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Gulf War and Health, Volume 6: Physiologic, Psychologic, and Psychosocial Effects of Deployment-Related Stress
The committee identified four primary papers and several secondary papers that assessed marital conflict and deployment. The committee also considered additional papers on the effects of parental deployment on children. Several of the studies considered the effects of deployment on marital stability of veterans with and without PTSD, and these are included in the discussions of both primary and secondary studies. The primary studies for marital conflict are summarized in Table 7-1.
Gimbel and Booth (1994) assessed the degree of marital adversity, combat exposure, and premilitary factors in a sample of 2101 Vietnam veterans who had participated in the Vietnam Experience Study (VES) conducted by the Centers for Disease Control and Prevention. The VES was conducted in two stages: first, a random sample of 17,867 Vietnam-era veterans was interviewed by telephone, of these veterans, 7748 were randomly selected for in-person testing and medical examinations. Of those selected, 4462 participated in the examinations which were conducted in 1985-1965. The 2101 veterans were selected from the ever-married examination participants who had served in the Vietnam theater; all the men were of enlisted rank and had only served one tour of duty in Vietnam. Combat exposure was found to be moderately related (standardized regression coefficient 0.109, p ≤ 0.01) with marital adversity (divorce, separation, abuse, or infidelity). Premilitary characteristics, such as early emotional problems and problems in school, when factored into the model, reduced the impact of combat by about one-third (standardized regression coefficient 0.073, p ≤ 0.01). The impact of combat on marital adversity was also mediated by two postmilitary factors: posttraumatic stress symptoms and antisocial behavior. When both those postmilitary factors were in the model, the impact of combat itself became insignificant and did not have a direct relationship with marital quality and stability. Furthermore, it appeared that the influence of postmilitary stress symptoms was mediated by antisocial behavior, as was the effect of combat stress. Thus, the authors concluded that combat exposure creates stress that leads to postcombat antisocial behavior and ultimately to adversity in marriage. Although the low participation rate (60%) in the VES and the retrospective nature of the early-life experience data represent limitations in this cross-sectional study, the representativeness of the sample and thoroughness of the data analysis lend credence to the conclusions.
The National Survey of the Vietnam Generation (NSVG) and the Spouse/Partner Interview (also called the Family Interview) components of the National Vietnam Veterans Readjustment Study (NVVRS) have been used by several researchers assessing impact of serving in Vietnam on the veterans’ marital and family status and intimate partner violence. In the NVVRS, male Vietnam-theater veterans with PTSD were compared with theater veterans without PTSD. In the NSVG, 1200 Vietnam-theater veterans were randomly selected from all military personnel who had served in the Vietnam theater between August 1964 and May 1975; 432 female Vietnam-theater veterans, and 412 male and 304 female era veterans were also included in the study. Most male veterans were middle-aged and married at the time of the interview; over 50% had some college education. About 17% of veterans were of black or Hispanic backgrounds. PTSD symptom level at the time of the interview was assessed with the Mississippi Scale for Combat-Related PTSD; a study cutoff score of 94 was used as a threshold for an assessment of current PTSD. A diagnosis of PTSD was confirmed in a subset of the veterans using the Structured Clinical Interview for DSM-III (SCID). Psychiatric comorbidity was diagnosed with the Diagnostic Interview Schedule (DIS). The veterans participated in face-