The Impact of Deployment on Service Members and their Families

1. The Impact of Deployment on Service Members and their Families Presented by: Jim Messina, Ph.D. Licensed Psychologist Lead Trainer: Florida ARC- Coping with Deployment PFA for Military Families Lead Disaster Mental Health Services Tampa Bay Chapter of American Red Cross Psychologist with: St. Joseph’s Hospital, Vericare, Argosy University Presentation Available on: www.jamesjmessina.com

2. Most current statistics on make up of Deployed Military • Men = 90% • Women = 10% • Married = 53% • with children = 68% • without children = 32% • Single = 47% • with children = 13% • without children = 87% • CTS Deployment File Baseline Report, Defense Manpower Data Center, Aug 31, 2007

3. Major Stressors for Military Families • Frequent moves and separations • Individual augmentees • Risk of injury and death • Expectations • Long and unpredictable Foreign residence

4. Risk Factors for Military Families • Younger spouses • Younger children • Socially isolated and dependent families • Families undergoing major transitions • Families with multiple needs and problems before deployment • Children with school history of special education • How well children show coping skills prior to deployment

5. Risk Factors for Military Families • Family history of mental health issues • Families of junior enlisted • Single parents • Foreign-born spouses • Pregnant spouses • Prior deployments • Dual military • Newly married

6. Stressors in the Deployment Cycle

7. Pre-Deployment Stressors Preparedness – Practical preparation • Power of attorney/Will/Financial plan • Location of important papers • Emergency contact procedures • Child care arrangements Emotional preparation • Prepared to cope with unexpected problems • Trust service member will be protected • Support mission

8. Pre-Deployment Stressors • Lack of Preparation Time • Unit Preparation vs. Family Preparation • Shifting expectations • Length of upcoming deployment • Open-ended deployments • Deployment date • Clarifying changes in family dynamics • Anticipation of threats to service member • Perception of mission purpose • Lack of information • Rumors

9. PRE-DEPLOYMENT Confusion Denial Resentment Arguing Worrying Planning DURING DEPLOYMENT Busier than usual Crying Loss of sleep, appetite Engrossed in war news Self-growth Independence Decision maker Less angry, but lonelier Deployment Stressors on Spouses

10. PRE-DEPLOYMENT Confusion Regression Anger Outbursts Sadness Surprise Guilt Behavioral problems DURING DEPLOYMENT At higher risk for problems than the national norm. Parenting stress during deployment is more than the national norm. Boys and younger children may experience more symptoms than girls. Internalizing symptoms may be more common than externalizing symptoms Deployment Stressors on Children

11. Pre-Deployment Stressors on Adolescents • “I don’t care” • Fear of rejection • Denial of feelings • Anger • Higher value on friends

12. Children’s Reaction to Deployment

13. Stressors in the Deployment Cycle

14. Deployment Stressors for Service Members • Operational-heat, dehydration, lack of comforts, desert, noises, fumes • Cognitive-boredom, monotony, unclear role or mission, experiences that defy beliefs, info overload • Emotional-fear of failure, guilt, horror, fear, anxiety, feeling devalued • Social-separation from loved ones, lack of privacy, public opinion and media • Spiritual-change in faith, inability to forgive, loss of trust • Charles Figley and William Nash, Combat Stress Injury (2007)

15. Trauma descriptions offered by Soldiers and Marines • Friends burned to death, one killed in blast • A friend was liquefied in the driver’s position on a tank • A huge bomb blew my friends’ head off like 50 meters from me • Marines being buried alive • Seeing, smelling, touching, dead, blown-up people

16. Tough Realities about Combat • Fear in combat is ubiquitous • Unit members will be injured and killed • There will be communication breakdowns • Leadership failures will be perceived • Combat impacts every soldier mentally and emotionally • Combat has lasting mental health effects • Soldiers are afraid to admit that they have a mental health problem • Deployments place a tremendous strain upon families • Combat environment is harsh and demanding • Combat poses moral/ethical challenges • WRAIR Land Combat Study Team

17. Challenges of Operation Iraqi Freedom (OIF) & Operation Enduring Freedom (OEF) • No “front line” • Highly ambiguous environment • Complex and changing missions – combat, peacekeeping, humanitarian • Long deployments • Repeated deployments • Environment is very harsh – extreme heat • 24 hour operations • constant movement by ground or air • limited down time • crowded uncomfortable living conditions • difficult communications

