Article

Family Problems Among Recently Returned Military Veterans Referred for a Mental Health Evaluation

VISN 4 MIRECC 116, Philadelphia VA Medical Center, Philadelphia, PA 19104, USA.
The Journal of Clinical Psychiatry (Impact Factor: 5.14). 03/2009; 70(2):163-70. DOI: 10.4088/JCP.07m03863
Source: PubMed

ABSTRACT Existing evidence suggests that military veterans with mental health disorders have poorer family functioning, although little research has focused on this topic.
To test whether psychiatric symptoms are associated with family reintegration problems in recently returned military veterans.
Cross-sectional survey of a clinical population. Respondents who were referred to behavioral health evaluation from April 2006 through August 2007 were considered for the survey.
Philadelphia Veterans Affairs Medical Center, Pa.
199 military veterans who served in Iraq or Afghanistan after 2001 and were referred for behavioral health evaluation from primary care (mean age = 32.7 years, SD = 9.1).
Measures included the Mini-International Neuropsychiatric Interview for psychiatric diagnoses, the 9-item Patient Health Questionnaire for depression diagnosis and severity, and screening measures of alcohol abuse and illicit substance use. A measure of military family readjustment problems and a screening measure of domestic abuse were developed for this study.
Three fourths of the married/cohabiting veterans reported some type of family problem in the past week, such as feeling like a guest in their household (40.7%), reporting their children acting afraid or not being warm toward them (25.0%), or being unsure about their family role (37.2%). Among veterans with current or recently separated partners, 53.7% reported conflicts involving "shouting, pushing, or shoving," and 27.6% reported that this partner was "afraid of them." Depression and posttraumatic stress disorder symptoms were both associated with higher rates of family reintegration problems.
Mental health problems may complicate veterans' readjustment and reintegration into family life. The findings suggest an opportunity to improve the treatment of psychiatric disorders by addressing family problems.

