EDUCATIONAL CHALLENGES EXPERIENCED BY SPOUSES OF VETERANS
WITH POST-TRAUMATIC STRESS DISORDER
A Thesis
Presented to the faculty of the Graduate and Professional Studies in Education
California State University, Sacramento
Submitted in partial satisfaction of
the requirements for the degree of
MASTER OF ARTS
in
Education
(Special Education)
by
Alma Mendoza
SPRING
2014
© 2014
Alma Mendoza
ALL RIGHTS RESERVED
ii
EDUCATIONAL CHALLENGES EXPERIENCED BY SPOUSES OF VETERANS
WITH POST-TRAUMATIC STRESS DISORDER
A Thesis
by
Alma Mendoza
Approved by:
________________________________, Committee Chair
Jean Gonsier-Gerdin, Ph.D.
________________________________, Second Reader
José Cintrón, Ph.D.
Date
iii
Student: Alma Mendoza
I certify that this student has met the requirements for format contained in the University
format manual, and that this thesis is suitable for shelving in the Library and credit is to
be awarded for the thesis.
, Graduate Coordinator
Albert Lozano, Ph.D.
Date
Graduate and Professional Studies in Education
iv
Abstract
of
EDUCATIONAL CHALLENGES EXPERIENCED BY SPOUSES OF VETERANS
WITH POST-TRAUMATIC STRESS DISORDER
by
Alma Mendoza
The purpose of this study was to provide insight into the subjective experiences of
five wives of combat war veterans diagnosed with PTSD attending college. The setting
was a state university in Northern California. The wives were recruited from the oncampus Veteran’s office and a sociology class being offered to veterans and dependents.
A collection of demographic information was gathered and a face-to-face open-ended
question interview was conducted in order to explore the challenges the wives’
experienced. The participants were asked to complete a checklist of stress-related
symptoms that they themselves had experienced. All five participants reported having 10
to 12 of a possible 15 symptoms and all five participants experienced the following eight
symptoms: anxiety, sadness, low self-esteem, emotional exhaustion, trouble making
decisions, difficulty concentrating, changes in sleep habits, and withdrawing from others.
The themes found in the interviews related to: (a) future financial stability, (b)
availability of Chapter 35, (c) strength and empowerment from going to school, (d)
challenges as a caregiver on school performance, (e) isolation, (f) feelings of anxiety and
being overwhelmed, (g) need to modify use of time and behavior to do school work, (h)
v
supports needed to overcome and meet challenges, and (i) on-campus supports. The
conclusion of this study contains recommendations for practice, which include the need
for on-campus supports and how the implementation of interventions may focus on
reducing the educational challenges that the wives of veterans with PTSD encounter. In
addition, future research could examine how managing all aspects of the personal needs
of a veteran with disabilities along with all other responsibilities and pressures may
impact a wife’s educational challenges.
, Committee Chair
Jean Gonsier-Gerdin, Ph.D.
Date
vi
DEDICATION
I dedicate this study to all the wives of veterans that are taking care of their spouses as
they pursue higher education.
vii
ACKNOWLEDGMENTS
This thesis would not have been possible without the support of several
individuals. First, I wish to thank Dr. Gonsier-Gerdin for all your support,
encouragement, and suggestions on this thesis. Thank you for all your patience, your
advice, and most importantly for your willingness to give of yourself to guide me through
my educational progress.
I would also like to thank my second reader Dr. Cintrón for taking the time to
read my thesis and contributing to my learning process.
I would also like to express my appreciation to Meredith Linden for all of the
editing and formatting you did for me. I would not have been to complete this thesis
without your computer skills.
I would also like to thank my son Andre; you have been my biggest support
throughout my graduate school experience. I can state that without you I would have not
made it through some very challenging times throughout my educational journey.
Ultimately, I would like to thank my husband Romero for believing in me and
encouraging me to pursue higher education.
viii
TABLE OF CONTENTS
Page
Dedication ......................................................................................................................... vii
Acknowledgments............................................................................................................ viii
List of Tables ..................................................................................................................... xi
Chapter
1. INTRODUCTION .........................................................................................................1
Background of the Problem .....................................................................................3
Purpose of the Research ...........................................................................................5
Research Theoretical Framework ............................................................................5
Definition of Terms..................................................................................................6
Assumptions.............................................................................................................9
Justifications ............................................................................................................9
Limitations .............................................................................................................10
Organization of the Remainder of the Thesis ........................................................11
2. LITERATURE REVIEW ............................................................................................12
Secondary Traumatization and Caregiver Burden .................................................12
Prevalence of Secondary Traumatization and Caregiver Burden ..........................16
Impact on Major Life Activities ............................................................................19
Interventions for Caregivers ..................................................................................24
Interventions for Students with Post Traumatic Stress Disorder ...........................26
ix
Summary ................................................................................................................29
3. METHODS ..................................................................................................................31
Setting and Participants..........................................................................................31
Data Collection ......................................................................................................33
Data Analysis .........................................................................................................34
4. FINDINGS ...................................................................................................................36
Descriptive Characteristics of Participants ............................................................36
Experiences of the College Wives of Combat War Veterans with PTSD .............39
Summary ................................................................................................................52
5. SUMMARY, DISCUSSION, AND RECOMMENDATIONS ...................................54
Summary and Discussion .......................................................................................54
Recommendations for Practice ..............................................................................58
Implications for Future Research ...........................................................................61
Conclusion .............................................................................................................62
Appendix A. Consent to Participate in Research ...............................................................64
Appendix B. Interview Questions ......................................................................................66
Appendix C. Demographic Questionnaire .........................................................................67
References ..........................................................................................................................69
x
LIST OF TABLES
Tables
Page
1.
Descriptive Characteristics of Participants ............................................................37
2.
Individual Participant Symptoms Associated with Stress and Anxiety .................38
xi
1
Chapter 1
INTRODUCTION
Over the past several decades, increasing concern has been raised regarding the
mental health of wives of combat veterans with Post-Traumatic Stress Disorder (Solomon
& Mikulincer, 2006). With a rate of 15-40% of all war veterans experiencing symptoms
of PTSD (Solomon, 1993), the impact of PTSD symptoms that may become manifested
in spouses of war veterans through secondary traumatization and caregiver burden should
be thoroughly examined. Symptoms of PTSD fall into two broad categories: emotional
numbing and hyper-arousal. Emotional numbing includes symptoms of detachment,
withdrawal, loss of interest in previously enjoyed activities, and restricted affect (Riggs,
Byrne, Weathers, & Litz, 1998). Hyper-arousal symptoms include irritability, lack of
concentration, and heightened hostility, making it difficult for many veterans with PTSD
to control aggression (Kotler et al., 2000). Wives of combat veterans with PTSD may
manifest their husbands’ traumatization and above-mentioned symptoms of PTSD (Dekel
& Solomon, 2006a). Although the wives did not directly experience the traumatic event,
they may indirectly suffer from the psychological consequences of their husbands’ PTSD.
Symptoms may include intrusive imagery, anxiety, depression, inability to concentrate,
and social withdrawal (Dekel, Solomon, & Bleich, 2005). This type of transference is
primary known as secondary traumatization, but is also known as compassion stress,
secondary victimization, and compassion fatigue (Figley, 1983).
2
Wives of veterans whose husbands are rated permanently and totally disabled
from service-connected causes are entitled to receive Survivors’ and Dependents’
Educational Assistance Program (DEA) benefits (Department of Veterans Affairs, 2009),
which provide the opportunity to receive up to 45 months of education, including degree
and certificate programs. These educational benefits allow wives to increase household
income, while obtaining an education in order to pursue gainful employment in the
future. This is a valuable resource since veterans diagnosed with PTSD may be 10 times
more likely to be unable to sustain employment than their counterparts who do not have
PTSD. Veterans without PTSD have the potential to earn 22% more per hour than
veterans who suffer from PTSD (Fairbank, Ebert, & Zarkin, 1999).
While research on secondary traumatization, caregiver burden, and symptoms of
PTSD is available outlining the possible hardships wives of war veterans with PTSD may
face in their daily lives, there is not as yet a similar body of research focusing on these
wives as students in college and the specific needs they may have due to having a spouse
with PTSD and be at risk for secondary traumatization and caregiver burden. The
purpose of this study is to explore the experiences of wives of war veterans with PTSD
who are primary caregivers while working toward a college degree and to examine the
types of services that may help facilitate the achievement of their educational goals while
attending college.
3
Background of the Problem
Wives of combat war veterans with PTSD who are attending college may find
their educational needs and supports vary from their peers due to their active roles as both
caregivers and students (Price & Stevens, 2009). Researchers have given little attention
to the wives of combat veterans regarding their educational and psychological needs or
the emotional effects of secondary traumatization and caregiving on their educational and
career goals. Research shows that 35% of all deployed soldiers who serve overseas in
combat situations will develop PTSD (Rosen et al., 2004). Symptoms of PTSD may
occur once a person has experienced or witnessed a trauma or a life-threatening event,
such as combat situations or being wounded (Vasterling, Brailey, Constans, & Sutker,
1998). Symptoms of PTSD may be conceptualized in three broad categories: (a)
increased arousal, (b) re-experiencing phenomena, and (c) avoidance behavior and
numbing of general responsiveness (American Psychiatric Association [APA], 2000).
Military war veterans are groups shown to be highly susceptible to having symptoms of
PTSD due to their high rate of exposure to traumatic events in combat. Soldiers have a
greater chance of developing PTSD than they have of being fired upon, killed, or
physically injured, “thus it has been argued that PTSD presents the greatest health risk
that soldiers face on tours of duty” (McLean, 2006, p. 1).
