6

MILITARY FAMILIES

image

This chapter examines the effects of deployments to Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF) on the mental, emotional, and social well-being of military family members, including spouses, children, and caregivers. It also discusses issues related to the availability of programs and services for military families. Military family members are an important part of the readiness and well-being of the military force. The care and support of military families is considered a top national security policy priority in recognition of the integral role family members have in supporting service members and, therefore, the mission of the military. With that priority, various challenges arise. Throughout this chapter, the committee presents evidence that military family members have to deal with additional relationship problems, impairments in psychologic and physical well-being, responsibilities as caregivers of children or wounded service members, and overwhelming household duties. The committee’s primary focus is on the impacts of deployment on military families, and not on the entire scope of experiences faced by military families. Given the exceptional demands that deployments to OEF and OIF have placed on military families and the impact that family concerns have on soldiers’ well-being, there continues to be a need for military leaders to gain a better understanding of the needs of families and to use that understanding to implement more-effective coordinated programs and services for the good of military families and, thus, for the military as a whole.

CHARACTERISTICS OF MILITARY FAMILIES

Military families are more diverse than most statistics or research might suggest. Many families do not meet the criteria used for official counts of military families and, therefore, are not included in the data (for example, common-law spouses). Because of that, this chapter reports information only about a subset of military families: those of service members in heterosexual marriages and parents with dependent children who live with them at least part of the time. The committee views the military’s definition of family as narrow and out of step with the diversity in family arrangements in modern society. The committee found little or no information about parents or siblings of service members (who are sometimes relied upon for important caregiving responsibilities), unmarried partners, stepfamilies, children who are not legal dependents (for example, stepchildren or nonresidential children), gay families, service members acting as substitute parents, or other nontraditional family configurations. Most published studies focus on active-duty male military personnel married to civilian wives.



The National Academies | 500 Fifth St. N.W. | Washington, D.C. 20001
Copyright © National Academy of Sciences. All rights reserved.
Terms of Use and Privacy Statement



Below are the first 10 and last 10 pages of uncorrected machine-read text (when available) of this chapter, followed by the top 30 algorithmically extracted key phrases from the chapter as a whole.
Intended to provide our own search engines and external engines with highly rich, chapter-representative searchable text on the opening pages of each chapter. Because it is UNCORRECTED material, please consider the following text as a useful but insufficient proxy for the authoritative book pages.

Do not use for reproduction, copying, pasting, or reading; exclusively for search engines.

OCR for page 257
6 MILITARY FAMILIES This chapter examines the effects of deployments to Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF) on the mental, emotional, and social well-being of military family members, including spouses, children, and caregivers. It also discusses issues related to the availability of programs and services for military families. Military family members are an important part of the readiness and well-being of the military force. The care and support of military families is considered a top national security policy priority in recognition of the integral role family members have in supporting service members and, therefore, the mission of the military. With that priority, various challenges arise. Throughout this chapter, the committee presents evidence that military family members have to deal with additional relationship problems, impairments in psychologic and physical well-being, responsibilities as caregivers of children or wounded service members, and overwhelming household duties. The committee’s primary focus is on the impacts of deployment on military families, and not on the entire scope of experiences faced by military families. Given the exceptional demands that deployments to OEF and OIF have placed on military families and the impact that family concerns have on soldiers’ well-being, there continues to be a need for military leaders to gain a better understanding of the needs of families and to use that understanding to implement more-effective coordinated programs and services for the good of military families and, thus, for the military as a whole. CHARACTERISTICS OF MILITARY FAMILIES Military families are more diverse than most statistics or research might suggest. Many families do not meet the criteria used for official counts of military families and, therefore, are not included in the data (for example, common-law spouses). Because of that, this chapter reports information only about a subset of military families: those of service members in heterosexual marriages and parents with dependent children who live with them at least part of the time. The committee views the military’s definition of family as narrow and out of step with the diversity in family arrangements in modern society. The committee found little or no information about parents or siblings of service members (who are sometimes relied upon for important caregiving responsibilities), unmarried partners, stepfamilies, children who are not legal dependents (for example, stepchildren or nonresidential children), gay families, service members acting as substitute parents, or other nontraditional family configurations. Most published studies focus on active-duty male military personnel married to civilian wives. 257

OCR for page 257
258 RETURNING HOME FROM IRAQ AND AFGHANISTAN Because women constitute a relatively small number of service members, they are sometimes excluded from studies. As the number of women in the military continues to increase, it becomes even more important that they be included in research studies. Despite the apparent popularity of marriage among military members, nonmarital intimate relationships are likely to become a more prominent feature of the relationships of service members in the future, as they are in the population as a whole, and methods of counting relationships may need to be amended as a result. The general population has been characterized in recent decades by rising tendencies for individuals to delay marriage and to cohabit before marriage (Copen et al., 2012). Delays in and alternatives to marriage might become more evident in the military, especially as policies change in the aftermath of discontinuing the “Don’t Ask, Don’t Tell” policy (McKean et al., 2011). Thus, marital status might become an increasingly inaccurate index of relationship patterns, and useful information about the health of intimate relationships of military members might be overlooked if tabulation methods are not adjusted. Defining Military Families Multiple definitions of family are used in the Department of Defense (DOD), each tied to specific regulatory requirements. The most common definition uses eligibility for military identification cards, which are necessary for access to health care, military exchanges, and a variety of supportive services for families. Military identification cards are currently issued to spouses and unmarried children of service members—exceptions and additional categories are defined by children’s ages, student status, or special needs and by whether the marriage ends in divorce or in death of the service member while on active duty. Spouses and unmarried children of reserve-component members are covered while the service member is on active duty for more than 30 consecutive days (DOD, 2012d). Stepchildren may or may not qualify for military identification cards, depending on such factors as age, student status, and the circumstances of the biologic parents. Single service members are not irrelevant in a chapter focused on the implications of deployment for family life. Single service members might have completed or be in the process of establishing families; for example, they might have cohabiting partners or they might be in close relationships that are precursors to marriage. The population of single service members also includes previously married individuals who might be in the process of establishing a second family. All service members, especially those who do not have spouses or partners, might rely on parents, siblings, or other family members for substantial emotional or tangible support, especially if they encounter hardships, such as illness, wounds, or other major life challenges. However, little research has examined family issues as they relate to single service members. Demographic Characteristics of Military Families This section describes the demographic characteristics of families of active-duty forces and selected reserve components. Because data presented here are derived from the DOD’s annual demographic profiles of the military community (DOD, 2011b, 2012a) and represent all service members—not only those who have been deployed—they will not be identical to the data presented in Chapter 3, which include only service members who have been deployed.

OCR for page 257
MILITARY FAMILIES 259 TABLE 6.1 Summary of Selected Demographic Characteristics for DOD Active-Duty and Selected Reserve Members Percent of Active-Duty Percent of Selected Reserve a Status Members and National Guard Membersb Percent married (enlisted, officers); 56.6 (54.0, 69.6); 47.7 (43.7, 70.6); (male, female) (58.5, 45.7) (50.1, 37.0) Percent in dual-military marriages (sex of 6.5c (3.9, 21.6) 2.6d (1.3, 8.6) active-duty member: male, female) Percent of married members in dual- 11.5 (6.8, 47.3) 5.5 (2.6, 23.3) military marriage (sex of active-duty member: male, female) a Includes 1,411,425 members of the four DOD active-duty branches (Army, Navy, Marine Corps, and Air Force). Limited data are included for the active-duty Coast Guard (Department of Homeland Security). b Includes 855,867 members of the six reserve components (Army National Guard, Army Reserve, Navy Reserve, Marine Corps Reserve, Air National Guard, and Air Force Reserve) and the Coast Guard Reserve. c Of these, 81.8% are enlisted members, and 18.2% are officers. d Of these, 76.1% are enlisted members, and 23.9% are officers. NOTE: Data are derived from a variety of sources, including the Active Duty Military Personnel Master File, the Active Duty Military Family File, the Reserve Components Common Personnel Data System, the Reserve Components Family File, and the Defense Enrollment and Eligibility Reporting System (DEERS). SOURCE: DOD, 2012a. Marital Status of Active-Duty and Selected Reserve Members Marriage Patterns Over two-thirds of active-duty and reserve officers are married, as are over half of enlisted active-duty service members and nearly half of those in the selected reserves (see Table 6.1). Reflecting the general makeup of the services, the great majority of both active-duty military (93.1%), and selected reserve (88.1%) spouses are female (DOD, 2011b). Male military members ages 18 to 41 are significantly more likely to have married at some point in their lives than are comparable civilians, particularly if they are black, Hispanic, or hold enlisted rank (Karney et al., 2012). On the basis of 1999 data from the Active Duty Survey of Military Personnel, Lundquist (2004) found that black service members in their early 20s were at least three times more likely to marry than their civilian counterparts and that the large marriage gap present between black and white civilians did not exist for those in the military. Although less is known about the marital patterns of women serving in the military, they are less likely to be married than their male counterparts, a pattern not observed among civilians of similar age. Women in the military are also much more likely to be married to other service members: In 2011, female active-duty service members and women serving in the reserve component were more likely than their male counterparts to be married to a fellow service member. Nearly half of married women on active duty were married to another service member (DOD, 2012a). In summary, military members are as likely or more likely to be married than their civilian counterparts, and this factor is particularly true for officers and members serving on active duty. Although the prevalence of marriage has been declining steadily in the civilian