18. Combat Exposure in Iraq

19. Common Reactions to Trauma • Fear and anxiety • Intrusive thoughts about the trauma • Nightmares of the trauma • Sleep disturbance • Feeling jumpy and on guard • Concentration difficulties

20. Common Reactions to Trauma • Avoiding trauma reminders • Feeling numb or detached • Feeling angry, guilty, or ashamed • Grief and depression • Negative image of self and world • The world is dangerous • I am incompetent • People can not be trusted

21. BATTLEMIND TRAINING • Battlemind skills helped you survive in combat, but may cause you problems if not adapted when you get home • Buddies (cohesion) vs. Withdrawal • Accountability vs. Controlling • Targeted Aggression vs. Inappropriate Aggression • Tactical Awareness vs. Hypervigilance • Lethally Armed vs. “Locked and Loaded” at Home • Emotional Control vs. Anger/Detachment • Mission OPSEC vs. Secretiveness • Individual Responsibility vs. Guilt • Non-Defensive Driving vs. Aggressive Driving • Discipline and Ordering vs. Conflict

22. Social Support Initial Reactions Trauma PTSD Symptoms

23. The Role of Families • In general, families provide a primary source of social support. • Spouses and intimate partners are typically identified as the chief source of social support. • Approximately 50% of service members deployed to OEF/OIF are married at the time of deployment.

24. Background Invisible Wounds of WarRand Corporation (2008) • Since October 2001, approximately 1.64 million U.S. troops were deployed to Operation Enduring Freedom (OEF; Afghanistan) and Operation Iraqi Freedom (OIF; Iraq). • Pace of deployments is unprecedented in the history of the all-volunteer force (Belasco, 2007; Bruner, 2006). • Higher proportion of armed forces are being deployed & deployments have been longer, redeployment to combat has been common, and breaks between deployments have been infrequent (Hosek, Kavanagh, and Miller, 2006).

25. Background Invisible Wounds of WarRand Corporation (2008) • OEF & OIF have employed smaller forces & produced lower casualty rates of killed or wounded than Vietnam and Korea. More service members are surviving due to advances in medical technology & body armor (Regan, 2004; Warden, 2006). • However, casualties of a different kind have emerged—invisible wounds, such as mental health conditions and cognitive impairments • These deployment experiences may include multiple deployments per individual service member and exposure to difficult threats, such as improvised explosive devices (IEDs).

26. Invisible Wounds of War Rand Corporation (2008) • Data from phone survey of approximately 2000 OIF & OEF veterans • 14% PTSD • 14% depression • 19% TBI • 33% PTSD, depression or TBI • 5% symptoms of all 3

27. Invisible Wounds of War Rand Corporation (2008) Top 3 barriers to mental health treatment 1. Treatment not confidential; could constrain future job assignments and military career advancement 2. Medications may have unpleasant side effects 3. Even good mental health care is not effective

28. Invisible Wounds of War Rand Corporation (2008) Costs of PTSD, depression and TBI–Other psychiatric diagnoses • Risk of attempting suicide • Higher rates of unhealthy behaviors (smoking, overeating, unprotected sex) • Higher rates of physical health problems and mortality • Missed more days of work or less productivity • A relationship to being homeless

29. Invisible Wounds of War Rand Corporation (2008) • Service members not on active duty (Reserve Corps, discharged, retired) • Enlisted personnel • Females • Hispanics • More lengthy deployments • More extensive exposure to combat trauma

31. Summary of FindingsInvisible Wounds of War Rand Corporation (2008) • About 10-15% of Soldiers develop PTSD after deployment • An additional 10-15% have significant symptoms of depression, anxiety, or PTSD • Alcohol misuse also increases post-deployment • Prevalence varies as a function of deployment experiences • MH problems associated with functional impairment, attrition, and physical health problems • One-third of Soldiers use MH services after deployment (includes screening and prevention services) • Perceptions of stigma may be improving. However, many Soldiers don’t seek help, due to stigma and other barrier

32. Financial Stressors of Deployment • Most do not experience serious financial difficulties – Potential loss of income offset by supplements • Substantial minority does face financial hardships– 18% of spouses report serious financial difficulties • 29% of spouses report trouble paying bills • 1/2 reporting difficulties are from junior enlisted grades • Increased expenses– Supplies for deployed service member • Shipping costs • Communication • Additional childcare costs

33. Stressors in the Deployment Cycle

34. Typical Course of Reintegration • Family resilience is the rule, not the exception. • Usually, families return to the normal routine. • Common to incorporate changes without major disruption in family functioning. • HOWEVER…