Many symptoms of PTSD such as rage, substance abuse, aggressive behavior, and
social problems may undermine an individual's ability to maintain intimate relationships
(Herman, 1997; Wilson, 2004). Veterans with PTSD are shown to be more likely to
4
report impaired relationship functioning and “are twice as likely as their non-PTSD
counterparts to have been divorced” (Riggs et al., 1998, p. 88). Due to the unique
relationship between the veterans with PTSD and their wives, increasing concern has
been raised concerning the mental health of the wives; the possibility of transference of
PTSD symptoms from their husbands, also known as secondary traumatization, is greater
(Figley, 1983). Nevertheless, current therapeutic interventions for combat veterans with
PTSD often neglect to include family members and fail to cover issues related to distress
in the home and family (Calhoun, Beckham, & Bosworth, 2002). As a consequence, the
wives often do not get services for challenges that they face, including secondary
traumatization.
Sherman, Sautter, Jackson, Lyons, and Han (2006) found that many veterans
receiving outpatient therapy for PTSD had spouses who also expressed a strong desire to
receive individual and family interventions. Yet, only 28% of the spouses reported they
had received any mental health treatment in the previous year. In the educational arena,
veterans diagnosed with PTSD may be eligible for accommodations depending on their
specific needs such as: (a) note takers, (b) extra time on tests and assignments, (c)
tutoring, and (d) quiet places to complete tests. In addition, a growing trend on many
campuses is the creation of school-sponsored veterans’ clubs where veterans may obtain
peer support and guidance. As PTSD symptoms manifest in the wives of veterans, the
wives too may benefit from types of therapy and educational accommodations similar to
those offered to their husbands. By studying the experiences and educational challenges
5
of wives of combat veterans with PTSD who are attending college, recommendations can
be made for the necessary services to be developed to help wives obtain their educational
goals and possibly enhance the income potential for their household.
Purpose of the Research
The purpose of this research was to examine and provide detailed insight into the
subjective experiences of wives attending college and married to combat war veterans
with PTSD. By surveying and recounting the stories of the spouses, the hope was to
bring attention to the educational challenges wives of veterans with PTSD may face so
needs may be clarified and services developed if found necessary. The research question
guiding this study was: What are the educational experiences and challenges spouses of
veterans with PTSD have attending college? Secondary questions addressed within this
study included: What did the spouses identify as different, if anything, in terms of their
own college experience compared to that of other students? What may be helpful
supports and services on campus for them and other spouses of combat war veterans who
attend college?
Research Theoretical Framework
The research theoretical approach for this study was based on the qualitative
research paradigm. The research did not begin with a hypothesis, but rather began with
an area of study, allowing what is important to that area of study to emerge from the data
sources (Strauss & Corbin, 1990). In the current study, individual exploratory interviews
to obtain information about the participants’ experiences were conducted with no prior
6
theory guiding the researcher. Data were analyzed using the grounded theory method, an
approach for the inductive generation and verification of hypotheses from empirical data
(Strauss & Corbin, 1990). There was continuous interaction between the collection of
and coding of data, which took place as the researcher wrote ideas about codes,
interrelations, and new directions of research (Lonkila, 1995). Based on this inductive
analysis, multiple particular instances were combined into a larger whole in order to
generate themes about the participants’ experiences as they related to PTSD and their
educational goals (Chinn & Kramer, 1991).
Definition of Terms
Academic Accommodation
Any academic accommodation services offered at a higher education institution
and fulfilling a requirement to provide support services to students with disabilities.
Colleges and universities define and follow their own eligibility models as well as state
and federal mandates. Examples of students who may receive academic accommodations
are students with learning disabilities and individuals with PTSD (Job Accommodations
Network, 2010; Neuts, 2011).
Caregiver Burden
The term “caregiver burden” describes the demands that are placed upon spouses
of combat veterans with PTSD and a compounded wound or injury. Caregiver burden is
similar to secondary traumatization, but encompasses difficulties such as financial strain
7
in addition to emotional and physiological symptoms (Dekel, Goldblatt, Keidar,
Solomon, & Polliak, 2005).
Combat War Veteran
This term is used to refer to members of the United States Armed Forces who
were deployed and spent active military time in combat zones of imminent danger,
including qualifying ground and air space. For the current study, this term was used to
refer to combat zones in the countries of Kuwait, Afghanistan, and Iraq (Department of
Defense, 2003)
Major Life Activities
For this study, major life activities are defined as adaptive, functional behaviors,
such as caring for oneself, exercising, good eating habits, sleeping habits, socializing,
going to one’s own doctor and dentist appointments on schedule, maintaining a job,
learning, etc. (National Alliance for Caregiving & United Health Foundation, 2010).
Post-Traumatic Stress Disorder (PTSD)
A condition affecting a person who has experienced a traumatic or lifethreatening event, such as being exposed to combat or being wounded. This condition
may lead a person to developing lasting symptoms, which may be conceptualized in three
broad categories: (a) hyperarousal, (b) intrusions of trauma (flashbacks, nightmares), and
(c) avoidance behavior and numbing of general responsiveness (National Institute of
Mental Health, 2009).
Primary Trauma
8
Primary trauma refers to the specific life-threatening event or wounding
experienced by the veteran him/herself in combat (Klarić, Kvesić, Mandić, Petrov &
Frančišković, 2013).
Secondary Traumatization
The phenomenon and emotional effects of a spouse/caretaker of a combat veteran
with PTSD developing their own traumatic symptoms. Symptoms may include intrusive
imagery, anxiety, depression, inability to concentrate, social withdrawal, irritability, and
various somatic complaints including headaches, sleep difficulties, fatigue, heart
palpitations, and gastrointestinal distress (Dutton & Rubinstein, 1995; McLean, 2006).
Survivors and Dependents Educational Benefits (Chapter 35 Benefits)
Spouse of veterans who are rated permanently and totally disabled from serviceconnected causes are entitled to receive Survivors’ and Dependents’ Educational
Assistance Program (DEA) benefits. These benefits provide the opportunity for spouses
to receive up to 45 months of education, including degree and certificate programs
(Department of Veterans Affairs, 2009).
Traumatic Brain Injury (TBI)
Brain injury caused by an “external mechanical force such as a blow to the head,
concussive forces, acceleration-deceleration forces, or a projectile missile such as a
bullet” (Rusk Institute of Rehabilitation Medicine, 2010, p. 1). Symptoms of traumatic
brain injury may be severe, moderate, or mild depending on the extent of the damage
done to the brain.
9
Assumptions
The following assumptions were made by the researcher in this study. The
researcher involved in the collection of data (i.e., conducting interviews) would follow
the methods selected for this study with fidelity. The data collected and analyzed would
be valid and indicate the participants’ views and opinions. Another assumption was that
the researcher, who is a wife of a Vietnam veteran diagnosed with PTSD, would actively
recognize throughout the research study how her biases may have impacted the research
and consciously take steps to avoid biases impacting data collection and analysis
processes. It was assumed the participants would speak openly and honestly regarding
their experiences, and their interview answers would be the truth.
Justifications
There are a few key studies surrounding secondary traumatization of wives of
veterans, the effects PTSD has on their relationships with their husbands, the various
psychological effects that occur for the wives, and the phenomenon of caregiver burden
(Calhoun et al., 2002; Price & Stevens, 2009; Riggs et al., 1998; Solomon, Waysman,
Avitzur, & Enoch, 1991). However, this researcher found that there are no available
studies examining the experiences of wives of veterans with PTSD who are students,
including the challenges of secondary traumatization. The current study explored the
need for any services to aid wives of veterans so they may succeed in college.
The outcomes of this study and future application of research results may help
identify ways to successfully support spouses of traumatized war veterans in their pursuit
10
of a college education. This study was intended to show the specific needs of wives as
well as assist in the design of programs that may help these at-risk individuals and
prevent the implementation of non-evidenced-based interventions by practitioners
working with the spouses and families of traumatized veterans.
Limitations
This study examined the possible challenges that wives of veterans with PTSD
may encounter while attending college. This study examined qualitative narratives of six
students attending only one university in Sacramento, California. The sample size was
limited, as was the ability to make general statements or program advisements for every
university and for every wife of a veteran with PTSD who is a student. The time frame
for the study was also limited in that interviews took place over a period of six weeks and
not throughout the participants’ whole college experiences. Finally, the researcher’s
experiences as a wife of a veteran (who was wounded in Vietnam and is 100% disabled)
may have also impacted the assumptions and views. However, steps were taken to
decrease the influence of any biases and to ensure credibility in data collection, analyses,
and interpretation of findings, including a review of interview data transcripts, analysis
matrices and emerging themes by a professional expert on the topic of PTSD and
secondary traumatization. Despite these limitations, the findings of this study may be
applicable to other universities and other students who are caregivers and who have
similar experiences.
11
Organization of the Remainder of the Thesis
The remainder of the thesis is organized as follows. Chapter 2 examines the
literature, and research pertinent to the focus of this study. In particular, the literature
review explores the concepts and prevalence of secondary traumatization and caregiver
burden, as it relates to the influences it has on major life activities, including the pursuit
of a higher education. Additionally, this chapter reviews interventions to assist
caregivers, and college students diagnosed with PTSD. Chapter 3 discusses the methods
of the study, including the setting, participants, data collection procedures, and the data
analysis process. Chapter 4 presents the findings of the study, including themes that
emerged from the data. Chapter 5 includes a summary and discussion of results in light
of current research, as well as implications for future practice and research.
12
Chapter 2
LITERATURE REVIEW
This literature review explores the concepts of secondary traumatization and
caregiver burden; prevalence of secondary traumatization and caregiver burden among
wives of veterans; impact of secondary traumatization and caregiver burden on major life
activities; interventions for caregivers and major life activities, including pursuing higher
education and intervention for students with PTSD, which might be applicable to students
who are spouses of veterans with PTSD.
Secondary Traumatization and Caregiver Burden
Secondary traumatization is a term used to describe symptoms resembling PTSD
as a result of a person’s exposure to knowledge of a traumatic event experienced by a
significant other or family member with PTSD and of stress due to wanting to help the
traumatized person (Figley, 1995; Frančišković et al., 2007; Verbosky & Ryan, 1988).