OCR for page 257
260 RETURNING HOME FROM IRAQ AND AFGHANISTAN population, in the military it has been essentially level, having some fluctuations, over the past two decades. Divorce Patterns An estimated 4.1% of married enlisted members and 2.1% of married officers divorced between September 2010 and September 2011. This percentage is a substantial increase over 2000 rates, when an estimated 1.4% of married officers and 2.9% of married enlisted members had divorced during the previous year. This increase was especially steep for married enlisted soldiers (2.3% in 2000 compared with 4.0% in 2011, a 74% increase) and sailors (2.6% in 2000 compared with 4.6% in 2010, a 77% increase). Among the selected reserve, an estimated 2.8% of married enlisted members and 1.9% of married officers divorced during the 1-year period before September 2010. This percentage shows modest increases above the 2000 rates, which were 2.4% for married enlisted members and 1.6% for married officers. Data analyses by Karney et al. (2012), however, suggest that the apparent increase in divorce rates in military relative to civilian populations is not statistically significant and does not reflect a widening gap between civilians and military members, at least during the 4 years before and after the start of combat operations in Afghanistan in 2001. In fact, male military officers and enlisted members reported being currently divorced at either the same or lower rates than civilian men with comparable education, age, race or ethnicity, and employment status both before (1998–2001) and during the war (2002–2005) (Karney et al., 2012). Marriages of women in the military are more likely to fail than those of men (Karney and Crown, 2007; Lundquist, 2006). Karney and Crown (2007) examined military personnel records to track the marital status of service members over a 10-year period (1996 to 2005) and found that rates of marital dissolution for female service members were more than double those of their male counterparts. Regarding marital dissolution and race, Lundquist (2006) found that black service members were 53% less likely to divorce than whites, unlike in the civilian population, in which blacks were 30% more likely to divorce than whites. When only one partner was in the military, white dual-military couples were 40% more likely to divorce than black couples. In summary, although overall divorce rates in the general population have been falling during the past decade, divorce rates in the military have risen noticeably. Nonetheless, on the basis of comparisons of matched civilian and military men, Karney et al. (2012) concludes that men serving in the military are no more likely than their civilian counterparts to divorce and that this gap did not widen between 1996 and 2004. A subsequent section about deployment and married couples examines research on the impact that deployment has on marital dissolution. Family Responsibilities of Active-Duty and Selected Reserve Members Information on the family status of service members is presented in Table 6.2.

OCR for page 257
MILITARY FAMILIES 261 TABLE 6.2 Family Status of DOD Active-Duty and Selected Reserve Members Percent or Number of DOD Percent or Number of Selected Reserve Status Active-Duty Members and National Guard Members Percent with children (overall) 44.2% 43.3% Percent married to civilian, with 36.1% 32.5% children Percent dual-military with children 2.8% 1.5% Percent single with children 5.3% 9.4% Average number of children of 2.0 2.0 members with children Percent of children ages 0 to 5 42.6% 28.8% Percent married to civilian with no 14.0% 12.7% children Percent dual-military with no 3.7% 1.2% children Percent single with no children 38.1% 42.9% Percent with family 59.0% (56.7%, 70.0%) 56.4% (52.9%, 76.4%) a responsibilities (enlisted, officers) Average number of dependents 2.4 2.4 of members with dependents a Members are classified as having family responsibilities if they have a dependent (spouse, children, other dependents) registered in the Defense Enrollment and Eligibility Reporting System (DEERS). NOTE: Children category includes minor dependents age 20 or younger or age 22 and younger enrolled as full-time students. SOURCE: DOD, 2012a. Over half of active-duty and selected reserve members have family responsibilities—that is, are married or have children or have another dependent registered in the Defense Enrollment and Eligibility Reporting System (DEERS)—as do over two-thirds of active-duty officers. Among active-duty enlisted service members, Army-enlisted soldiers are more likely to have family responsibilities than enlisted members of other active-duty service branches (63.5% for Army enlisted, compared with 53.0% for Navy, 46.3% for Marines, and 55.7% for Air Force enlisted). Approximately half to two-thirds of enlisted members of the selected reserve across reserve components have family responsibilities, the exception being Marine reserve families, in which just over a quarter (27.1%) have responsibilities. The majority (67.1%) of active-duty single parents are male service members. However, female service members are much more likely than males to be single parents (12.1% vs 4.2%, respectively). The large minority of minor dependent children of active-duty members are 5 years old or younger (42.6%), followed by 6 to 11 years (30.7%), 12 to 18 years (22.4%), and 19 to 22 years old (4.3%; includes full-time students). The children of selected reserve members tend to be older than those of active-duty members, 28.8% being ages 5 or younger, 29.7% being ages 6 to 11, 29.6% being ages 12 to 18, and 11.8% being ages 19 to 22. A study examining marital transitions among service members found that almost one- third of service members (30%) had nonresidential children, a strikingly high percentage in a population where 64.8% of the members were younger than age 30 (Adler-Baeder et al., 2006). Almost all of the service members with nonresidential children had only nonresidential children,

OCR for page 257
262 RETURNING HOME FROM IRAQ AND AFGHANISTAN meaning that under military rules, they were defined as single, not as single parents. Among remarried respondents, 42.2% had children from a previous relationship. In 2008, the Military Family Life project included two items related to marital transitions in a survey of a probability sample of 28,500 military spouses. The first item asked respondents, all of whom were married or separated, if they were currently living in a stepfamily; 20% indicated that they were. In addition, 35% of the participants indicated that they had a child from the service member’s or spouse’s prior relationship or were acting as parents for someone else’s child, such as a grandchild, niece, or nephew. Thus, a substantial proportion of service members are living in stepfamilies or are acting as parents for the children of others. A small proportion of active-duty (0.7%) and selected reserve (0.2%) members are responsible for one or more adult dependents, such as a parent, grandparent, sibling, disabled older child, or other adult claimed as a dependent in the DEERS system. In the large majority of cases, the dependents are females age 51 or older. DEPLOYMENT AND FAMILIES Rewards and Challenges of Military Service for Families Understanding the effects of wartime deployments on military families requires some understanding of the baseline conditions of military life. The demands of military service may characterize other occupations, but rarely with the prevalence and frequency of demands that occur in military life (Castro et al., 2006). However, military service offers tangible and intangible benefits and supports that other occupations might lack. Rewards of Military Service Research about military families tends to focus more on negative than beneficial aspects, but the latter are nonetheless important. Rewards of military service can include personal growth from surmounting difficult challenges, increased appreciation of personal relationships, increased earnings from hazardous duty pay, and a sense of purpose from performing an important mission for the country (Newby et al., 2005a). A review of studies of appraisals by veterans from a variety of combat and peacekeeping operations (Schok et al., 2008) found that most veterans reported positive aspects of their experiences, primarily in three domains: self-image, such as self-discipline, self-confidence, and coping; in social relationships, such as cooperating better and becoming more tolerant; and in personal growth and priorities in life, such as valuing life, recognizing the importance of family, and strengthening of faith. In a focus group, data gathered by Hosek et al. (2006) showed that service members reported similar themes, including satisfaction from using the skills they had acquired in training and fulfillment of a sense of duty. Family members also reported increased closeness, patriotism, pride, civic responsibility, and personal growth (Werber et al., 2008). Being in the military can also provide a sense of community for military families and a social support system of other military families who understand the demands of military life. Although relocations can be stressful, military life provides families with the opportunity to see and live in different parts of the country or the world that would not otherwise be available to them.