35. Reunions can be stressful • Changed roles/responsibilities • New independence of spouse • Lack of time • Tug on loyalties • Extended family • Health/Mental health problems • Unresolved marital issues haven’t vanished

36. Most frequently identified stressors following soldiers’ return • Readjustment to marital and family relationships • Lack of time for family reintegration • Couple jealousy and suspicions • Ongoing military stressors • Uncertainty about future retention • Teitelbaum (WRAIR,1992) conducted a study with the Army after ODS

37. Post Deployment Stressors of Service Members • Physical: traffic, crowds, unarmed, access to alcohol • Cognitive: loyalty issues to family vs unit, secrecy vs disclosure, boredom, regrets, thoughts of losses • Emotional: grief, anger, feeling unsafe, guilt, withdrawal from war “rush,” numbness • Social: separated from buddies, overwhelmed or misunderstood by family, feelings of alienation • Spiritual: asking why buddies died, lack of purpose, changed faith, conflicting values • Charles Figley and William Nash, Combat Stress Injury (2007)

38. Service Mindset when Deployed • Stay focused on mission /nothing else matters • Truly life or death / always on the edge • Constant adrenaline “rush” • Black or white / all or nothing • Sense of purpose, invincibility • Only trust battle buddies /others are threat • Need to control environment • Real problems and needs exist in Iraq • Adapted from briefing by COL Kevin Gerdes, May 2008

39. Mindset of Returned Service Members at Home • Life is now unfocused and complex • No longer on the verge of life or death • What can replace the “high” of war? • Things aren’t clear cut • No sense of purpose, nothing matters • Can’t trust anybody • Can’t be in control of surroundings • Problems at home pale in comparison to those in Iraq • Adapted from briefing by COL Kevin Gerdes, May 2008

40. Reserve Components Stress after Deployment • Return to civilian life • Job may no longer be available • May experience a reduction in income • Transition of health care or loss of health coverage • Loss of unit/military support system for the family • Lack of follow up/observation by unit commanders to assess needs

41. Changes in Family faced by returning Service Members • FAMILY HAS • New routines • New responsibilities • More independence and confidence • Made many sacrifices • Worried, felt lonely • Gone through milestones that were missed • Adapted from briefing by COL Kevin Gerdes, May 2008

42. Impact of Returning Home • VETERAN’S RETURN CAN • Interrupt routine • Disrupt space • Throw off decision making • Cause family to walk on tip toes • Not make everything perfect • Not replace the sacrifices and missed milestones • Adapted from briefing by COL Kevin Gerdes, May 2008

43. Post Deployment Stressors for Spouses

44. Post Deployment Stressors for Children • Afraid of returning parent /Avoiding • Wants attention • Clingy • Anger • Needs reassurance • Attempts to split parents • Desires recognition • Joy • Excitement • Briefing by Doug Lehman, May 2008

45. Spending more time with friends School problems Behavioral problems Relief Defiance Resentment Avoidance Withdrawal Briefing by Doug Lehman, May 2008 Post-Deployment Stressors of Adolescents

46. Tips for both spouses during reintegration • Recognize that readjustment stress is common • Listen to each other’s stories and be curious • Recognize that experiences have changed both partners • Discover new family strengths • Negotiate a new balance, roles, and routine • Make sure each spouse has space

47. Tips for both spouses during reintegration • Don’t play “one-up” games about deployment • Build common interests again • Go slow • Don’t drill the other if there are concerns regarding an affair • Don’t plan sudden romantic getaways • Both spouses may feel unneeded, unwanted - discuss changes and gradually develop solutions

48. Tips for both spouses during reintegration • Expect children to test limits • Be flexible and patient • Communicate respect • Plan for future together • Compliment each other more • Be willing to apologize • Take time outs when things feel out of control

49. Tips for Both Parents during Reintegration • Spend one-on-one time with each child • Be giving of time and energy • Allow child to also have space • Listen and accept child’s feelings • Be realistic and flexible • Avoid excess gift giving • Don’t get upset if child has reactions to you • Don’t give into demands of guilt

50. Tips for Both Parents during Reintegration • Express specific concerns and offer to help but don’t push • Become an expert in available resources • Have honest discussion about financial situation • Use connections made during deployment to develop strategies to help transition • Give your child a chance to talk about war experiences • Have a battle buddy talk to your child • Armstrong, K., Best, S., & Domenici, P. (2006), Courage After Fire