As a result of this exposure, chronic stress symptoms may develop in those close to the
primary traumatized person. Studies on the effects of secondary traumatization have
shown an emotional and physical toll placed on wives of veterans with PTSD and that
these women are at higher risk for developing psychological distress and anxiety, which
are symptoms of secondary traumatization (Dekel & Solomon, 2006b; Dirkzwager,
Bramsen, Ader, & Van der Ploeg, 2005; Galovski & Lyons 2004; Nelson & Wright
1996).
13
Figley (2005) stated, “The secondary effects of war on the family are widely
acknowledged, but rarely studied” (p. 227). Indeed, there is comparatively little research
on secondary traumatization compared to research available on PTSD (Arvay, 2001).
Nevertheless, data and research do validate the concept that those working with or closely
involved with someone who has PTSD may develop and demonstrate trauma-like
symptomology (Figley, 1995; McCann & Pearlman, 1990; Pearlman & Saakvitine,
1995). Wives in particular are at higher risk of developing secondary traumatization
stress due to the close and emotional nature of the spousal relationship (Figley, 1995). In
a study conducted by Solomon et al. (1992), there was a positive correlation between the
psychiatric symptoms the wives were experiencing and the symptoms of PTSD
experienced by their husbands. Specifically, the wives of veteran husbands diagnosed
with PTSD had greater somatization, depression, anxiety, loneliness, and hostility than
wives of veteran husbands who did not have PTSD. Dekel, Goldblatt, Keidar, Solomon,
and Polliack (2005) examined the experiences of nine wives of Israeli veterans with
PTSD. These wives began to experience symptoms similar to those of their husbands.
Other studies have also indicated that the severity of the husbands’ PTSD correlates to
the wives’ higher rates of distress, both psychological and marital (Goff & Smith, 2001;
Solomon et al., 1991).
In addition to secondary traumatization, wives of veterans with PTSD may have
caregiver burden. Caregiver burden is described by subjective (i.e., emotional) and
objective (i.e., being the primary caregiver, being a childcare provider, being responsible
14
for household chores and bills, etc.) responsibilities placed upon the wives. As
caregivers, the wives of veterans with disabilities may often manage the household
finances, do all the chores, shop for clothing and groceries, prepare meals, and provide
transportation. These wives may also help the veteran with activities of daily living,
which may include, but are not limited to, feeding, bathing, dressing, and administering
medicine. In short, due to the demands of caring for their husbands with PTSD and other
family members (e.g., children), these wives may exhibit signs of stress, depression,
anxiety, and isolation (Bell, 2003; Ben Arzi, Solomon, & Dekel, 2000; Dutton &
Rubinstein, 1995; Koić, Frančišković, Mužinić-Masle, Đorđević, & Vondraček, 2002).
While a spouse may have caregiver burden, she may not have secondary
traumatic stress. However, she is more likely to exhibit symptoms of secondary
traumatization if she is the primary caregiver (McCann & Pearlman, 1990; Talbot,
Manton, & Dunn, 1992). On the other hand, individuals may have symptoms of
secondary traumatization without caregiver burden, particularly if she does not have to
care full-time for the person with PTSD. Individuals who may have secondary
traumatization without caregiver burden include hospital personnel working with
HIV/AIDS patients and those working in pediatric and neonatal intensive units
(Alexander & Atcheson, 1998; Crothers, 1995; Gabriel, 1994; Garrett, 1999; Lyon, 1993;
Peebles-Klieger 2000).
A few studies have been conducted on caregiver burden in relation to wives of
veterans with PTSD (Beckham, Lytle, & Feldman, 1996; Calhoun et al., 2002; Dekel et
15
al., 2005). In particular, research studies have explored the correlation between the
severity of a veteran’s PTSD and caregiver burden symptoms experienced by the spouse.
A study conducted by Beckham et al. (1996) examined the effects of caregiver burden on
58 wives of Vietnam veterans diagnosed with PTSD. The results of their study indicated
the anxiety and psychological distress that the wives experienced were related to the
severity of the veterans’ PTSD. Moreover, the findings revealed that the PTSD severity
was uniquely associated with the caregiver burden that the wives experienced. In other
words, the more severe the PTSD of the veteran, the greater burden and poorer
psychological adjustment was experienced by the wife.
In another study, Calhoun et al. (2002) also researched caregiver burden and
psychological distress among partners of Vietnam War veterans. The study was
comprised of 71 married male Vietnam War combat veterans seeking help for PTSD.
This study had two parts and phase two of the study consisted of an assessment of the
male veterans’ partners. The partners were asked to complete the Burden Interview (BI)
(Zarit, Reever, & Bach-Peterson, 1980), which consisted of 22 measured items assessing
the level of objective and subjective burden experienced by the primary caregivers. The
partners also completed the Symptom Checklist-90-Revised (SCL-90-R) (Derogatis,
1994, 1997), which evaluated psychological disorders and symptoms. Findings revealed
that partners of veterans with chronic PTSD experienced greater burden, anxiety,
depression and hostility than partners of veterans without PTSD. The authors also noted
an association between the severity of PTSD and caregiver burden (Calhoun et al., 2002).
16
In a study conducted by Manguno-Mire et al. (2007), 89 wives of veterans in
outpatient PTSD treatment were interviewed over the telephone. The study used the
PTSD CheckList-Military Version (PCL-M) (Weathers, Litz, Herman, Huska, & Keane,
1993), a 17-item self-report scale that provides an estimated of PTSD severity using a 5point scale and the Burden Interview (BI) (Zarit et al., 1980), a 22-item self-report
inventory also with a 5-point scale to measure subjective and objective caregiver burden.
The findings of the study demonstrated that the scores of all 89 wives of veterans with
PTSD exceeded the 90th percentile in terms of psychological distress experienced.
Approximately 15% of the wives also experienced severe levels of depression and
suicidal ideation that warranted clinical attention. The findings of the study also
indicated that high levels of partner burden (i.e., caregiver burden) were experienced by
the wives of veterans with PTSD, with a positive correlation between the severity of the
veterans’ PTSD and the degree of caregiver burden and psychological distress. These
findings corroborated the results from the studies by Beckham et al. (1996) and Calhoun
et al. (2002).
Prevalence of Secondary Traumatization and Caregiver Burden
To place the prevalence of secondary traumatization and caregiver burden of
wives of veterans into context, one first needs to consider the prevalence of PTSD in
veterans. According to the Department of Veterans Affairs (2009), 134,000 veterans of
the Iraq War and the Afghanistan War were diagnosed with PTSD. In another study
conducted by Atkinson, Guetz, and Wein (2009), the researchers found that
17
approximately 35% of all veterans have PTSD. Moreover, for soldiers with repeated
deployments, the prevalence of PTSD was 40% (Atkinson et al., 2009). In addition, the
incidence of Traumatic Brain Injury (TBI) in veterans has risen from 12% during the
Vietnam War to approximately 22% during the conflicts in Afghanistan and Iraq due to
motor vehicle accidents, gunshot wounds, and blasts from explosives (Department of
Defense and Veteran’s Brain Injury Center, 2003). This is significant because veterans
with TBI also may develop symptoms similar to PTSD, such as depression, being quick
to anger, anxiety, fear, feeling nervous, and personality changes (Defense Centers of
Excellence for Psychological Health and Traumatic Brian Injury, 2012).
Authors, Klarić, Kvesić, Mandić, Petrov and Frančišković (2013), stated that in
the past, research has been geared toward the direct trauma survivors and not the victim’s
family and professional caregivers. However, clinicians are just starting to explore how
an individual's traumatic stress can affect the family in a systemic way, how family
members cope within the family dynamics, and how living with a person that has PTSD
has the potential to be transferred to subsequent generations (Klarić et al., 2013).
Consequently, there is limited empirical research on the prevalence of secondary
traumatization on the wives of veterans with PTSD.
Frančišković et al. (2007) conducted a study to determine the prevalence of
secondary traumatic stress on wives of veterans with PTSD who served in the Croatian
War, 1991-1995. The participants for the study were 56 wives of veterans with PTSD.
The results of the study were that 13 of the wives had 11 or more symptoms of secondary
18
traumatization, 19 of the wives had between 6 and 10 symptoms, 21 of the wives had up
to five symptoms, and only 3 of the 56 had none of the symptoms. The authors also
noted that 37 of the wives felt they needed professional help; however, only four of the
wives sought help. Of the 56 participants, 22 met the standard for PTSD, 31 of the wives
reported having periods of rage and annoyance, 35 wives had avoidance of thoughts and
feelings, and 40 wives experienced emotional disturbance.
A recent study conducted by the National Alliance for Caregiving and the United
Health Foundation (2005) compared the experiences, health problems, and subjective
well-being of 1,307 caregivers from the general population and 462 caregivers of
veterans with disabilities. Findings showed that 96% of caregivers of veterans were
women, and that 65% of the 462 caregivers of veterans with disabilities experienced
caregiver burden compared to 31% of the general population of caregivers who
experienced caregiver burden. The results of this report found that a caregiver
experienced 72% higher stress if the veteran with disabilities was under the age of 65,
compared to that experienced by a caregiver to an older veteran with disabilities
(National Alliance for Caregiving and the United Health Foundation, 2010). The data
also showed that 70% of caregivers to veterans experienced depression or anxiety
compared to 28% of caregivers among the general population (National Alliance for
Caregiving and the United Health Foundation, 2010). Additional findings of this study
will be discussed within the following section on Impact on Major Life Activities.
19
Some contributing factors that may add to the stress of caregivers of veterans with
disabilities are whether the veteran has PTSD, depression or anxiety and TBI (American
Association of Retired Persons [AARP], 2009; National Alliance for Caregiving and
United Health Foundation, 2010). Clearly, research data indicate the wives of veterans
with PTSD appear to experience more caregiver burden and poorer psychological
adjustment than caregivers of veterans without PTSD and caregivers in general (Calhoun
et al., 2002).