OCR for page 257
MILITARY FAMILIES 263 Challenges of Military Service Military service includes a number of stressors related to the structure of work (Adams et al., 2006; MacDermid Wadsworth and Southwell, 2011; van Steenbergen et al., 2008). Military work is demanding, often requiring long hours and physically tiring tasks (Huffman and Payne, 2006; Kavanagh, 2005), and even nondeployed units must work to prepare for future deployments and support currently deployed units. Service members may be assigned with little advance notice to a variety of duties that require repeated episodes of time away from their families (for example, temporary duty assignments, training, disaster relief, humanitarian aid, and combat), all of which may expose service members to danger (Kavanagh, 2005). Service members and their families are required to relocate much more frequently than civilian families (every 2 to 3 years), with little opportunity to influence the choice of the next duty station (DOD, 1998; GAO, 2001). In 2010, 31% of military members (excluding unmarried service members living in barracks) moved, compared with 13% of civilians (US Census Bureau, 2011c). Rates of international relocations, which can be more challenging than domestic moves, are four times higher among military families than their civilian counterparts (Reinkober Drummet et al., 2003). Frequent obligatory moves are associated with frustration and decreased satisfaction with military life (GAO, 2001). Lack of support and isolation in the new community is particularly mentioned as a concern by spouses (Burrell et al., 2006). In addition to their emotional consequences, frequent relocations disrupt the ability of spouses to achieve educational or career goals (Burrell et al., 2006; Eby et al., 1997; Harrell et al., 2004). Relocations can require spouses to transfer certifications and change jobs or retrain. Military spouses are less likely than their civilian counterparts to work full-time, to average fewer work hours and fewer days in the year, and to earn less than spouses of civilians (Hosek et al., 2002; Lim and Schulker, 2010). Beyond dealing with the occupational demands of the service members, military life also may impose codes of conduct for family members as well as service members, especially when living in military housing, using military support services, or when the service member occupies a leadership position (Segal, 1986). Military scrutiny and expectations for good conduct on and off duty may lead service members and their families to perceive a lack of privacy. Furthermore, the behavior of spouses and children can impact service members and their careers. For example, spouses’ problematic behavior (e.g., traffic violations, financial problems, substance abuse) can come to official attention and result in pressure on service members to “control their family member” (Segal, 1986). The high proportion of military women in dual-service marriages, when combined with the high rates of marital dissolution among military women, raises questions about the severity of the unique challenges faced by dual-military families in coordinating leaves between parents, arranging child care, and other challenges posed by dual commitments to military service (Bethea, 2007). As discussed by Huffman and Payne (2006), individuals in dual-military marriages have multiple roles—at the very least as spouse and as service member, and often as parent or active community member. In dual-military marriages, having multiple roles can have positive implications, but the difficulty of fulfilling obligations associated with each role can strain individuals, particularly for those with children. In addition, military-specific challenges, such as being in the presence of danger, working at a high pace, and frequent or long separations, are magnified in dual-military marriages.

OCR for page 257
264 RETURNING HOME FROM IRAQ AND AFGHANISTAN Impact of Deployments on Families Deployments are not single events but complex configurations of predictable and unpredictable experiences. Deployments are diverse, varying along several dimensions. The most obvious dimension is content, such as exposure to trauma, physical demands, harsh living conditions, access to resources, and the ability to communicate with family. The dimensions of deployment structure include duration and frequency of individual deployments, which also leads to consideration of “dwell time” or the interval between repeated deployments. As deployments accumulate, cumulative duration becomes relevant. Although every deployment comprises a before, during, and after period, there are differences in the amount of advance notice service members receive and when, where, and for how long they must receive training before departing or after they return. Deployments have been categorized as both normative and catastrophic. The former is characterized by adequate time to prepare, by predictable duration and content, and by relatively mild emotional distress; the latter is characterized by little advance warning, uncertainty and danger, and prolonged emotional distress (McCubbin and Figley, 1983; Wiens and Boss, 2006). To the extent that every deployment comprises before, during, and after deployment periods, they have a predictable structure. The duration and content of these phases vary widely, however—raising caution about the confidence with which predictions can be made about the implications for families. Several scholars have constructed stage models to describe the emotional experiences and coping challenges that are thought to characterize the deployment and reunion periods (Wiens and Boss, 2006); see also Mateczun and Holmes (1996), Peebles-Kleiger and Kleiger (1994), and Pincus et al. (2001) for more information about stage models. Although these stage models are appealing in their clarity and appear to be consistent with the findings of some empirical studies, no longitudinal studies have documented that these stages occur, occur in the proposed sequence, incorporate the proposed experiences or challenges, or display the proposed durations. Although the number of published peer-reviewed studies of the impact of OEF and OIF deployments is rapidly increasing, large knowledge gaps remain. For example, many studies do not incorporate family factors or gather data from family members. The studies that do incorporate that information focus mostly on spouses and to a lesser extent on children. Little attention is given to the parents or the “significant others” of service members, a particularly concerning gap for single service members. Similar to studies of military families in general, most OEF and OIF studies focus on male military personnel married to civilian women and serving in the Army (Kelley et al., 2002). Many studies focus on negative consequences, especially posttraumatic stress disorder (PTSD), rather than other potential sequelae of deployment. Almost no studies have been conducted that include prospective data from the predeployment period. A few have gathered data during deployment but rarely from service members and even more rarely from both service members and family members. Most research—even of the period during deployment—has been conducted following return from deployment, and most studies are cross-sectional rather than longitudinal (de Burgh et al., 2011). Two large longitudinal studies, currently in the data-collection phase, are likely to generate important data about the effects of military service and deployments on families in the coming years. The family component of the Millennium Cohort Study is recruiting 10,000 spouses of service members participating in a 20-year prospective study of four cohorts totaling 150,000

OCR for page 257
MILITARY FAMILIES 265 service members. Data gathered from these spouses will permit comparisons of families of combat-deployed, noncombat-deployed, and nondeployed service members (Crum-Cianflone et al., 2012). The RAND Corporation is conducting a prospective, longitudinal study of approximately 2,000 military families who are expected to experience a deployment. This study will follow the cohort for 3 years; data will be gathered across a number of domains every 4 months. The design includes measures that will be repeated before, during, and after the deployment phases. One of the primary goals is to understand both risk and protective factors across the deployment phases in an effort to define family readiness. Other key elements of this study include data collection from multiple respondents per family, including one child 11 to 17 years old. Measures include physical health, behavioral health, marital relationship, parenting, use of services, career intentions, and deployment experience (RAND Center for Military Health Policy, 2012). Theoretical Models Several theoretical approaches have been presented to account for families’ experiences of deployment. Most of them take a systemic approach, recognizing that families have properties distinct from the characteristics of individual members. Systemic approaches also draw attention to patterns of information flow that can foster or impede adaptation to challenges within families. The theoretical perspectives used to account for the impact of deployment on families focus on stress processes (see Karney and Crown, 2007; McCubbin, 1979; Patterson, 2002) or on patterns of family resilience (see Saltzman et al., 2011; Walsh, 2006; Wiens and Boss, 2006). Several approaches are based on the attachment theory, which posits that individuals develop internal working models for attachments to others during childhood that condition their responses not only to separations from primary attachment figures but also to interactions with future partners and children. Attachments vary in their characteristics and may be secure or insecure, the latter characterized by anxiety or avoidance. Deployment constitutes a significant challenge to attachment systems and, depending on the nature of attachment relationships among family members, can result in reactions ranging from adaptation that allows the family to function well during separation and incorporate the service member on his or her return and ranging to problematic arrangements that “close ranks” against the service member (Riggs and Riggs, 2011). Finally, attention is being given to the conditions surrounding military families, including informal support from social networks of family, friends, colleagues, and others, as well as formal support from community agencies and programs. This perspective is prompted in part by greater recognition of the differences between the circumstances of active- and reserve- component families (Bowen and Martin, 2011; MacLean and Elder, 2007; Wiens and Boss, 2006). Characteristics of Deployments and Impact on Families Families appear to experience greater stress and anticipate more difficulties when deployments are longer (Booth et al., 2007; Orthner and Rose, 2002). In a systematic review of studies of deployment length, Buckman et al. (2011) concluded that longer deployments are associated with adverse effects on service members and their families, deployments having a possible threshold of 6 months, beyond which negative effects are more likely to occur.