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Available from: Steven Sayers, Aug 30, 2015
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    • "The Post-Deployment Family Reintegration Scale was constructed for the current investigation and includes six items assessing service members' challenges related to family reintegration following deployment. Two of the six items overlapped with a screening measure developed by Sayers et al. (2009) including " Uncertainly about my responsibilities in the home " and " Feeling like I am a guest in my own home. " Four additional items assessed lack of belongingness or purpose ( " Feeling no longer needed in the household " ), adjustment to new routines ( " Dealing with new household routines established during deployment " and " Being given too much responsibility too soon in "
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    ABSTRACT: The consequences of deployment extend beyond the service member to impact the entire family. The current investigation evaluated the unique challenges of family reintegration for partnered service members using a prospective design. In total, 76 partnered service members who deployed on a year-long, high-risk mission to Iraq were assessed across the entirety of the deployment cycle, i.e., pre-, during, and postdeployment. At follow-up, nearly 1 in 5 partnered service members reported moderate to severe difficulties in multiple aspects of family reintegration. Prospective interpersonal indicators such as preparations for deployment as a couple, shared commitment to the military, and predeployment relationship distress predicted postdeployment family reintegration difficulties. Significant interpersonal risk factors were medium to large in their effect sizes. Airmen's willingness to disclose deployment- and combat-related experiences, and postdeployment relationship distress served as concurrent interpersonal correlates of difficulties with family reintegration. Intrapersonal factors, including posttraumatic stress symptoms and alcohol misuse were concurrently related to challenges with family reintegration; predeployment alcohol misuse also predicted subsequent family reintegration difficulties. Additional analyses indicated that pre- and postdeployment relationship distress, combat disclosure, and postdeployment alcohol misuse each contributed to family reintegration when controlling for other intra- and interpersonal risk factors. Implications for prevention and early intervention strategies as well as future research are discussed. (PsycINFO Database Record (c) 2015 APA, all rights reserved).
    Psychological Services 08/2015; 12(3):213-221. DOI:10.1037/ser0000020 · 1.08 Impact Factor
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    • "at least one act of physically aggressive behavior in the past 4 months, 27.7% with less severe physical aggression (i.e., threatening without a weapon), and 18.9% with more severe physical aggression (i.e., physical fight and threatening with a weapon). Sayers, 2009 (62) 199 United States Clinical assessment questionnaire Clinical sample from Department of Veteran Affairs clinic Combat exposure, PTSD, and alcohol misuse screening Family reintegration problems, including self-reported domestic aggression in the past year Over 75% of married or cohabiting veterans reported some type of family problem in the past week; 53.7% of veterans with current or recently separated partners reported conflicts involving shouting, pushing, or shoving. Table continues "
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    ABSTRACT: A systematic review and meta-analyses were conducted on studies of the prevalence of aggressive and violent behavior, as well as of violent offenses and convictions, among military personnel following deployment to Iraq and/or Afghanistan; the relationship with deployment and combat exposure; and the role that mental health problems, such as post-traumatic stress disorder (PTSD), have on the pathway between deployment and combat to violence. Seventeen studies published between January 1, 2001, and February 12, 2014, in the United States and the United Kingdom met the inclusion criteria. Despite methodological differences across studies, aggressive behavior was found to be prevalent among serving and formerly serving personnel, with pooled estimates of 10% (95% confidence interval (CI): 1, 20) for physical assault and 29% (95% CI: 25, 36) for all types of physical aggression in the last month, and worthy of further exploration. In both countries, rates were increased among combat-exposed, formerly serving personnel. The majority of studies suggested a small-to-moderate association between combat exposure and postdeployment physical aggression and violence, with a pooled estimate of the weighted odds ratio = 3.24 (95% CI: 2.75, 3.82), with several studies finding that violence increased with intensity and frequency of exposure to combat traumas. The review's findings support the mediating role of PTSD between combat and postdeployment violence and the importance of alcohol, especially if comorbid with PTSD.
    Epidemiologic Reviews 01/2015; 37(1). DOI:10.1093/epirev/mxu006 · 7.33 Impact Factor
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    • "Approximately 2.4 million United States military personnel have been deployed to Iraq and Afghanistan since September 11, 2001. Military deployment and combat has historically shown to result in medical [1] [2] [3] [4], psychological [5] [6] [7] [8], and social problems [9] [10] [11] [12] [13], all of which affect veterans' post-deployment health across the life course [13] [14] [15] [16]. "
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    ABSTRACT: OBJECTIVE To describe returning veterans’ transition experience from military to civilian life and to educate health care providers about culture-centered communication that promotes readjustment to civilian life. METHODS Qualitative, in-depth, semi-structured interviews with 17 male and 14 female Iraq and Afghanistan veterans were audio recorded, transcribed verbatim, and analyzed using Grounded Practical Theory. RESULTS Veterans described disorientation when returning to civilian life after deployment. Veterans’ experiences resulted from an underlying tension between military and civilian identities consistent with reverse culture shock. Participants described challenges and strategies for managing readjustment stress across three domains: intrapersonal, professional/educational, and interpersonal. CONCLUSIONS To provide patient-centered care to returning Iraq and Afghanistan veterans, health care providers must be attuned to medical, psychological, and social challenges of the readjustment experience, including reverse culture shock. Culture-centered communication may help veterans integrate positive aspects of military and civilian identities, which may promote full reintegration into civilian life. PRACTICE IMPLICATIONS Health care providers may promote culture-centered interactions by asking veterans to reflect about their readjustment experiences. By actively eliciting challenges and helping veterans’ to identify possible solutions, health care providers may help veterans integrate military and civilian identities through an increased therapeutic alliance and social support throughout the readjustment process.
    Patient Education and Counseling 06/2014; 95(3). DOI:10.1016/j.pec.2014.03.016 · 2.60 Impact Factor
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