Impact on Major Life Activities
As previously discussed, wives who are sole caregivers for their husbands who
are veterans with disabilities have reported an increase in stress and anxiety (Dirkzwager
et al., 2005; National Alliance for Caregiving and United Health Foundation, 2010; Price
& Stevens, 2009). Research has also explored the impact of PTSD, secondary
traumatization, and caregiver burden on major life actives and relationships, such as
sleeping, exercising, healthy eating, health issues, and marital distress. In a study
conducted by Hayes et al. (2010), seven women participated in focus group interviews.
All, but one of the women were married to an Operation Enduring Freedom/Operation
Iraqi Freedom (OEF/OIF) veteran; however, for the purpose of this study all women were
referred to as spouses. The mean age of the women was 29.7 years, three of the
participants had children at home, and four of the spouses worked full-time. The
emerging themes of this study were: burden, health status/mental health, alcohol and
20
substance abuse, marital satisfaction, conflict (marital and parental), role discrepancy,
and self-efficacy and social support (Hayes et al., 2010).
Under the theme of burden, the study showed that military families affected by
PTSD experienced financial burden, distress, and severe strain on their marriage due to
the constant diffusing of situations that may become potential crises. The research
showed that working outside the home and taking care of the home, children, and the
veteran were very difficult, thus creating a significant strain on the spouse (Hayes et al.,
2010). The results indicated that caregiving affected the spouses’ mental and physical
well-being and that the spouses had sought counseling and medications for depression
and/or anxiety. In other words, the data showed that the health/mental health of the
spouses were impacted.
Hayes et al., (2010) noted that alcohol and substance abuse was
not reported to be an issue within their family dynamics. However, the spouses did
mention that many husbands will use alcohol, drugs, and medication as a means to cope
with stress.
The results related to martial satisfaction showed that due to all the demands (i.e.,
mother, wife, caregiver) placed upon the spouses, they experienced marital strain and
decreased feelings about their quality of life, along with (caregiver) burden (Hayes et al.,
2010). Within the conflict (marital and parental) theme, the study indicated physical
abuse was not an issue. Nevertheless, the study did show that all participants described
their husbands as explosive and easily angered. The research also showed how role
discrepancy and self-efficacy had changed within their marriages with the spouses taking
21
larger roles in parenting or caregiving to the veteran. Other results within this study
showed how the veteran had lost interest in seeing friends and how he became angry with
the children. Although the participants were committed to their relationship, they did
question whether they would be able to sustain lifelong support for the veteran. Due to
the veterans’ needs, the spouses felt that education on PTSD would be of great help to
them so they could acquire skillsets that could help them deal with their husbands’ needs
(Hayes et al., 2010).
A number of studies have been conducted to examine the prevalence of marital
and family issues surrounding veterans with PTSD and veterans without PTSD. The
research findings reveal that veterans with PTSD have a higher risk of marital discord
and higher rates of divorce, with many having more failed marriages compared to
veterans without PTSD (Jordan et al., 1992; Kulka et al., 1990; Nelson & Wright, 1996;
Renshaw, Rodrigues, & Jones, 2008; Riggs et al., 1998). Solomon, Mikulincer, Freid,
and Wosner (1987) also found a correlation between caregiver burden and marital strain
on the relationship of wives of veterans with PTSD. In another study, Riggs et al. (1998)
examined the quality of intimate relationships of 50 Vietnam veterans and their partners.
The measures that these authors used were the Dyadic Adjustment Scale (DAS), Marital
Status Inventory (MSI), Relationship Problems Scale (RPS), Fear of Intimacy Scale
(FIS), and the PTSD Checklist Military Version (PCL-M). Their findings showed that
couples with a veteran who had PTSD experienced distress in their relationship along
22
with difficulties with intimacy, and some had actually taken steps toward separation or
divorce (Riggs et al., 1998).
Other areas in which the wives of veterans may experience problems are in the
area of self-care, health, nutrition, and exercise, as other non-veteran caregivers have
been found to experience. In a study conducted by Schulz and Beach (1999), elderly
spouse caregivers who experienced high levels of stress had a 63% risk of premature
death compared to non-caregivers of the same age. Also, their health declined as they
felt more caregiver burden. Other studies reported that caregivers experienced sleep
disturbances, fatigue, high blood pressure, cardiovascular disease, increased levels of
insulin, and lower immune functioning (Cannuscio et al., 2009; Franklin, Ames, & King,
1994; Jensen & Given, 1993; Kiecolt-Glaser, Dura, Speicher, Trask, & Glaser, 1991;
Kiecolt-Glaser et al., 2003; Kiecolt-Glaser, Glaser, Gravenstein, Malarkey, & Sheridan,
1996; Kiecolt-Glaser, Marucha, Malarkey, Mercado, & Glaser 1995; Lee, Colditz,
Berkman, & Kawachi, 2003). Burton, Newsom, Schulz, Hirsch, and German (1997)
conducted a study that examined the preventive health behaviors among spousal
caregivers. The results of the study showed that as the demands of caregiving increase, it
was harder for the caregivers to rest, recuperate from illness, remember to take their
medications, and find time to exercise, which compromised the caregiver's own health as
well as the person for whom they were providing care.
As previously mentioned, The National Alliance for Caregiving and United
Health Foundation (2010) conducted a study to explore experiences of caregivers from
23
the general population and caregivers of veterans with disabilities. Part of the results
demonstrated the impact of caregiving for a veteran with disabilities on caregivers’ major
life activities. The study was comprised of 462 self-identified family members, 18 years
or older, who provided caregiving to a veteran who had a military service related injury
or illness, including PTSD and TBI. Findings showed that caregiving for a veteran with
PTSD or TBI places a strain on the entire family and the marriage. Of the 70% of
caregivers with children under 18 years old, 30% reported they spent less time with their
children than they would like. Another finding showed that 57% of the caregivers
reported their children had school and/or emotional problems due to their caregiving.
Furthermore, findings demonstrated that the caregivers had a major change in their life
activities. For instance, caregivers reported a decline in their own health; 88% of
caregivers had an increase of stress or anxiety, and 77% reported sleep deprivation as a
result of caregiving. As many as 58% of these wives reported missing their own medical
appointments, 69% reported they stopped exercising, and 66% replaced healthy eating
habits with unhealthy ones which led them to lose or gain weight. The spouses of the
veterans shared how being a caregiver impacted their employment; 59% of the spouses
with caregiver burden did not have a job, while only 27% of them were employed fulltime and 14% worked part-time. In addition, 47% had to take early retirement or stop
working entirely, and 50% felt a financial hardship due to having to care for a veteran
(National Alliance for Caregiving and the United Health Foundation, 2010).
24
As Senator Dick Durbin (D-IL) (2011) wrote in a letter to Congress on the impact
of caring for a disabled veteran, “Many families are making enormous sacrifices to care
for their loved ones. They are often forced to give up their full-time jobs [and] bear the
cost of home care.” According to the National Alliance on Caregiving (2005), caregivers
to veterans with a disabilityare indeed having to make choices that impact major life
activities. Many caregivers neglect their own health by implementing unhealthy eating
habits, stop exercising and missing their own medical appointments. The National
Alliance for Caregiving and United Health Foundation study (2010), found that 59% of
the caregivers of veterans with caregiver burden do not have a job. Interestingly, there is
no empirical research that focuses on the educational pursuits as caregivers of veterans
with PTSD and the possible challenges they may encounter.
Interventions for Caregivers
While there is research to support the existence of secondary traumatization and
caregiver burden among wives of veterans with PTSD, there has been little research done
on interventions to assist these wives. The information available is related to
interventions for caregivers in general (i.e., caregivers of individuals who have Multiple
Sclerosis or Alzheimer’s disease). For example, respite care (i.e., someone coming into
the home and providing companionship or nursing care) has been found to reduce
depression and improve caregivers’ well-being (Sorenson, Pinquart, & Duberstein, 2002).
In addition, there are interventions that help improve the physical and mental health of
caregivers, such as traditional psychotherapy, individual problem-solving, couples
25
counseling, group counseling, and family counseling (Schulz et al., 2003). A review of
the caregiver intervention literature indicates that successful interventions are flexible and
multi-faceted to meet the unique needs of the caregiver (Kennet, Burgio, & Schulz,
2000).
The National Women's Health Information Center has a list of symptoms under
Caregiver Stress so the wives of veterans with PTSD can educate themselves and thus
take proper steps to reduce their stress (Office of Women’s Health, 2008). The wives
may also become involved in support groups that may encourage disclosure of feelings or
situations the wives may be experiencing in their personal lives (Harris & Fisher, 1985).
In terms of interventions for caregivers pursuing higher education, there is no
available literature. One reason for the lack of research may be that caregiver burden and
secondary traumatization are not recognized as psychological disorders in The Diagnostic
and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5)(APA, 2013) and
therefore, these individuals who experience secondary traumatization are not considered
to have a disability and do not qualify for services. Nevertheless, the co-morbidity
symptomology of depression and anxiety are recognized in the DSM-5, which entitles
students to academic accommodations at the college or university level. In other words,
to receive such assistance, veterans’ wives with caregiver burden or secondary
traumatization would need to get diagnosed with depression and/or anxiety.
26
Interventions for Students with Post Traumatic Stress Disorder
As previously discussed, veterans’ wives with secondary traumatization or
caregiver burden may have the need to pursue higher education and subsequently face
challenges as students. However, no research is available on the efficacy of educational
accommodations or interventions for these wives. It may be useful and relevant to
examine the available research on the educational accommodations for students with
PTSD since symptoms of secondary traumatization mirror those of PTSD. PostTraumatic Stress Disorder is listed in the DSM-5 as a trauma and stressor-related
disorder; therefore, students documented with having PTSD are entitled to equal access
through the legislations of the Americans with Disabilities Act of 1990 (ADA) and
Section 504 of the Rehabilitation Act (Alster, 1997; National Center for Educational
Statistics [NCES], 2010; Trammell, 2003). Students with a psychological trauma such as
PTSD and cognitive difficulties from traumatic brain injury may have educational
difficulties. For example, veterans who acquire a learning disability as a result of a
combat-related injury realize that learning has become a challenge (Burnett & Segoria,
2009; Church, 2009; Grossman, 2009; Madaus, 2009; Madaus, Miller, & Vance, 2009;
Vance & Miller, 2009). Students with PTSD and TBI may not experience the same
degree of severity due to different parts of the brain being injured (Smith-Osborne, 2009).