OCR for page 257
266 RETURNING HOME FROM IRAQ AND AFGHANISTAN Several studies suggest that cumulative duration of deployments might be more important than frequency of deployment or the duration of a single deployment for certain family-related outcomes (Chandra et al., 2011; Hurley, 2011). For example, Lara-Cinisomo et al. (2011) found that caregivers who experienced more months of deployment of military members during the past 3 years (but not a larger number of deployments) reported lower relationship satisfaction, more relationship hassles, and poorer emotional well-being. Mansfield et al. (2010) found that the number of cases of depression was larger among wives whose husbands had been deployed longer. Franklin (2011), however, found that reports of psychologic symptoms on the Air Force Community Assessment rose with both frequency and duration of deployment. For length of deployment, but not for frequency, the connection to relationship quality was mediated by psychologic symptoms. These findings probably underestimate the impact of the frequency of deployment because most studies exclude deployments lasting less than 30 days or deployments not in support of war operations. Thus, the number of service members’ departures from and returns home are greatly underestimated, and the statistical effects associated with deployment frequency may be attenuated as a result. There is considerable evidence that family-related concerns weigh heavily on service members during deployment. In each administration of the Army-led Mental Health Advisory Team (MHAT) surveys, concerns about being separated from family are among the foremost deployment concerns, as reported by about one-third of service members (MHAT-VII, 2011). Responses to the 2008 DOD Survey of Health-Related Behaviors indicated that service members who had been deployed recently were significantly more likely to report high family stress than were service members who had not been deployed; levels of these concerns did not change between 2002 and 2008 (Bray et al., 2010). In another study, British Forces service members surveyed during deployments to Iraq and Afghanistan reported poorer mental health when negative events occurred at home and when they perceived poor military support for their families. These findings were firm regardless of combat exposure but were somewhat weaker in the presence of strong military unit cohesion or military leadership (Mulligan et al., 2012). Skopp et al. (2011), in a large study that included pre- and postdeployment data from 2,583 Army soldiers, found that female soldiers with higher levels of combat exposure were significantly more likely to screen positive for PTSD if the strength of their intimate relationships had declined during deployment. In their longitudinal study of more than 88,000 soldiers who served in Iraq, Milliken et al. (2007) found a fourfold increase in interpersonal problems from when they returned from deployment and a median of 6 months thereafter. The authors made special note of the cumulative burden of mental-health problems on family relationships and advocated greater mental-health resources for family members. Baseline levels of perceived stress appear to have risen among Army spouses in recent years. The recent Army “Gold Book” indicated that more than half of all spouses reported experiencing stress in 2010 (56%, up from 46% in 2006) (Department of the Army, 2012). Supporting the notion of relatively high baseline rates of stressors, almost half of the spouses (44%) reported concern about finances, and two-thirds reported that they had less than $500 in savings accounts. More than half of the spouses were employed or were looking for work. Finally, 19% of spouses who responded indicated that they were in counseling, mostly for stress, family, and marital issues (Department of the Army, 2012).

OCR for page 257
MILITARY FAMILIES 267 Evidence assembled so far from both prior and current wars suggests that the likelihood of negative consequences for families rises with the amount of the service members’ exposure to traumatic or life-altering experiences. Thus, military service by itself does not appear to significantly raise the probability of negative outcomes (MacLean and Elder, 2007), and the same appears to be largely true for uneventful deployments lacking exposures to trauma (although traumatic exposures can occur not only with combat but also with duties related to peacekeeping and natural disasters (Allen et al., 2010). In contrast, deployment to combat zones has been found to significantly predict a variety of negative outcomes, including marital conflict and intimate partner violence (IOM, 2008). When service members display negative psychologic symptoms, the likelihood of negative consequences for families rises substantially (de Burgh et al., 2011), and families who experience the injury or death of service members are almost certain to experience at least some negative consequences. Deployment and Married Couples The health of marriages is typically assessed in research by two key indicators: marital quality and marital dissolution, which refers to the end of the marital relationship, typically via divorce (Karney and Bradbury, 1995). Although marital quality is difficult to measure, to date, measurements have focused primarily on the levels of satisfaction expressed by each partner (Knapp and Lott, 2010). Ideally, stable marriages have not only avoided dissolution, but also avoided separation or consideration of divorce, although studies vary in which of those elements are included (Karney and Bradbury, 1995). Dissolution, although relatively straightforward to measure, is a limited indicator of marital health because divorce is only the outcome of a lengthy and uncertain process. In this section, we review research related to the impact of deployments on marital quality and marital dissolution. Marital Quality Throughout the Deployment Cycle The IOM (2008) found strong evidence that service members returning from deployments to combat zones were more likely to have marital problems, including intimate partner violence, than people who were not deployed and that this pattern was particularly strong when veterans had been diagnosed with PTSD. Evidence based on studies of Vietnam veterans was judged insufficient to conclude the existence of a causal relationship between deployment and marital conflict or marital dissolution. On the basis of the perspectives of service members themselves, marital quality in the military population appears to have declined in the past decade. Data gathered from service members during deployments to Iraq and Afghanistan, as part of the MHAT research program, revealed a steady downward trend in marital satisfaction each year between 2003 and 2009, from 79% agreeing or strongly agreeing that they were satisfied with their marriages in 2000 to 57% giving similar reports in 2009 (MHAT-VII, 2011). The declines were limited to enlisted members and were largest among junior enlisted males (pay grades E1 to E4). Service members’ reports that they intended to seek a divorce also rose from 12.4% in 2003 to 21.9% in 2009, again being much more evident among junior enlisted members. The 2006 MHAT report (MHAT-IV, 2006) indicated that problems with infidelity rose from 4% to 15% between 2003 and 2006, and marital problems more than doubled—from 12% to 27%.

OCR for page 257
320 RETURNING HOME FROM IRAQ AND AFGHANISTAN Gewirtz, A. H., C. R. Erbes, M. A. Polusny, M. S. Forgatch, and D. S. Degarmo. 2011. Helping military families through the deployment process: Strategies to support parenting. Professional Psychology Research and Practice 42(1):56-62. Gibbs, D. A., S. L. Martin, L. L. Kupper, and R. E. Johnson. 2007. Child maltreatment in enlisted soldiers' families during combat-related deployments. Journal of the American Medical Association 298(5):528-535. Glynn, S. M., S. Eth, E. T. Randolph, D. W. Foy, G. B. Leong, G. G. Paz, J. D. Salk, G. Firman, and J. W. Katzman. 1995. Behavioral family therapy for Vietnam combat veterans with posttraumatic stress disorder. Journal of Psychotherapy Practice and Research 4(3):214-223. Glynn, S. M., S. Eth, E. T. Randolph, D. W. Foy, M. Urbaitis, L. Boxer, G. G. Paz, G. B. Leong, G. Firman, J. D. Salk, J. W. Katzman, and J. Crothers. 1999. A test of behavioral family therapy to augment exposure for combat-related posttraumatic stress disorder. Journal of Consulting and Clinical Psychology 67(2):243-251. Goff, B. S. N., J. R. Crow, A. M. J. Reisbig, and S. Hamilton. 2007. The impact of individual trauma symptoms of deployed soldiers on relationship satisfaction. Journal of Family Psychology 21(3):344- 353. Golding, J. M. 1999. Intimate partner violence as a risk factor for mental disorders: A meta-analysis. Journal of Family Violence 14(2):99-132. Gorman, G. H., M. Eide, and E. Hisle-Gorman. 2010. Wartime military deployment and increased pediatric mental and behavioral health complaints. Pediatrics 126(6). Gorman, L. A., A. J. Blow, B. D. Ames, and P. L. Reed. 2011. National Guard families after combat: Mental health, use of mental health services, and perceived treatment barriers. Psychiatric Services 62(1):28-34. Gould, M., House Committee on Veterans Affairs. 2012. Veterans Affairs in the 112th Congress: Reviewing VA’s Performance and Accountability. September 20, 2012. Griffin, J. M., G. Friedemann-Sanchez, C. Hall, S. Phelan, and M. van Ryn. 2009. Families of patients with polytrauma: Understanding the evidence and charting a new research agenda. Journal of Rehabilitation Research and Development 46(6):879-892. Griffin, J. M., G. Friedemann-Sanchez, A. C. Jensen, B. C. Taylor, A. Gravely, B. Clothier, A. B. Simon, A. Bangerter, T. Pickett, C. Thors, S. Ceperich, J. Poole, and M. van Ryn. 2012. The invisible side of war: Families caring for US service members with traumatic brain injuries and polytrauma. Journal of Head Trauma Rehabilitation 27(1):3-13. Haas, D. M., and L. A. Pazdernik. 2006. A cross-sectional survey of stressors for postpartum women during wartime in a military medical facility. Military Medicine 171(10):1020-1023. ———. 2007. Partner deployment and stress in pregnant women. Journal of Reproductive Medicine 52(10):901-906. Haine, R. A., T. S. Ayers, I. N. Sandler, and S. A. Wolchik. 2008. Evidence-based practices for parentally bereaved children and their families. Professional Psychology: Research and Practice 39(2):113. Harrell, M. C., N. Lim, L. Werber Castaneda, and D. Golinelli. 2004. Working Around the Military: Challenges to Military Spouse Employment and Education. Santa Monica, CA: RAND Corporation. Helfrich, C. A., G. T. Fujiura, and V. Rutkowski-Kmitta. 2008. Mental health disorders and functioning of women in domestic violence shelters. Journal of Interpersonal Violence 23(4):437-453. Heyman, R. E., and P. H. Neidig. 1999. A comparison of spousal aggression prevalence rates in US Army and civilian representative samples. Journal of Consulting and Clinical Psychology 67(2):239. Hill, R. 1949. Families Under Stress. New York: Harper and Brothers.

