems mediate the association between PTEs and DIMS. Foster youths in Norway (n = 299) completed a survey on sleep behaviour, the Child and Adolescent Trauma Screen, and the Strengths and Difficulties Questionnaire. Overall, 53.2% reported DIMS. For 82.1%, these sleep problems had lasted 3 months plus. Increased PTEs, PTSD and general mental health problems were all associated with increased DIMS score. Increased rate of PTEs was associated with decreased sleep duration. PTSD and general mental health problems partially mediated the association between PTEs and DIMS. Youth in foster care are at high risk of sleep problems, related to traumatic experiences and mental health problems. Treatment of PTSD may improve sleep problems among maltreated youth.     

Complex trauma treatment in the Republic of Georgia: Stemming the contagion of psychopolitical trauma across the continuum of care

Clinical social workers in the United States increasingly have become involved as consultants in countries besieged by psychopolitical trauma. These workers face complex challenges as they provide therapy to torture survivors or consultation to indigenous mental health professionals. Workers must refine their understanding of trauma to encompass the often less familiar practice of providing treatment in the context of torture. Mental health professionals practicing in war‐torn environments must deal with their own intense reactions such as secondary traumatic stress, vicarious trauma, countertransference, and projective identification as they address the ripples of torture's devastation across the continuum of care. The author will present a case study from the Republic of Georgia in order to elucidate some subtleties of clinical practice in the context of psychopolitical trauma.     

Warriors and Healers: Preparing for Returning Veterans

Despite its ideological differences, social work has had a long history of affiliation with the military. In 1918, the Smith College School for Social Work was established to respond to the mental health needs of “shell‐shocked veterans.” In 2008, the School renewed this commitment by sponsoring a three‐day conference aimed at preparing social workers to respond to the new and complex needs of veterans returning from the Iraq and Afghanistan wars. A joint planning process effectively developed a program that helped military and civilian social workers gain insight into the impact of multiple deployments, traumatic brain disorder, post‐traumatic stress disorder and other factors present in today’s new military culture.     

The Legacy of War: An Intergenerational Perspective

Children of combat veterans are affected to varying extents by the physical and psychological aftermath of war as experienced by the parent. Traumatic experiences exist on a continuum; trauma related messages can be communicated by a parent who does not have Post Traumatic Stress Disorder. An intergenerational perspective explores the complex family processes by which those who did not experience the actual events come to exhibit varying degress of emotional, psychological and behavioral manifestations of their parents' traumatic experiences.     

Secondary Traumatic Stress of Service Providers who Practice with Survivors of Family or Sexual Violence: A National Survey of Social Workers

Past research demonstrates that professionals helping survivors of family violence or sexual assault are at risk of experiencing secondary traumatic stress. Although social workers frequently provide services to these families, the risk of exhibiting secondary traumatic stress symptoms has rarely been investigated. Using a national sample (N >= 154), this research project examines the prevalence and severity of secondary traumatic stress among social workers who assist survivors of family violence or sexual assault. Implications for social work practice are also discussed.     

Trauma-Informed Mindfulness-Based Stress Reduction: A Promising New Model for Working with Survivors of Interpersonal Violence

This article addresses the benefits of modifying the Mindfulness-Based Stress Reduction (MBSR) program by Kabat-Zinn for survivors of interpersonal trauma. MBSR, originally designed for those dealing with chronic health conditions, is being offered to individuals with a variety of issues around the country, including people who have histories of surviving interpersonal violence. Discussed here are the psychosocial needs of women who have survived interpersonal trauma and the rationale for creating a phase I trauma-intervention based on the MBSR model. An example of one model of a trauma-informed MBSR intervention developed by the author is presented, as well as a summary of findings derived from a randomized controlled pilot study of the model with a community-based sample of women survivors of interpersonal trauma. Outcomes include statistically and clinically significant improvements in reducing symptoms of posttraumatic stress disorder and depression, as well as decreases in a measure of anxious attachment. Qualitative findings are also summarized.     

Trauma and Stress Among Older Adults in the Criminal Justice System: A Review of the Literature with Implications for Social Work

The purpose of this article was to review the empirical literature that investigated trauma and stress among older adults in the criminal justice system. Nineteen journal articles published between 1988 and 2010 were identified and extracted via research databases and included mixed age samples of adjudicated older and younger adults (n = 11) or older adult only samples (n = 8). Findings revealed past and current trauma and stress, consequences and/or correlates, and internal and external coping resources among aging offenders. The implications and future directions for gerontological social work, research, and policy with older adults in the criminal justice system are advanced.     

Behavioural problems of adolescents in secure residential youth care: Gender differences and risk factors

Adolescents in secure residential care mostly suffer from serious behavioural problems, often accompanied by trauma and adverse family circumstances. This paper presents findings of a comparison of behavioural problems and risk factors of 255 boys and girls (aged 12 to 18 years) in secure residential care in the Netherlands and their association with behavioural problems. A cross-sectional design and standardized questionnaires were used to measure behavioural problems and individual and familial risk factors. By using independent-sample t tests, the severity of these factors in boys and girls was compared, and by using structural equation modelling (SEM), associations between these factors and behavioural problems were investigated. The findings of the study show that post-traumatic stress disorder (PTSD) symptoms, maladaptive emotion regulation, impaired perceived competence and internalizing behavioural problems were more severe in girls than in boys. Boys experienced more severe externalizing behavioural problems and more family problems than girls. Maladaptive emotion regulation, PTSD symptoms, perceived competence and parenting problems were related to behavioural problems. The results indicate that treatment for girls should address PTSD symptoms, perceived competence and maladaptive emotion regulation and that extra attention for family problems in the treatment of boys is warranted.     