Just as with a learning disability and psychological disabilities, manifestations may be
different for each student (APA, 2003). Similarly, students with PTSD may exhibit
manifestations to learning and psychological disabilities, which include anxiety, memory
27
deficits, attention and concentration difficulties, depression, and panic attacks (Church,
2009). There is very limited information on how accommodations aid the success of
students with PTSD; yet many of the needs and accommodations are similar to the types
of services students with learning disabilities receive.
A new survey for students living with mental health conditions was conducted by
the National Institute of Mental Illness (NAMI, 2012) titled College Students Speak. The
primary diagnoses of the participants were depression, bipolar disorder, and posttraumatic stress disorder (PTSD). The survey had two objectives. The first objective was
to note if the colleges were meeting the students’ needs. The second objective was
focused on what improvements could benefit the students’ college learning experiences
and retention rates. The survey asked the participants “What might have helped you stay
in school?” The participants responded with seven particular areas of supports and
accommodations they believed would have helped them stay in school. According to the
NAMI survey, 64% of the college students indicated they left school because of their
mental health condition. The participants indicated that on-campus supports such as
accommodations and mental health services would have helped them stay in school. On
the other hand, the participants mentioned they were not aware of these types of services
offered on campus and they did not utilize the services when they were attending college.
Of the participants who left college, 45% did not receive on-campus accommodations,
and 50% of them did not use the on-campus mental health services. Many of the
participants noted that they were unaware of the academic accommodations available to
28
them through their university, noting that these services would have been beneficial to
their success in college.
The following are the accommodations and supports the students felt would have
been helpful:
1. Receiving accommodations, such as tutoring, lower course loads, books on
tape, and help with communicating their needs to professors or online classes
2. Accessing mental health services and supports on campus to help them
address mental health issues impacting their academic performance
3. Earlier connection with mental health providers
4. Availability of peer-run support groups
5. Assistance with medical bills and transportation
6. Managing medication side effects
7. Getting support from family and friends. (NAMI, 2012 p. 8)
As previously mentioned, a student diagnosed with a mental health condition such
as PTSD and/or TBI is entitled to accommodations under the ADA and Section 504;
universities meet this requirement by providing academic accommodations that meet the
reported needs of students based on their individual disabilities. Interventions for
students with PTSD, TBI, and learning disabilities include, but are not limited to: tape
recorded lectures, additional time to complete writing and in-class assignments, extended
exam time, oral rather than written exams, quiet environments for test taking, use of
calculators, scratch paper, dictation software, grammar assistive devices for essay exams,
29
in-class peer note takers, access to professors’ lecture notes or outlines, and tutor
assistance (Brinckerhoff, Shaw, & McGuire, 1992; Madaus et al., 2009; Neuts, 2011;
Vickers, 2010). The above mentioned are some of the strategies that may be useful for
veterans with TBI and PTSD to succeed in college (American Council on Education,
2006).
Wives of veterans with PTSD may also benefit from academic accommodations
in a postsecondary setting since the research has shown that the wives of veterans’ with
PTSD also show manifestations of symptoms of PTSD that can impact cognitive
functioning (Dirkzwager et al., 2005). However, as previously mentioned, there is no
data on the subject of academic accommodations and supports for wives of veterans in a
postsecondary setting.
Summary
In conclusion, studies show that combat veterans with PTSD exhibit
psychological as well as physiological symptoms. The symptoms may lead to veterans’
wives experiencing secondary traumatization. Secondary traumatization may lead to a
sense of greater distress, marital problems, and symptoms of somatization (Alessi, Ray,
Ray, & Stewart, 2001). The wives of veterans with PTSD may also experience a
diminished quality of life due to their husbands’ issues with isolation and emotional
stress (Riggs et al., 1998). The empirical studies reviewed in this chapter, comprised of
different sample groups of veterans and wives, provided further evidence of the existence
of secondary traumatization. While the groups were made up of veterans from different
30
wars, countries, and personal combat experiences, the consistent findings show the wives
of combat veterans with PTSD show higher rates of PTSD-like symptoms than wives
married to veterans without PTSD (Calhoun et al., 2002; Dekel et al., 2005; Jordan et al.,
1992).
Clearly, further research is needed on the impact secondary traumatization has on
the wives of veterans as well as on evidence-based practices that could have positive
effects on the lives of wives of veterans with PTSD. The current study is one effort
toward understanding the challenges that wives of veterans with PTSD face as they
pursue higher education and will hopefully lead to recommendations for possible support
and future research.
31
Chapter 3
METHODS
Setting and Participants
This qualitative study explored the subjective experiences and caregiver burden
on spouses of war veterans with PTSD who are attending college, either as undergraduate
or graduate students. The participants included students at one four-year state public
university in Sacramento, California and the veterans’ college director at this school. At
the time of the study, this university had a population of 15,964 students with ethnic
backgrounds as follows: 384 African American, 689 Asian, 69 Pacific Islander, 264
Native American/Alaskan Native, 14,506 White (including Hispanic) and 626 Other (J.
Weston, personal communication, March 5, 2012). The number of individuals who were
veterans receiving veteran services at this university was 600. The number of individuals
who were dependents of veterans (i.e., spouses and children) who received Chapter 35
benefits was approximately 600.
The primary sample chosen for this study consisted of five female college
students who were at the time of the study attending the university and met the following
criteria: (a) be a spouse of a veteran of the first Gulf War, the Iraq War, or the
Afghanistan War who has been diagnosed with PTSD by the military, (b) be eligible for
Chapter 35 benefits, (c) be enrolled a minimum of six units as an undergraduate or
graduate student, and (d) have completed a minimum of two full semesters at the
university. With the aid of the veterans’ college director for the university, 100 packets
32
were mailed to female spouses already attending the university and receiving Chapter 35
benefits. These packets included the following: (a) an introductory letter (see Appendix
A), (b) consent form (see Appendix A) and (c) self-addressed stamped return envelope.
The individuals who returned the completed packets and fit the criteria were placed into a
pool of possible participants. The researcher received 20 responses from students
interested in participating in this study; however, of those 20 students, only nine met the
criteria to qualify as participants. Of the nine students who qualified for the study, only
four agreed to participate and the other five declined participation after speaking with the
researcher, stating they felt the topic was too difficult to openly speak about with others
and or they did not have the time available to participate.
The researcher also visited a sociology class the veterans’ college director
recommended because a number of veterans and dependents enrolled in it. She presented
her study and answered any questions potential participants may have had. After the
presentation, five students showed interest in the study; however, only one student
qualified for it. The other four did not meet the criteria for the study. For example, one
student wanted to participate in the study because she was the sole caregiver to her father
who was a veteran diagnosed with PTSD. She expressed that juggling school and her
home life were very difficult. Another student whose husband had committed suicide
due to his PTSD was also very interested in becoming a participant because she had
experienced educational challenges as she dealt with her husband’s illness and death.
Ultimately, five women did agree to participate. The study also included an interview
33
with the university’s veterans director who was able to provide insight into the process of
providing educational assistance, such as the enrollment of classes approved for Chapter
35 benefits and aiding in the finding of services (both on-campus and off). This director
also offered observations of student success rates and possible recurring struggles or
issues.
Data Collection
Interview and Descriptive Survey
The five student participants met individually with the researcher for three
approximately one-hour interviews each, held on a bi-weekly basis over a period of six
weeks. The interviews took place on the university campus in a private office. The
veterans’ college director met with the researcher for a one-hour meeting. While actual
interviews varied in length, all participants were required to meet for the allocated
number of interviews required in the design of the study. Each participant signed a
consent form informing her/him of the parameters of the study and the anonymity and
confidentiality policy (see Appendix A). The interviews consisted of open-ended
questions (see Appendix B), which helped to solicit reflections on the students’
experiences and the veterans’ college director’s observations. With participants’
permission, the interviews were tape recorded and transcribed. In addition, the researcher
collected demographic and descriptive information about each student regarding age,
length of marriage, children, and academic and work history through a survey (see
Appendix C). The demographic survey also had a checklist of 15 health-related
34
symptoms. The participants checked off any of the symptoms they had experienced and
the symptoms were tallied in order to see what symptoms the wives were experiencing.
The study emphasized anonymity and confidentiality so all names of participants were
replaced with pseudonyms and any identifying information on interview transcripts,
notes, and other documents were removed. All materials were kept in a locked file
cabinet in the researcher’s home office, accessible by the researcher only.
Data Analysis
Data were analyzed using an inductive approach. All interviews were transcribed
verbatim to help produce the most accurate and complete representation of the interview
content as possible. The researcher listened to each tape to verify accuracy of
transcription. The transcriptions were then used to aid the researcher in the writing of
descriptive summaries of each question answered or statement made by the participants.
This consisted of making matrices to categorize participant responses to questions asked
during the interview process. The researcher highlighted the answers that occurred with
the most frequency. From these matrices, the researcher then created a list of possible
themes based on the collected data, which were compared and contrasted across
participants to develop the final themes. To ensure the quality of the work, the researcher
made her work available to an expert in secondary traumatization for his opinion. This
expert was able to look at the data collected and reviewed the themes with the researcher.
He confirmed the themes that this study identified and stated that those are some of the
issues he encounters when he meets with the veterans and their spouses. In addition, the
35
researcher met with her thesis advisor to review data and also to receive any
recommendations pertaining to the study.