OCR for page 257
MILITARY FAMILIES 321 Hinojosa, R., M. S. Hinojosa, and R. S. Hognas. 2012. Problems with veteran-family communication during Operation Enduring Freedom/Operation Iraqi Freedom military deployment. Military Medicine 177(2):191-197. Hopkins-Chadwick, D. L., and N. Ryan-Wenger. 2009. Stress in junior enlisted Air Force women with and without children. Western Journal of Nursing Research 31(3):409-427. Hosek, J., B. Asch, C. C. Fair, C. Martin, and M. Mattock. 2002. Married to the Military: The Employment and Earnings of Military Wives Compared with Those of Civilian Wives. Santa Monica, CA: RAND Corporation. Hosek, J., J. Kavanagh, and L. Miller. 2006. How Deployments Affect Service Members. Santa Monica, CA: RAND Corporation. Huebner, A. J., J. A. Mancini, G. L. Bowen, and D. K. Orthner. 2009. Shadowed by war: Building community capacity to support military families. Family Relations 58(2):216-228. Huffman, A. H., and S. C. Payne. 2006. The challenges and benefits of dual-military marriages. In Military Life: The Psychology of Serving in Peace and Combat (Vol 3): The Military Family. Westport, CT: Praeger Security International. Pp. 115-137. Hurley, E. C. 2011. Rejection sensitivity as a predictor of marital adjustment among military spouses during military deployments. Dissertation Abstracts International: Section B: The Sciences and Engineering 72(5-B):3096. Interagency Policy Committee, Presidential Study Directive, and The White House. 2011. Strengthening Our Military Families. Washington, DC: The White House. IOM (Institute of Medicine). 2008. Gulf War and Health: Volume 6. Physiologic, Psychologic, and Psychosocial Effects of Deployment-related Stress. Washington, DC: The National Academies Press. ———. 2010. Returning Home from Iraq and Afghanistan: Preliminary Assessment of Readjustment Needs of Veterans, Service Members, and Their Families. Washington, DC: The National Academies Press. ———. 2012. Substance Use Disorders in the US Armed Forces. Washington, DC: The National Academies Press. Jensen, P. S., D. Martin, and H. Watanabe. 1996. Childrenʼs response to parental separation during Operation Desert Storm. Journal of the American Academy of Child and Adolescent Psychiatry 35(4):433-441. Johnson, A. J. 2011. Examining partner experiences of returning Operation Enduring Freedom and Iraqi Freedom Veterans. Dissertation Abstracts International: Section B: The Sciences and Engineering 71(11-B):7118. Jowers, K. 2011. Bereavement Study to Focus on 3,000 Survivors. http://militarytimes.com/news/2011/10/military-ausa-bereavement-study-3000-survivors-101111w (accessed October 25, 2012). Karney, B. R., and T. N. Bradbury. 1995. The longitudinal course of marital quality and stability: A review of theory, method, and research. Psychological Bulletin 118(1):3-34. Karney, B. R., and J. S. Crown. 2007. Families Under Stress: An Assessment of Data, Theory, and Research on Marriage and Divorce in the Military. Santa Monica, CA: RAND Corporation. ———. 2011. Does deployment keep military marriages together or break them apart? Evidence from Afghanistan and Iraq. In Risk and Resilience in US Military Families. New York: Springer. Pp. 23- 45. Karney, B. R., D. S. Loughran, and M. S. Pollard. 2012. Comparing marital status and divorce status in civilian and military populations. Journal of Family Issues 33(12):1572-1594.

OCR for page 257
322 RETURNING HOME FROM IRAQ AND AFGHANISTAN Kavanagh, J. 2005. Stress and Performance: A Review of the Literature and Its Applicability to the Military. Santa Monica, CA: RAND Corporation. Kelley, M. L., E. Hock, J. F. Bonney, M. S. Jarvis, K. M. Smith, and M. A. Gaffney. 2001. Navy mothers experiencing and not experiencing deployment: Reasons for staying in or leaving the military. Military Psychology 13(1):55-71. Kelley, M. L., E. Hock, M. S. Jarvis, K. M. Smith, M. A. Gaffney, and J. F. Bonney. 2002. Psychological adjustment of Navy mothers experiencing deployment. Military Psychology 14(3):199-216. Khaylis, A., M. A. Polusny, C. R. Erbes, A. Gewirtz, and C. M. Rath. 2011. Posttraumatic stress, family adjustment, and treatment preferences among National Guard soldiers deployed to OEF/OIF. Military Medicine 176:126-131. Knapp, S. J., and B. Lott. 2010. Forming the central framework for a science of marital quality: An interpretive alternative to marital satisfaction as a proxy for marital quality. Journal of Family Theory and Review 2(4):316-333. Knobloch, L. K., and J. A. Theiss. 2011. Depressive symptoms and mechanisms of relational turbulence as predictors of relationship satisfaction among returning service members. Journal of Family Psychology 25(4):470-478. Kreider, R. M., and R. Ellis. 2011. Living arrangements of children: 2009. Current Population Reports (June):P70-126. Kreutzer, J. S., L. J. Rapport, J. H. Marwitz, C. Harrison-Felix, T. Hart, M. Glenn, and F. Hammond. 2009. Caregivers' well-being after traumatic brain injury: A multicenter prospective investigation. Archives of Physical Medicine and Rehabilitation 90(6):939-946. Kulka, R. A., W. E. Schlenger, J. A. Fairbank, R. L. Hough, B. K. Jordan, C. R. Marmar, D. S. Weiss, and D. A. Grady. 1990. Trauma and the Vietnam War Generation: Report of Findings from the National Vietnam Veterans Readjustment Study. New York: Routledge. Lara-Cinisomo, S., A. Chandra, R. Burns, L. Jaycox, T. Tanielian, T. Ruder, and B. Han. 2011. A mixed- method approach to understanding the experiences of non-deployed military caregivers. Maternal and Child Health Journal 16(2):374-384. Lester, P., K. Peterson, J. Reeves, L. Knauss, D. Glover, C. Mogil, N. Duan, W. Saltzman, R. Pynoos, K. Wilt, and W. Beardslee. 2010. The long war and parental combat deployment: Effects on military children and at-home spouses. Journal of the American Academy of Child and Adolescent Psychiatry 49(4):310-320. Lester, P., C. Mogil, W. Saltzman, K. Woodward, W. Nash, G. Leskin, B. Bursch, S. Green, R. Pynoos, and W. Beardslee. 2011. Families overcoming under stress: Implementing family-centered prevention for military families facing wartime deployments and combat operational stress. Military Medicine 176(1):19-25. Lester, P., W. R. Saltzman, K. Woodward, D. Glover, G. A. Leskin, B. Bursch, R. Pynoos, and W. Beardslee. 2012. Evaluation of a family-centered prevention intervention for military children and families facing wartime deployments. American Journal of Public Health 102(Suppl1):S48-S54. Lilly, M. B., A. Laporte, and P. C. Coyte. 2007. Labor market work and home care's unpaid caregivers: A systematic review of labor force participation rates, predictors of labor market withdrawal, and hours of work. Milbank Quarterly 85(4):641-690. Lim, N., and D. Schulker. 2010. Measuring Underemployment Among Military Spouses. Santa Monica, CA: RAND Corporation. Lincoln, A., E. Swift, and M. Shorteno-Fraser. 2008. Psychological adjustment and treatment of children and families with parents deployed in military combat. Journal of Clinical Psychology 64(8):984-992. Lundquist, J. H. 2004. When race makes no difference: Marriage and the military. Social Forces 83(2):731-757.