Going It Alone: Post-9/11 Veteran Nonuse of Healthcare and Social Service Programs During Their Early Transition to Civilian Life

Transitioning from military to civilian life is challenging for a substantial number of veterans. Successful transitions require veterans to function well in various well-being domains including employment, education, financial, health, and social relationships. There are many programs and services designed to assist veterans transition to civilian life. However, veterans rarely avail themselves of supportive resources. This study examined veteran nonuse of programs and services within the first three months of their transition to civilian life. Results revealed that male veterans often reported that they did not need programs. Female veterans and veterans from the lowest enlisted ranks were more likely to report that they did not know if they were eligible for support programs. A small percentage of veterans indicated they had not found the right program or did not know where to go to get help. Veterans need clear information about available programs, eligibility requirements, where to locate them, and how to identify which programs will benefit them. Future research should focus on what predicts veteran use of programs and services, how use changes over time, and how programs and services should be advertised/marketed to different veteran populations, particularly those at risk for poor transition outcomes.     

Veterans’ Use of Programs and Services as They Transition to Civilian Life: Baseline Assessment for the Veteran Metrics Initiative

Abstract

A substantial minority of veterans struggle as they reintegrate into civilian life, reporting problems with vocational attainment, legal/financial/housing challenges, physical and mental health conditions, and social/interpersonal issues. While there are thousands of programs and services offered to veterans, little is known about which ones they use. In the current exploratory study, veterans separated from active duty in the prior three-months (48,965) were invited to complete a survey. Two primary questions were addressed: What programs/services did veterans use to assist in their reintegration to civilian life? What specific components/attributes of those programs did veterans report using? A total of 9566 veterans completed the survey. Approximately, two-thirds of veterans used at least one program to enhance their well-being, while one-third reported using multiple programs across multiple domains. Veterans primarily sought assistance for employment and educational advancement. Fewer veterans sought assistance for legal/financial/housing, health, and social functioning challenges. Social service providers and policy makers should be aware of the resources veterans use as they reintegrate into civilian life. Future research should examine factors that predict the use and nonuse of veteran reintegration programs, how use changes over time, and what factors predict program/service use, particularly among veterans at risk for poor transition outcomes.     

Predictors of Posttraumatic Growth Among Adult Tsunami Survivors: The Role of Employment,Religion, and Family Attributes

ABSTRACT

This study examined the positive effects of trauma exposure among adult survivors of the 2004 Indian Ocean tsunami and was guided by a bioecological framework. A total of 301 adults from India were assessed for posttraumatic growth and a set of demographic, individual, family, and social capital variables. Hierarchical regression analysis revealed that religion, employment, family type, family flexibility, and family communication were significant predictors of posttraumatic growth. Contrary to expectations, individual factors and social capital did not contribute to posttraumatic growth. Findings imply that helping survivors make meaning out of their traumatic experience may facilitate posttraumatic growth. Intervention to promote increased employment opportunities and family resources is highly recommended for adult trauma survivors. Future trauma research should explore the role of perceived as well as actual familial and community resources, in addition to personal resources, in fostering posttraumatic growth.     

Veterans’ Informal Caregivers in the “Sandwich Generation”: A Systematic Review Toward a Resilience Model

Social work theory advanced the formulation of the construct of the sandwich generation to apply to the emerging generational cohort of caregivers, most often middle-aged women, who were caring for maturing children and aging parents simultaneously. This systematic review extends that focus by synthesizing the literature on sandwich generation caregivers for the general aging population with dementia and for veterans with dementia and polytrauma. It develops potential protective mechanisms based on empirical literature to support an intervention resilience model for social work practitioners. This theoretical model addresses adaptive coping of sandwich- generation families facing ongoing challenges related to caregiving demands.     

Intergenerational pathways leading to foster care placement of foster care alumni's children

This study examined a path model that postulated intergenerational relationships between biological parent psychosocial functioning and foster care alumni mental health, economic status and social support; and from these to the likelihood of children of foster care alumni being placed in foster care. The sample included 742 adults who spent time in foster care as children with a private foster care agency and who reported having at least one biological child. A full pathway was found between poorer father's functioning to greater alumni depression, which was in turn associated with negative social support, and then a greater likelihood of child out‐of‐home placement. Other parent to alumni paths were that poorer father functioning was associated with alumni anxiety and post‐traumatic stress disorder (PTSD), and poorer mother's mental health was associated with PTSD; however, anxiety and PTSD were not implicated as precursors of foster care placement of the child. Findings support the need for increased practice and policy support to address the mental health needs of parents of children in or at risk of foster care, as well as the children themselves, as family history may have a lasting influence on quality of life, even when children are raised apart from biological parents.