36
Chapter 4
FINDINGS
This qualitative research was conducted for the purpose of gathering the
subjective experiences of wives of veterans with PTSD and the challenges that they faced
as they pursue their goal of higher education. The researcher collected data from the
aforementioned spouses of veterans with PTSD through three approximately one-hour
interviews held bi-weekly over a period of six weeks. Demographic and descriptive
information was collected through a survey regarding age, length of marriage, children,
symptoms of stress and anxiety experienced, and academic and work history. These
surveys were completed prior to the interviews. In addition, the veterans’ college
director was interviewed in an effort to gain insight into the process of providing
educational assistance to the spouses of veterans with PTSD.
Descriptive Characteristics of Participants
The five women who volunteered for the study all qualified under the following
criteria presented in the methodology: (a) spouse of a veteran of the first Gulf War, Iraq
War, or Afghanistan War who was diagnosed with PTSD by the military, (b) eligible for
Chapter 35 benefits, (c) enrolled in a minimum of six units as an undergraduate or
graduate student, and (d) completed a minimum of two full semesters of college at the
university. See Table 1 for personal demographic information.
37
Table 1
Descriptive Characteristics of Participants
Name
Pseudonym
Savannah
Age
Ethnicity
Children
Major
Employment
Years in College
30
Hispanic
Yes, 1
Accounting
None
3
Emily
25
Hispanic
No
Nursing
None
4
Maya
26
European
Yes, 1
Business
None
3
Kari
32
European
Yes, 1
Women’s Studies
None
5
Nicole
36
European
Yes, 2
Nursing
None
3
As part of the demographic survey, participants were asked to complete a
checklist of stress-related symptoms they themselves experienced. The checklist
consisted of 15 symptoms associated with PTSD and secondary traumatization; the
purpose was not for medical or psychological diagnoses, but instead was to be used to
help understand the experiences of the wives. All five wives reported having 10 to 12 of
a possible 15 symptoms and all five participants experienced the following eight
symptoms: anxiety, sadness, low self-esteem, emotional exhaustion, trouble making
decisions, difficulty concentrating, changes in sleep habits, and withdrawing from others.
Each symptom was noted by at least one participant. One participant reported having an
increase in addictions; two reported having anger and changes in eating; three reported
having depression, headaches, or body aches; and four of the participants noted they had
difficulty remembering things and suffered from fatigue (see Table 2).
38
Table 2
Individual Participant Symptoms Associated with Stress and Anxiety
PTSD Symptom
Savannah
Emily
Maya
Kari
Nicole
X
X
X
X
Anger
X
X
Anxiety
X
Depression
X
Sadness
X
X
X
X
X
Low self-esteem
X
X
X
X
X
Emotional exhaustion
X
X
X
X
X
Trouble making decisions
X
X
X
X
X
Difficulty concentrating
X
X
X
X
X
Memory difficulties
X
X
X
X
Fatigue
X
X
X
Headaches/body aches
X
X
X
X
X
Sleep disturbance
X
X
Changes in eating habits
X
X
X
X
Increased addictive behavior
Withdrawal from others
X
X
X
X
Note: “X” Indicates that the participant experiences the symptom.
X
X
39
Experiences of the College Wives of Combat War Veterans with PTSD
Upon completion of the qualitative analysis of the interview data, three themes
emerged regarding the experiences of wives of veterans attending college. The themes
were: (a) the reasons for and influences on participants pursuing higher education, (b)
challenges a caregiver experiences related to school performance, and (c) supports
needed to overcome/meet these challenges. Each of the themes has subcategories and all
the themes and subcategories are discussed, including illustrative quotes from the
participant interviews.
The Reasons for and Influences on Pursuing Higher Education
After careful review of the data, it became apparent there were three subcategories within the theme of influences on the wives of veterans deciding to pursue
higher education and the reasons for them. First, the participants believed that by
attaining higher education, they would have greater financial stability for them and their
family. They also believed they would have better job opportunities if they had a college
degree. Second, all the participants received financial help from Chapter 35, which
allowed them to pursue their educational goals while reducing some financial stress, due
to the monthly stipend they received. Lastly, the wives shared that by being enrolled in
college, they had the opportunity to be around other adults, explore new ideas, and
experience the feelings of empowerment and strength in their personal lives.
Future financial stability. Future financial stability was expressed by the
participants as a primary reason for pursuing higher education. Four out of the five
40
women expressed financial concerns, in particular how their husband’s monthly disability
compensation checks from the Veterans Administration regularly was not enough for
them to financially make it every month. The wives shared that financial strains added to
their daily stresses of caring for their husbands and that the disability compensation
checks did not allow them to just stay home and not worry about their economic future.
All the participants (Kari, Maya, Emily, Nicole, and Savannah) were proactively
pursuing higher education so they may feel more secure about their financial future.
They noted they would be able to gain employment, make a higher income, and become
more financially stable overall once completing college. Savannah summed it up by
sharing:
[The monthly VA compensation] does not increase as much as our real financial
needs increase. We need more income and the best way to insure that we have a
better financial future is for me to get training so that I can get a professional job
in the future.
Availability of Chapter 35 benefits. The participants reported that the financial
help they received in the form of Chapter 35 benefits allowed them to attend college,
which would otherwise not be financially feasible for them at the time of the study.
Chapter 35 benefits provide the wives a monthly stipend for attending college as well as
covering their tuition costs. Chapter 35 permitted the spouses to have one less stress in
regard to how they would pay for school and school-related expenses, thus lifting some
of the financial fear of attending college. Savannah stated that Chapter 35 “really made it
41
possible for me to attend college and cover my tuition and helped pay for my other
college related expenses.” Maya shared how “Chapter 35 motivated me to earn a degree
so that I can get a job and earn a decent wage.”
Strength and empowerment from going to school. During interviews, the
participants expressed how they did not fully relate to their classmates and described
themselves as nontraditional students with unique life experiences due to their selfperceptions of being older than their classmates and their status of being active caregivers
to their husbands. Nevertheless, they shared that they enjoyed being students and that
being students allowed them to learn and prepare themselves for future employment,
which they viewed as a means to gaining greater independence. Furthermore, the
participants shared that while keeping up with their school workload was difficult, they
found being around happy students encouraged them to keep moving forward in their
educational goals. Kari said, “Learning is the best thing for me and learning new things.
I like all of the young people that seem so free, it gives me some hope. Just being able to
do something for me.” Savannah echoed Kari’s sentiment, “Being a student gives me the
opportunity to pursue my goal and work on myself. I am growing as a person and my
self-esteem is improving. I am also doing something for myself.”
In short, the participants felt empowered knowing that when they earned their
college degree they would be more likely to gain employment in their respective fields of
study and have a greater chance of being able to care for their families’ future financial
needs. The participants shared how attending college gave them the strength to do
42
something for themselves and helped empower them to be more self-sufficient and
independent. Emily stated, “I like to know that I can take care of myself to be selfsufficient.” Nicole also shared, “I get to learn something that I like and my career as a
nurse will help give me some job security and good pay in the future.” While school
offers the participants the potential of achieving their goals, it remains difficult for them.
As they have shared, it has been difficult separating their roles as student and caregiver.
Challenges as Caregiver on School Performance
The participants described how being a caregiver to their husbands with PTSD
created a variety of challenges for them. These challenges had an effect on their school
performance due to the participants having to assume greater responsibility for household
tasks as well as caring for the physical and emotional needs of their husbands. Savannah
explained that, due to her husband's demands, anger, and mood swings, completing her
schoolwork was a constant struggle:
My college work is very hard and it is a constant struggle to keep up with my
college studies. My husband is very, very demanding. My husband has constant
anger tantrums and gets very jealous about my college studies. There are times
that I feel that he is trying to sabotage my college program.
Further analysis of interviews revealed the following three subcategories within
the theme of challenges a caregiver experiences related to school performance: isolation,
feelings of anxiety and being overwhelmed, and the need to modify their use of time and
behavior to do school work. The participants shared that being a caregiver has left them
43
with feelings of isolation as well as feelings of being overwhelmed and experiencing
chronic anxiety. Kari summed up her experience of being a caregiver:
Being a caregiver is draining and leaves little time for me to do anything else. He
doesn’t help around the house at all; I mow the grass, take the trash out, do
everything around the house plus school work, and needless to say I am
exhausted. My studies suffer because it is hard for me to focus. There are times I
cry, there are times I scream, there are times I just sit resigned, but I never give
up, I can’t.
Isolation. Participants described how isolation, due to caring for a husband with
a disability, has led to them not being able to participate in extracurricular and social
activities that may enrich their college experiences. Another way isolation affects them
in college is not being able to access services that would help them in their academic
performance (e.g., tutorials, writing center, math centers) and not being able to engage in
study groups. The participants spoke of how different their lives became after their
husbands were disabled with PTSD. Emily noted she would “withdraw from others, you
know I used to go out more and go out to more study groups and then some people don't
understand the situation I'm in and I don’t want to explain it to them.” Emily further
explained that her husband accused her of lying as a way to isolate her from anything not
centered on him, such as friends, family, and school. Additionally, the wives shared that
their husbands expected them to be home with them and only leave the house when
necessary. As Maya explained, “He wants me at home if I don’t have classes.” She also
44
noted her husband would not allow her to leave the house without writing down her
schedule “so that he will know that I will not be home during those times.” As a result,
the participants ignored their own social needs, eventually sacrificing healthy social
interactions and isolating themselves from extracurricular activities and academic services
offered on campus.
Feelings of anxiety and being overwhelmed. Participants disclosed that they
constantly felt an undercurrent of anxiety, whether they were at home or at school. At
school, the participants shared they felt anxiety due to factors such as worrying if their
spouse was upset or had any unmet needs due to their disabilities. For example, Emily
explained:
Even when I was at the hospital as a student nurse I was stressed. I will
sometimes feel like crying. I just think of things that would happen when we are
together. How he will be rude or grumpy or anxious and angry and it makes me
sad. I just wish he wasn't like that, because he didn't used to be like that before.
Likewise, anxiety was present for the participants in their lives outside of school. Emily
stated, “sometimes the anxiety will make me rush into decisions. I can’t sleep and it
causes fatigue and stress.”