OCR for page 257
MILITARY FAMILIES 323 ———. 2006. The black-white gap in marital dissolution among young adults: What can a counterfactual scenario tell us? Social Problems 53(3):421-441. Luthar, S. S. 2006. Resilience in development: A synthesis of research across five decades. In Developmental Psychopathology: Risk, Disorder, and Adaptation, edited by D. Cicchetti and D. J. Cohen. New York: Wiley. Pp. 740-795. Lyle, D. S. 2006. Using military deployments and job assignments to estimate the effect of parental absences and household relocations on children's academic achievement. Journal of Labor Economics 24(2):319-350. MacDermid Wadsworth, S., and K. Southwell. 2011. Military families: Extreme work and extreme “work-family.” Annals of the American Academy of Political and Social Science 638(1):163-183. MacLean, A., and G. H. Elder. 2007. Military service in the life course. Annual Review of Sociology 33:175-196. Makin-Byrd, K., E. Gifford, S. McCutcheon, and S. Glynn. 2011. Family and couples treatment for newly returning veterans. Professional Psychology—Research and Practice 42(1):47-55. Mannarino, A. P., J. A. Cohen, E. Deblinger, M. K. Runyon, and R. A. Steer. 2012. Trauma-focused cognitive-behavioral therapy for children sustained impact of treatment 6 and 12 months later. Child Maltreatment 17(3):231-241. Mansfield, A. J., J. S. Kaufman, S. W. Marshall, B. N. Gaynes, J. P. Morrissey, and C. C. Engel. 2010. Deployment and the use of mental health services among US Army wives. New England Journal of Medicine 362(2):101-109. Mansfield, A. J., J. S. Kaufman, C. C. Engel, and B. N. Gaynes. 2011. Deployment and mental health diagnoses among children of US Army personnel. Archives of Pediatrics and Adolescent Medicine 165(11):999-1005. Martin, S. L., D. A. Gibbs, R. E. Johnson, K. Sullivan, M. Clinton-Sherrod, J. L. Walters, and E. D. Rentz. 2010. Substance use by soldiers who abuse their spouses. Violence Against Women 16(11):1295-1310. Mateczun, J. M., and E. K. Holmes. 1996. Return, readjustment, and reintegration: The three R's of family reunion. In Emotional Aftermath of the Persian Gulf War: Veterans, Families, Communities and Nations, edited by R. J. Ursano and A. E. Norwood. Washington, DC: American Psychiatric Press, Inc. Pp. 250-282. McCarroll, J. E., R. J. Ursano, X. Liu, L. E. Thayer, J. H. Newby, A. E. Norwood, and C. S. Fullerton. 2000. Deployment and the probability of spousal aggression by US Army soldiers. Military Medicine 165(1):41-44. McCarroll, J. E., K. J. Hoffman, A. Grieger, and H. C. Holloway. 2005. Psychological aspects of deployment and reunion. In Military Preventive Medicine: Mobilization and Deployment Vol. 2, edited by P. W. Kelley. Washington, DC: Office of the Surgeon General, Department of the Army and Borden Institute. Pp. 1395-1426. McCauley, J., D. E. Kern, K. Kolodner, L. Dill, A. F. Schroeder, H. K. DeChant, J. Ryden, L. R. Derogatis, and E. B. Bass. 1997. Clinical characteristics of women with a history of childhood abuse. Journal of the American Medical Association 277(17):1362-1368. McCreary, D. R., M. M. Thompson, and L. Pasto. 2003. Predeployment family concerns and soldier well- being: The impact of family concerns on the predeployment well-being of Canadian forces personnel. Canadian Journal of Police and Security Services 1:33-40. McCubbin, H. I. 1979. Integrating coping behavior in family stress theory. Journal of Marriage and the Family 41(2):237-244.

OCR for page 257
324 RETURNING HOME FROM IRAQ AND AFGHANISTAN McCubbin, H. I., and C. R. Figley. 1983. Bridging normative and catastrophic family stress. In Stress and the Family, Volume I: Coping with Normative Transitions, edited by H. I. McCubbin and C. R. Figley. New York: Brunner/Mazel. Pp. 218-228. McCubbin, H. I., B. B. Dahl, G. R. Lester, and B. A. Ross. 1975. The returned prisoner of war: Factors in family reintegration. Journal of Marriage and the Family 37(3):471-478. McFarlane, W. R., B. Link, R. Dushay, J. Marchal, and J. Crilly. 1995. Psychoeducational multiple family groups: Four-year relapse outcome in schizophrenia. Family Process 34(2):127-144. McKean, D., J. Goodman, B. Bodnar, H. Warden, E. Shirey, Z. Stokes, A. Scheideberg, and A. Searvis. 2011. Freedom to Serve: The Definitive Guide to LGBT Military Service. Washington, DC: Servicemembers Legal Defense Network. McNulty, P. A. F. 2005. Reported stressors and health care needs of active duty Navy personnel during three phases of deployment in support of the war in Iraq. Military Medicine 170(6):530-535. Meis, L. A., C. R. Erbes, M. A. Polusny, and J. S. Compton. 2010. Intimate relationships among returning soldiers: The mediating and moderating roles of negative emotionality, PTSD symptoms, and alcohol problems. Journal of Traumatic Stress 23(5):564-572. Merrill, L. L., J. L. Crouch, C. J. Thomsen, and J. M. Guimond. 2004. Risk for intimate partner violence and child physical abuse: Psychosocial characteristics of multirisk male and female Navy recruits. Child Maltreatment 9(1):18-29. Mghir, R., W. Freed, A. Raskin, and W. Katon. 1995. Depression and posttraumatic stress disorder among a community sample of adolescent and young adult Afghan refugees. Journal of Nervous and Mental Disease 183(1):24-30. MHAT-IV. 2006. Mental Health Advisory Team IV (MHAT- IV): Operation Iraqi Freedom 05-07 Final Report. Washington, DC: Office of the Surgeon General, United States Army Medical Command, Office of the Surgeon Multinational Force-Iraq. MHAT-V. 2008. Mental Health Advisory Team V (MHAT-V) Operation Iraqi Freedom 06-08: Iraq; Operation Enduring Freedom 8: Afghanistan. Washington, DC: Office of the Surgeon General, United States Army Medical Command, Office of the Surgeon Multinational Force-Iraq. MHAT-VII. 2011. Joint Mental Health Advisory Team 7 (J-MHAT 7) Operation Enduring Freedom 2010. Washington, DC: Office of the Surgeon General, United States Army Medical Command, Office of the Command Surgeon HQ, USCENTCOM, Office of the Command Surgeon U.S. Forces Afghanistan. Miller, L. L., S. O. Meadows, L. M. Hanser, and S. L. Taylor. 2011a. Year of the Air Force Family: 2009 Survey of Active-Duty Spouses. Santa Monica, CA: RAND Corporation. Miller, L. L., B. D. Rostker, R. M. Burns, D. Barnes-Proby, S. Lara-Cinisomo, and T. R. West. 2011b. A New Approach for Assessing the Needs of Service Members and Their Families. Santa Monica, CA: RAND Corporation. Milliken, C. S., J. L. Auchterlonie, and C. W. Hoge. 2007. Longitudinal assessment of mental health problems among active and reserve component soldiers returning from the Iraq war. Journal of the American Medical Association 298(18):2141-2148. Monson, C. M., S. P. Stevens, and P. P. Schnurr. 2005. Cognitive-behavioral couple’s treatment for posttraumatic stress disorder. In Focus on Posttraumatic Stress Disorder Research, edited by T. A. Corales. Hauppauge, NY: Nova Science Publishers, Inc. Pp. 250-274. Monson, C. M., C. T. Taft, and S. J. Fredman. 2009. Military-related PTSD and intimate relationships: From description to theory-driven research and intervention development. Clinical Psychology Review 29(8):707-714.

OCR for page 257
MILITARY FAMILIES 325 Monson, C. M., S. J. Fredman, K. C. Adair, S. P. Stevens, P. A. Resick, P. P. Schnurr, H. Z. MacDonald, and A. Macdonald. 2011. Cognitive-behavioral conjoint therapy for PTSD: Pilot results from a community sample. Journal of Traumatic Stress 24(1):97-101. Mulligan, K., N. Jones, M. Davies, P. McAllister, N. T. Fear, S. Wessely, and N. Greenberg. 2012. Effects of home on the mental health of British forces serving in Iraq and Afghanistan. British Journal of Psychiatry. Murray-Swank, A. B., and L. Dixon. 2004. Family psychoeducation as an evidence-based practice. CNS Spectrums 9(12):905-912. Nathanson, A. M., R. C. Shorey, V. Tirone, and D. L. Rhatigan. 2012. The prevalence of mental health disorders in a community sample of female victims of intimate partner violence. Partner Abuse 3(1):59. National Alliance for Caregiving. 2010. Caregivers of Veterans—Serving on the Homefront. Bethesda, MD: National Alliance for Caregiving. Negrusa, B., and S. Negrusa. 2012. Home Front: Post-Deployment Mental Health and Divorces. Santa Monica, CA: RAND Corporation. Nelson, H. D., P. Nygren, Y. McInerney, and J. Klein. 2004. Screening women and elderly adults for family and intimate partner violence: A review of the evidence for the US Preventive Services Task Force. Annals of Internal Medicine 140(5):387-396. Nelson Goff, B. S., and B. D. Smith. 2005. Systemic traumatic stress: The couple adaption to traumatic stress model. Journal of Marital and Family Therapy 31(2):145-157. Newby, J. H., J. E. McCarroll, R. J. Ursano, Z. Fan, J. Shigemura, and Y. Tucker-Harris. 2005a. Positive and negative consequences of a military deployment. Military Medicine 170(10):815-819. Newby, J. H., R. J. Ursano, J. E. McCarroll, X. Liu, C. S. Fullerton, and A. E. Norwood. 2005b. Postdeployment domestic violence by US Army soldiers. Military Medicine 170(8):643-647. NRC (National Research Council) and IOM. 2010. Student Mobility: Exploring the Impact of Frequent Moves on Achievement: Summary of a Workshop. Washington, DC: The National Academies Press. O’Leary, K. D. 1999. Psychological abuse: A variable deserving critical attention in domestic violence. Violence and Victims 14(1):3-23. Orthner, D. K., and R. Rose. 2002. Relocation Adjustment Among Army Civilian Spouses. Washington, DC: Army Research Institute for the Behavioral and Social Sciences. Padden, D. L., R. A. Connors, and J. G. Agazio. 2011. Stress, coping, and well-being in military spouses during deployment separation. Western Journal of Nursing Research 33(2):247-267. Parsons, C. 2008. US Military Marriages Strained by Long Deployments. http://www.reuters.com/article/2008/05/06/us-usa-military-marriage-idUSN2228946820080506 (accessed August 22, 2012). Patterson, J. M. 2002. Integrating family resilience and family stress theory. Journal of Marriage and Family 64(2):349-360. Peebles-Kleiger, M. J., and J. H. Kleiger. 1994. Re-integration stress for Desert Storm families: Wartime deployments and family trauma. Journal of Traumatic Stress 7(2):173-194. Perlesz, A., G. Kinsella, and S. Crowe. 1999. Impact of traumatic brain injury on the family: A critical review. Rehabilitation Psychology 44(1):6-35. Perlick, D. A., K. Straits-Troster, D. G. Dyck, D. M. Norell, J. L. Strauss, C. Henderson, J. Close, N. Berger, E. R. Bonuck, K. H. Taber, C. Kalvin, T. Dolber, and A. Cristian. 2011. Multifamily group treatment for veterans with traumatic brain injury. Professional Psychology—Research and Practice 42(1):70-78.

