The Impact of Deployment on Service Members and their Families Presented by: Jim Messina, Ph.D. Licensed Psychologist Lead Trainer: Florida ARCCoping 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 Most current statistics on make up of Deployed Military Men = 90% Women = 10% Married = 53% Single = 47% with children = 68% without children = 32% with children = 13% without children = 87% CTS Deployment File Baseline Report, Defense Manpower Data Center, Aug 31, 2007 Major Stressors for Military Families Frequent moves and separations Individual augmentees Risk of injury and death Expectations Long and unpredictable Foreign residence 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 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 Stressors in the Deployment Cycle 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 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 Deployment Stressors on Spouses 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 Children 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 Pre-Deployment Stressors on Adolescents “I don’t care” Fear of rejection Denial of feelings Anger Higher value on friends Children’s Reaction to Deployment Stressors in the Deployment Cycle 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) 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 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 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 Combat Exposure in Iraq 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 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 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 Social Support Trauma Initial Reactions PTSD Symptoms 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. Background Invisible Wounds of War Rand 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). Background Invisible Wounds of War Rand 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). 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 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 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 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 Summary of Findings Invisible 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 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 Stressors in the Deployment Cycle 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… 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 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 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) 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 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 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 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 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 Post Deployment Stressors for Spouses 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 Post-Deployment Stressors of Adolescents Spending more time with friends School problems Behavioral problems Relief Defiance Resentment Avoidance Withdrawal Briefing by Doug Lehman, May 2008 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 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 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 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 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 References The Center for Deployment Psychology http://www.deploymentpsych.org/ Mission of CDP: To train military and civilian psychologists and other mental health professionals to provide high quality deployment-related behavioral health services to military personnel and their families. CDP's Course Resources: http://www.deploymentpsych.org/courseres.html Introduction to the CDP (powerpoint) PTSD and Domestic Violence (powerpoint) Families in the Wake of Trauma (powerpoint) CDP's Links : http://www.deploymentpsych.org/links.html