The participants further described how their feelings of stress surrounding their
husband’s PTSD had affected their actual schoolwork. Kari shared:
It’s like no experience I've ever had. When I'm at school, I worry about him, and
when I’m home, I'm a basket case thinking about all the homework and studying I
45
need to get done. I barely have words to describe how hard it is. PTSD is a huge
life adjustment.
Kari and Emily stated they had bouts of crying and constant fatigue, which led to their
inability to concentrate on schoolwork. Another way stress affected their academic
performance was because they were unable to spend quality time studying, working on
class assignments or attending study groups. As Emily explained:
Since, now my husband has PTSD, it is more stressful because he will get upset
and be like why are you going to study again! Or, he won’t think I am really
going to study. He thinks I [am] studying to get away, and I will be like “No, I'm
really studying because tomorrow I need to know what I'm studying.” He will
question me and be kind of possessive and I don't know if that is caused by PTSD
or because of him. But, I did notice that he is even like always questioning things
and [saying] “Where are you going?” I think, like... even with him having PTSD
it was harder to concentrate on myself.
Maya expressed how her husband's behavior interferes with her ability to
accomplish certain assignments that may be assigned by instructors, which compounds
her anxiety regarding her schoolwork. Maya shared that her “heart sinks if the instructor
says we need to work in groups because he [her husband] gets so angry if I have to meet
with other students.” Maya also revealed how she was in a continuous state of worry
due to the uncertainties she would face when she returned home:
46
I’m constantly worrying about what mood I am going to encounter when I get
home and what will set him off. I have to replay every conversation I have with
him before I have it so I won’t say anything that I might set him off.
In addition, caring for a spouse with a disability, home responsibilities, and school
demands created feelings of being overwhelmed. The wives found it hard for them to
manage both their home lives and schoolwork, which placed a greater amount of stress
on them. Emily shared, “I will still study, but it is really hard to focus. It will cause me
concern all the time.” It is evident the demands placed on the wives of veterans are
enormous along with the responsibility of being a student which, can create feelings of
being overwhelmed. Savannah mentioned how “It is so stressful to maintain a home and
juggling all of my college courses…I would not wish my experience on anyone, let alone
a person attending college.” Such feelings of being overwhelmed led to wives modifying
their time and behavior to be able to cope with all the demands placed upon them.
Need to modify use of time and behavior to do school work. The participants
noted the veterans’ moods determined how they would schedule their daily activities,
regardless of personal needs. Savannah shared:
I need to stay focused and plan my days, or else my study habits take on the mood
swings that take place in my house. I also get up early every day so that I can
plan out my day and the assignments that need to be completed. It takes so much
detailed planning and energy to stay focused, juggling things are a constant
struggle.
47
The participants also described that they modified their personal behavior in order
to keep peace within the home, stating they had to think about what words and
expressions they used because the spouse may interpret verbal statements and body
language the wrong way, causing an altercation or emotional blow up which would
prevent them from completing their schoolwork.
Furthermore, these women faced the challenges of needing to change their use of
time (i.e., daily plans) and other behavior in order to be a student. Emily related how her
husband’s moods would cause her to modify her studying time so she could avoid
conflicts with him: “I will be like I don't want to study now, because he's going to get
grumpier that I'm not spending more time with him. So I think that it is harder to stay
focused on your studying.” Emily also noted that she felt as if she were “walking on
eggshells,” which makes it hard for her to focus on her school work. “I am always
having to worry about is he okay? Or is it too loud? Or I don't know, just watching some
movies will be like...walking on egg shells because he will be grumpy.”
The participants expressed how living with a person diagnosed with PTSD has
dramatically changed how they live on a daily basis and how they need to modify their
own time and behavior to keep a semblance of stability in their home. They shared how
their husbands’ PTSD had taken away their ability to make individualized decisions in
every aspect of their lives, which included their academic endeavors. These challenges
appear to create a need for specific on and off-campus supports that can address some of
the academic needs.
48
Supports Needed to Overcome and Meet Challenges
Due to the limited knowledge concerning the needs of wives of veterans
diagnosed with PTSD, there are currently few on-campus services available to meet their
educational and personal needs. The participants shared what on-campus supports they
did use and how effective each was for them as students. The participants provided
additional information regarding on-campus supports that they felt were needed to assist
them in accomplishing their educational objectives.
On-campus supports. One of the challenges a wife of a veteran with PTSD
faces when pursuing higher education is that she is a member of a minority group on the
college campus. Jeff, the Director of the Veterans Office at the university, explained this
fact in an interview:
The biggest challenge the [wives of veterans with PTSD] face is that it's a small
select group. So I don't think as a spouse, you always know where to go for help.
I know when I was on active duty, my wife, who was not enlisted, but she had a
huge support network on base. She was always doing things with folks on base
and everybody knew what was going on. Once we left the military, that whole
support system left.
Jeff also shared how the campus VA office has planned workshops that focused on
meeting some of the challenges the wives of veterans with PTSD may face. However, in
spite of all their efforts, they could use new ideas along with resources to handle this
population. Jeff further noted:
49
To do events specifically for spouses. It's sort of in its infancy. It's really the only
things we can point to so far, is we've brought out folks like the Department of
Veterans Affairs to do workshops and awareness type things. For the spouses
themselves we haven’t got great attendance. There's been a few that we've
actually had no one attending. But, I think part of that is we need to do a better
job marketing it and a better job of getting the word out, so there’s a lot of work
to do.
Interestingly, the most commonly used campus resource is not specific to veterans
or their families; rather, it is the campus library. As Savannah stated, “I have had to learn
to get as much of my work done at the campus library. There are just too many
interruptions at home, just too many demands on my time and energy.” Nicole similarly
noted, “One thing that I’ve done is to go to the library between classes and sneak in some
study time.”
When asked how on-campus supports could better aid wives of veterans with
PTSD in their educational endeavors, most interviewees stressed the importance of
faculty members being made aware of what PTSD is and the types of challenges spouses
of veterans may face in an educational setting. Maya expressed the need for having
“training for faculty on PTSD and how it affects the whole family. I would also get a
counselor that understands PTSD and teach the wives how to deal with the veteran’s
emotional outbreaks.” All participants felt that having counselors available on campus
who were knowledgeable on the subject of PTSD would be beneficial. Specifically, they
50
believed counselors could help the wives acknowledge and cope with the challenges of
being a student living with and caring for a veteran diagnosed with PTSD. Since PTSD
has distinctive characteristics and problems, wives may gain tools that could help them
cope with their husbands’ PTSD.
Another idea the participants had for an on-campus support was the creation of a
woman’s group specifically for wives of veterans with PTSD. The students would be
able to connect with other wives of husbands with PTSD, creating a peer support system
on campus. The wives would be able to interact with one another since they may be
experiencing many of the same life challenges. Nicole described it as “a place where
women married to disabled veterans could go sometime during the day to share with each
other.” Maya also indicated the need for an on-campus peer support group where women
could meet with other wives of veterans who may have similar life experiences: “It is
hard to talk to people that don’t understand PTSD and also the shame and guilt we feel
because we stay in relationships that are so emotionally draining.” This support group
could be used to inform how PTSD is affecting the family, to teach coping strategies, and
to create a safe place where they could express themselves freely without feeling guilt or
shame from people unaware of the burden PTSD puts on the family. Kari shared the
need for a place where “I want to be told it's okay to get upset, it's okay to be frustrated
and it's okay to even shed a few tears now and then. Classes on how to deal with all the
emotions that are new to us.” Jeff shared a similar sentiment about the need for a
support network for wives to be able to connect with other wives:
51
I'm sure it would have been easier on my wife [a spouse of a veteran] if she had
that support network to lean on. So, I think the biggest challenge is being able to
connect spouses with one another. To let you know that as the wives of veterans
they are not going at it alone, which I think a lot of the veterans’ wives sometimes
think that they're going through the issues alone.
Off-campus supports. The participants shared that they were very limited with
regard to off-campus supports. The main off-campus supports for many of the
participants consisted of only one or two individuals, most commonly a mother, sister, or
close female friend. Nicole stated, “When I get a chance I can talk to a friend about what
is going on in my life.” Savannah shared that she “has some friends that are married to
veterans that are disabled and they have been my main support system.” Emily
discussed, “I rely on my mom to help. She helps a lot…and my sister also, because she
was in nursing school and she will help me through it and tell me what is normal and
what isn’t normal.” Overall, the participants explained how dramatically their lives had
changed as a result of their husband’s disability, which had made it hard for them to
develop a support network of people with whom they felt comfortable discussing their
problems. As noted by Kari, “I have friends that I call, but sometimes I really just don't
want to try to explain why I feel the way I do; some details are just too harsh to talk
about.” The participants suggested that on-campus supports would enable them to better
cope with the challenges of being a student married to a veteran with PTSD. In fact,
52
these on-campus supports could provide social networks for the wives, which could in
turn strengthen and expand their off-campus support system.
Summary
In summary, this study sought to explore the experiences of wives of veterans
with PTSD as they pursued higher education. Each of the participants had unique, yet
similar experiences. All five of the participants reported having 10-12 symptoms out of
the possible 15 health related item checklist. The symptoms that were experienced by all
participants were: anxiety, sadness, low self-esteem, emotional exhaustion, trouble
making decisions, difficulty concentrating, changes in sleep habits, and withdrawing
from others. Most of the participants voiced that a combination of factors, such as
finances, home life, caregiving, and school, created challenges in their lives. Many of the
participants expressed their motives for pursuing higher education by explaining that
education represented future financial independence for them and their family.
The results of this study also yielded information on the struggles the participants
experienced as a result of being a caregiver to their spouses, specifically feeling isolated,
overwhelmed, and anxious. Furthermore, as a result of being a caregiver, the participants
discussed trying to minimize conflict with their spouses by modifying their time and
behavior, which helped them cope with their conflicting roles as caregivers and students.