OCR for page 257
326 RETURNING HOME FROM IRAQ AND AFGHANISTAN Phelan, S. M., J. M. Griffin, W. L. Hellerstedt, N. A. Sayer, A. C. Jensen, D. J. Burgess, and M. van Ryn. 2011. Perceived stigma, strain, and mental health among caregivers of veterans with traumatic brain injury. Disability and Health Journal 4(3):177-184. Pietrzak, R. H., and S. M. Southwick. 2011. Psychological resilience in OEF-OIF veterans: Application of a novel classification approach and examination of demographic and psychosocial correlates. Journal of Affective Disorders 133(3):560-568. Pincus, S. H., R. House, and J. Christenson. 2001. The emotional cycle of deployment: A military family perspective. Army Medical Department Journal 4/5/6:15-23. Pinquart, M., and S. Sörensen. 2003. Differences between caregivers and non-caregivers in psychological health and physical health: A meta-analysis. Psychology and Aging 18:250-267. ———. 2005. Ethnic differences in stressors, resources, and psychological outcomes of family caregiving: A meta-analysis. Gerontologist 45(1):90-106. ———. 2011. Spouses, adult children, and children-in-law as caregivers of older adults: A meta-analytic comparison. Psychology and Aging 26(1):1-14. Polusny, M. A., C. R. Erbes, P. A. Arbisi, P. Thuras, S. M. Kehle, M. Rath, C. Courage, M. K. Reddy, and C. Duffy. 2009. Impact of prior Operation Enduring Freedom/Operation Iraqi Freedom combat duty on mental health in a predeployment cohort of National Guard soldiers. Military Medicine 174(4):353-357. President’s Commission on Care for America’s Returning Wounded Warriors. 2007. Serve, Support, Simplify: Report of the President’s Commission on Care for America’s Returning Wounded Warriors. Washington, DC. RAND Center for Military Health Policy. 2012. The Deployment Life Study. http://www.rand.org/multi/military/deployment-life.html (accessed October 17, 2012). Reddy, M. K., L. A. Meis, C. R. Erbes, M. A. Polusny, and J. S. Compton. 2011. Associations among experiential avoidance, couple adjustment, and interpersonal aggression in returning Iraqi war veterans and their partners. Journal of Consulting and Clinical Psychology 79(4):515-520. Reinkober Drummet, A., M. Coleman, and S. Cable. 2003. Military families under stress: Implications for family life education. Family Relations 52(3):279-287. Renshaw, K. D., and S. B. Campbell. 2011. Combat veterans’ symptoms of PTSD and partners’ distress: The role of partners’ perceptions of veterans’ deployment experiences. Journal of Family Psychology 25(6):953-962. Renshaw, K. D., and C. M. Caska. 2012. Relationship distress in partners of combat veterans: The role of partners’ perceptions of posttraumatic stress symptoms. Behavior Therapy 43(2):416-426. Renshaw, K. D., C. S. Rodrigues, and D. H. Jones. 2008. Psychological symptoms and marital satisfaction in spouses of Operation Iraqi Freedom veterans: Relationships with spouses' perceptions of veterans’ experiences and symptoms. Journal of Family Psychology 22(4):586-594. Renshaw, K. D., E. S. Allen, G. K. Rhoades, R. K. Blais, H. J. Markman, and S. M. Stanley. 2011. Distress in spouses of service members with symptoms of combat-related PTSD: Secondary traumatic stress or general psychological distress? Journal of Family Psychology 25(4):461-469. Rentz, E. D., S. L. Martin, D. A. Gibbs, M. Clinton-Sherrod, J. Hardison, and S. W. Marshall. 2006. Family violence in the military: A review of the literature. Trauma Violence and Abuse 7(2):93-108. Rentz, E. D., S. W. Marshall, D. Loomis, C. Casteel, S. L. Martin, and D. A. Gibbs. 2007. Effect of deployment on the occurrence of child maltreatment in military and nonmilitary families. American Journal of Epidemiology 165(10):1199-1206. Richardson, A., A. Chandra, L. T. Martin, C. M. Setodji, B. W. Hallmark, N. F. Campbell, S. Hawkins, and P. Grady. 2011. Effects of Soldiers’ Deployment on Children’s Academic Performance and Behavioral Health. Santa Monica, CA: RAND Corporation.

OCR for page 257
MILITARY FAMILIES 327 Riggs, S. A., and D. S. Riggs. 2011. Risk and resilience in military families experiencing deployment: The role of the family attachment network. Journal of Family Psychology 25(5):675-687. Robinson-Whelen, S., and D. H. Rintala. 2003. Informal care providers for veterans with SCI: Who are they and how are they doing? Journal of Rehabilitation Research and Development 40(6):511-516. Robrecht, D. T., J. Millegan, L. L. Leventis, J. B. Crescitelli, and R. N. McLay. 2008. Spousal military deployment as a risk factor for postpartum depression. Journal of Reproductive Medicine 53(11):860- 864. Rodgers, M. L., A. D. Strode, D. M. Norell, R. A. Short, D. G. Dyck, and B. Becker. 2007. Adapting multiple-family group treatment for brain and spinal cord injury intervention development and preliminary outcomes. American Journal of Physical Medicine and Rehabilitation 86(6):482-492. Rosen, L. N., D. Durand, D. J. Westhuis, and J. M. Teitelbaum. 1995. Marital adjustment of Army spouses one year after Operation Desert Storm. Journal of Applied Social Psychology 25(8):677-692. Ruger, W., S. E. Wilson, and S. L. Waddoups. 2002. Warfare and welfare: Military service, combat, and marital dissolution. Armed Forces and Society 29(1):85-107. Sahlstein, E., K. C. Maguire, and L. Timmerman. 2009. Contradictions and praxis contextualized by wartime deployment: Wives’ perspectives revealed through relational dialectics. Communication Monographs 76(4):421-442. Saltzman, W. R., P. Lester, W. R. Beardslee, C. M. Layne, K. Woodward, and W. P. Nash. 2011. Mechanisms of risk and resilience in military families: Theoretical and empirical basis of a family- focused resilience enhancement program. Clinical Child and Family Psychology Review 14(3):213- 230. SAMHSA (Substance Abuse and Mental Health Services Administration). 2008. Results from the 2007 National Survey on Drug Use and Health: National Findings: Major Depressive Episode and Treatment for Depression Among Veterans Aged 21 to 39. Rockville, MD: Substance Abuse and Mental Health Services Administration. Sautter, F. J., S. M. Glynn, K. E. Thompson, L. Franklin, and X. Han. 2009. A couple-based approach to the reduction of PTSD avoidance symptoms: Preliminary findings. Journal of Marital and Family Therapy 35(3):343-349. Sayers, S. L. 2011. Family reintegration difficulties and couples therapy for military veterans and their spouses. Cognitive and Behavioral Practice 18(1):108-119. Schok, M. L., R. J. Kleber, M. Elands, and J. M. P. Weerts. 2008. Meaning as a mission: A review of empirical studies on appraisals of war and peacekeeping experiences. Clinical Psychology Review 28(3):357-365. Schulz, R., and L. M. Martire. 2004. Family caregiving of persons with dementia: Prevalence, health effects, and support strategies. American Journal of Geriatric Psychiatry 12(3):240-249. Segal, M. W. 1986. The military and the family as greedy institutions. Armed Forces and Society 13(1):9- 38. Shear, M. K. 2012. Grief and mourning gone awry: Pathway and course of complicated grief. Dialogues in Clinical Neuroscience 14(2):119-128. Sheppard, S. C., J. W. Malatras, and A. C. Israel. 2010. The impact of deployment on US military families. American Psychologist 65(6):599-609. Sherman, M. D. 2006. Updates and five-year evaluation of the S.A.F.E. Program: A family psychoeducational program for serious mental illness. Community Mental Health Journal 42(2):213- 219. Sherman, M. D., D. A. Perlick, and K. Straits-Troster. 2012. Adapting the multifamily group model for treating veterans with posttraumatic stress disorder. Psychological Services 9(4):349-360.

OCR for page 257
328 RETURNING HOME FROM IRAQ AND AFGHANISTAN Shin, P., S. Rosenbaum, and D. R. Mauery. 2005. Medicaid’s Role in Treating Children in Military Families. Washington, DC: George Washington University SPHHS Center for Health Services Research and Policy. Silverman, A. B., H. Z. Reinherz, and R. M. Giaconia. 1996. The long-term sequelae of child and adolescent abuse: A longitudinal community study. Child Abuse and Neglect 20(8):709-723. Silverman, W. K., C. D. Ortiz, C. Viswesvaran, B. J. Burns, D. J. Kolko, F. W. Putnam, and L. Amaya- Jackson. 2008. Evidence-based psychosocial treatments for children and adolescents exposed to traumatic events. Journal of Clinical Child and Adolescent Psychology 37(1):156-183. Skopp, N. A., M. A. Reger, G. M. Reger, M. C. Mishkind, M. Raskind, and G. A. Gahm. 2011. The role of intimate relationships, appraisals of military service, and gender on the development of posttraumatic stress symptoms following Iraq deployment. Journal of Traumatic Stress 24(3):277- 286. Smith, D. C., M. L. Munroe, L. M. Foglia, P. E. Nielsen, and S. H. Deering. 2010. Effects of deployment on depression screening scores in pregnancy at an Army military treatment facility. Obstetrics and Gynecology 116(3):679-684. Smith, P., S. Perrin, W. Yule, and S. Rabe-Hesketh. 2001. War exposure and maternal reactions in the psychological adjustment of children from Bosnia-Herzegovina. Journal of Child Psychology and Psychiatry 42(3):395-404. Spera, C. 2009. Spouses’ ability to cope with deployment and adjust to Air Force family demands. Armed Forces and Society 35(2):286-306. Stanley, S. M., E. S. Allen, H. J. Markman, G. K. Rhoades, and D. L. Prentice. 2010. Decreasing divorce in Army couples: Results from a randomized controlled trial using prep for strong bonds. Journal of Couple and Relationship Therapy 9(2):149-160. SteelFisher, G. K., A. M. Zaslavsky, and R. J. Blendon. 2008. Health-related impact of deployment extensions on spouses of active duty Army personnel. Military Medicine 173(3):221-229. Stenberg, U., C. M. Ruland, and C. Miaskowski. 2010. Review of the literature on the effects of caring for a patient with cancer. Psycho-Oncology 19(10):1013-1025. Street, A. E., and I. Arias. 2001. Psychological abuse and posttraumatic stress disorder in battered women: Examining the roles of shame and guilt. Violence and Victims 16(1):65-78. Taft, C. T., R. P. Weatherill, H. E. Woodward, L. A. Pinto, L. E. Watkins, M. W. Miller, and R. Dekel. 2009. Intimate partner and general aggression perpetration among combat veterans presenting to a posttraumatic stress disorder clinic. American Journal of Orthopsychiatry 79(4):461-468. US Census Bureau. 2011a. America’s Families and Living Arrangements: 2011, Table C2: Household Relationship and Living Arrangements of Children Under 18 Years, by Age and Sex: 2011. http://www.census.gov/population/www/socdemo/hh-fam/cps2011.html (accessed October 25, 2012). ———. 2011b. America’s Families and Living Arrangements: 2011, Table C3: Living Arrangements of Children Under 18 Years and Marital Status of Parents, by Age, Sex, Race, and Hispanic Origin and Selected Characteristics of the Child for all Children: 2011. http://www.census.gov/population/www/socdemo/hh-fam/cps2011.html (accessed October 25, 2012). ———. 2011c. Current Population Survey, 2010 Annual Social and Economic Supplement. www.census.gov/hhes/migration/files/cps/cps2010/tab02.xls (accessed June 1, 2012). US House of Representatives. 2008. National Month of the Military Child. H. Res. 265. 110th Congress. US Social Security Administration. 2012. Office of Retirement and Disability Policy. http://www.ssa.gov/policy/docs/statcomps/supplement/2012/5f.html#table5.f4 (accessed October 25, 2012). VA (Department of Veterans Affairs). 2006. VHA directive 2006-041: Veterans Health Care Service Standards. Washington, DC: Veterans Health Administration, Department of Veterans Affairs.

OCR for page 257
MILITARY FAMILIES 329 ———. 2011. New Services for Family Caregivers of Post-9/11 Veterans. http://www.caregiver.va.gov/support_benefits.asp (accessed July 9, 2012). van der Voort, T. Y., P. J. Goossens, and J. J. van der Bijl. 2007. Burden, coping and needs for support of caregivers for patients with a bipolar disorder: A systematic review. Journal of Psychiatric and Mental Health Nursing 14(7):679-687. Van Houtven, C. H., E. Z. Oddone, and M. Weinberger. 2010. Informal and formal care infrastructure and perceived need for caregiver training for frail US veterans referred to home and community-based services. Chronic Illness 6(1):57-66. van Steenbergen, E. F., N. Ellemers, S. A. Haslam, and F. Urlings. 2008. There is nothing either good or bad but thinking makes it so: Informational support and cognitive appraisal of the work-family interface. Journal of Occupational and Organizational Psychology 81(3):349-367. Verhaeghe, S., T. Defloor, and M. Grypdonck. 2005. Stress and coping among families of patients with traumatic brain injury: A review of the literature. Journal of Clinical Nursing 14(8):1004-1012. Vitaliano, P. P., J. Zhang, and J. M. Scanlan. 2003. Is caregiving hazardous to one's physical health? A meta-analysis. Psychological Bulletin 129(6):946-972. Vormbrock, J. K. 1993. Attachment theory as applied to wartime and job-related marital separation. Psychological Bulletin 114(1):122-144. Walsh, F. 2006. Strengthening Family Resilience, 2nd ed. New York: Guilford. Warner, C., G. N. Appenzeller, C. Warner, and T. Grieger. 2009. Psychological effects of deployments on military families. Psychiatric Annals 39(2):56-63. Weinick, R. M., E. B. Beckjord, C. M. Farmer, L. T. Martin, E. M. Gillen, J. D. Acosta, M. P. Fisher, J. Garnett, G. C. Gonzalez, T. C. Helmus, L. H. Jaycox, K. A. Reynolds, N. Salcedo, and D. M. Scharf. 2011. Programs Addressing Psychological Health and Traumatic Brain Injury Among US Military Servicemembers and Their Families. Santa Monica, CA: RAND Corporation. Werber, L., M. C. Harrell, D. M. Varda, K. Curry Hall, and M. K. Beckett. 2008. Deployment Experiences of Guard and Reserve Families: Implications for Support and Retention. Santa Monica, CA: RAND Corporation. Wiens, T. W., and P. Boss. 2006. Maintaining family resiliency before, during, and after military separation. In Military Life: The Psychology of Serving in Peace and Combat, Volume 3: The Family, edited by C. A. Castro, A. B. Adler, and T. W. Britt. Westport, CT: Praeger. Worthen, M., R. Moos, and J. Ahern. 2012. Iraq and Afghanistan veterans’ experiences living with their parents after separation from the military. Contemporary Family Therapy:1-14. Wright, K. M., L. M. Burrell, E. D. Schroeder, and J. L. Thomas. 2006. Military spouses: Coping with the fear and the reality of service member injury and death. In Military Life: The Psychology of Serving in Peace and Combat. Volume 3: The Family, edited by C. A. Castro, A. B. Adler, and T. W. Britt. Westport, CT: Praeger. Zarit, S. 2006. Assessment of family caregivers: A research perspective. In Caregiver Assessment: Voices and Views from the Field. Report from a National Consensus Development Conference (Vol. II), edited by Family Caregiver Alliance. San Francisco, CA: Family Caregiver Alliance. Pp. 12-37.

OCR for page 257