Additionally, the participants offered suggestions for on-campus supports. For instance,
it was suggested that having counselors with knowledge of PTSD available to the wives
would be very helpful in enhancing their understanding of PTSD and would also assist
53
them with learning coping strategies. Another suggestion was the establishment of small
groups in which women could interact with other wives going through some of the same
issues. These on-campus supports would help build social networks that could then
become off-campus supports. The women expressed the need to increase off-campus
supports since they tended to be limited to mothers, sisters, and a few friends.
54
Chapter 5
SUMMARY, DISCUSSION, AND RECOMMENDATIONS
The purpose of this qualitative research was to explore the effects educational
challenges and caregiver burden had on wives of war veterans with PTSD and to examine
the types of services that may help facilitate their achievement of educational goals while
attending college. This chapter presents a summary and discussion of the findings along
with recommendations for future research and practice.
Summary and Discussion
Examination of the limited literature of the wives of veterans diagnosed with
PTSD revealed common themes of secondary traumatization, caregiver burden, and
negative impact on major life activities. Yet, there are no research studies that
particularly examine the experiences of these wives as college students and the specific
needs they may have due to having a spouse with PTSD. Therefore, the current
qualitative study sought to gain an understanding of the challenges of having a spouse
who is a veteran diagnosed with PTSD faced by wives who are college students at one
four-year state public university in Sacramento, California.
This study consisted of five wives of veterans diagnosed with PTSD who were
attending the university in the pursuit of higher education. The wives completed a
demographic questionnaire collecting demographic and descriptive information such as
age, length of marriage, children, and academic and work history. The questionnaire also
had a checklist of 15 symptoms associated with PTSD and secondary traumatization,
55
which are related to symptoms of stress and anxiety. All five wives in this study reported
having 10-12 of the symptoms and all the symptoms were noted by all five participants.
In fact, the symptoms of anxiety, sadness, low self-esteem, emotional exhaustion, trouble
making decisions, difficulty concentrating, changes in sleep habits, and withdrawing
from others were experienced by all the wives. The symptoms checklist was not intended
to provide medical advice, diagnoses, or treatment, but was for informational purposes
and to gain insight into the experiences of the wives. The study provided information and
insight into the needs of wives of veterans in their efforts to successfully complete their
education objectives. Upon completing the analysis, three themes emerged: (a) reasons
for and influences on participants pursuing higher education, (b) challenges a caregiver
experiences related to school performance, (c) supports needed to overcome/meet these
challenges. Conclusions from the findings are: (a) higher education will provide greater
financial stability; (b) feelings of stress and anxiety appear to have affected their school
experience and performance, thus the wives needed to learn coping skills to deal with the
challenges of being married to a veteran with PTSD; and (c) there is a need for small
groups for wives where they can meet with other student wives encountering similar
situations.
In this current study, financial burden was noted by participants. Financial
concerns were shared by four of the five participants, in particular how their husband’s
monthly disability compensation checks from the Veterans Administration was not
enough for them to financially make it every month. The wives shared that financial
56
strains added to their daily stresses of caring for their husbands and that the disability
compensation checks did not allow them to just stay home and not worry about their
economic future. However, they discussed they would be able to gain employment, make
a higher income, and become more financially stable overall once completing college.
Similarly, The National Alliance for Caregiving and the United Health Foundation (2010)
found in their study, that of the 462 caregivers of veterans with disabilities, 59% did not
have a job, and experienced financial hardship. It is worth noting that the participants
who sought higher education as a means of attaining financial stability, expressed that
they would not have the opportunity without the availability of Chapter 35 benefits.
Chapter 35 benefits enable dependents of veterans with a disability to enroll in state
colleges at no out-of-pocket expense due to receiving a monetary educational benefit.
The participants in this study also described how being a caregiver for a husband
diagnosed with PTSD created challenges for them due to having to care for the physical
and emotional needs of their husbands as well as assuming the responsibility for all
household activities while pursuing their studies. As previous literature suggested that
wives of veterans with disabilities often assume many household duties, including
managing household finances, doing all the chores, shopping for clothing and groceries,
preparing meals, and providing transportation. These wives may also help the veteran
with activities of daily living, which may include, but are not limited to, feeding, bathing,
dressing, and administering medicine (Bell, 2003; Ben Arzi, Solomon, & Dekel, 2000;
Dutton & Rubinstein, 1995; Koić, Frančišković, Mužinić-Masle, Đorđević, &
57
Vondraček, 2002). The present findings demonstrated that the participants experienced
isolation, anxiety, and feelings of being overwhelmed due to their roles of being
caregivers. Participants disclosed that they had persistent feelings of anxiety, whether
they were at home or at school. These findings are similar to those found by Beckham et
al. (1996) which indicated the wives of veterans with PTSD experienced anxiety and
psychological distress
Impact on major life activities was an additional theme discussed by the
participants, noting that the veterans’ moods determined how they would schedule their
daily activities, regardless of their own personal needs. The participants expressed how
they had dramatically changed how they live and how they have made choices that have
impacted their health including changes in eating and sleeping habits. According to the
National Alliance on Caregiving (2005), many caregivers to veterans neglect their own
health by implementing unhealthy eating habits, missing their own medical appointments
and neglecting to exercise. This finding was also substantiated by Burton, Newsom,
Schulz, Hirsch, and German (1997) who found that as the demands of caregiving
increase, it becomes harder for the caregivers to rest, recuperate from illness, remember
to take their medications, and find time to exercise, which compromised the caregiver's
own health as well as the person for whom they were providing care.
In light of the findings of this study the participants shared that they would like to
have on-campus support groups where they could meet other spouses of veterans with
PTSD who are also students. Lastly, the spouses in this study noted that these support
58
groups could also provide workshops on coping strategies a well as how to become
educated on the effects that PTSD has on them and their family. Nelson and Wright
(1996) similarly suggested, small groups would be beneficial for teaching coping
strategies and educate the spouses about the effects of trauma on individuals and families.
Often, these groups function as self-help support groups for spouses of veterans.
One of the limitations of this study was the sample size. One of the implications
of a small sample size may be that one cannot generalize that every wife married to a
veteran with PTSD will share these same experiences. Another limitation was that the
study was a glimpse into the participants’ educational college experiences; hence, the
interviews took place over a period of six weeks and not throughout the participants’
whole college experiences.
Recommendations for Practice
Based on the findings of this study, the recommendations for practice include the
need for the veterans service center on the university campus to provide education on
PTSD, secondary traumatization and caregiver burden; counseling; small support groups;
and workshops related to acquiring skills that will aid the students with their personal
and/or educational needs. These types of interventions could help reduce the educational
challenges faced by wives of veterans with PTSD. The primary objective is to help the
wives of veterans gain optimum support from the university so as to minimize some of
the educational challenges they may be facing, thus allowing them to accomplish their
educational goals.
59
The wives of veterans with PTSD may be experiencing physical, verbal, or
emotional abuse, which causes stress in their lives, and may eventually cause the wives to
experience secondary traumatization (Figley, 1995; Kulka et al., 1990). By receiving
education and becoming aware of secondary trauma and caregiver burden, the wives may
be able to recognize the symptoms in themselves and others. Education on coping skills
and personal development will equip the wives to better handle stressful situations that
may arise within the home that may affect their school life. Furthermore, the wives
would benefit from counseling and/or therapy from a professional counselor who is
knowledgeable on the subject of PTSD, so effective and efficient interventions may be
learned. It would be an opportunity for the professional counselor to support the wives
and be able to give them positive coping methods. Additional emotional support could
be provided by creating a place on campus where the wives can congregate. Ideally, this
would be a safe place where the wives could meet and join small groups with other wives
who may be facing the same issues. This would allow the wives to meet in a nonjudgmental and accepting atmosphere where they do not have to explain what struggles
they are going through because the other wives would understand. Thus, the wives could
give help to and receive help from one another. Hopefully, the wives would forge
friendships with other wives of veterans outside of campus so they may not feel so
isolated out in the community.
Wives of veterans with PTSD face a variety of challenges within their
relationships and their lives since the wives may have to assume the responsibilities of
60
keeping the household together as well as the demands of schoolwork. As caregivers, the
wives assume greater responsibilities for finances, household tasks, family relationships,
and outside relationships that may be part of their family structure. The wives of veterans
with PTSD could greatly benefit from workshops that help them acquire skills for time
management and financial planning, as well as workshops on how to take care of their
personal or educational needs by setting boundaries that would allow them to accomplish
their goals.
Education on PTSD and how it affects the veteran and the family would enlighten
not only the student, but also the university faculty. Faculty could benefit from
workshops on the topic of PTSD and how it impacts both students diagnosed with PTSD
and students who are the caregivers of veterans with PTSD. These workshops would
teach the faculty on how PTSD is an illness that has many triggers and significantly adds
distress to the individual as well as impairs a person’s social interactions and interferes
with important areas of functioning. The knowledge and insight that the faculty would
gain from these workshops could help them to better assist students that may be in one of
their classes.
One of the limitations of this study was the sample size. One of the implications
of a small sample size may be that one cannot generalize that every wife married to a
veteran with PTSD will share these same experiences. Another limitation was that the
study was a glimpse into the participants’ educational college experiences; hence, the
61
interviews took place over a period of six weeks and not throughout the participants’
whole college experiences.
Implications for Future Research
There are several implications for further research. The current study
demonstrates findings from a very small pool of participants. Therefore, a larger, more
comprehensive study should be conducted to examine how managing all aspects of the
personal needs of a veteran with disabilities along with all other responsibilities and
pressures (e.g., financial stress, time management) may impact a wife’s functioning as a
college student. This study could utilize a survey format with opportunity for participants
to provide short answer responses. In addition, data for this study could be collected
from a larger population of students at public four year universities in California, and
perhaps even at similar universities from other states.
Further research into the effectiveness of on-campus and off-campus supports for
this population of students is also warranted. For example, the findings from this study
indicate the spouses may benefit from participating in small support groups with other
wives of veterans with similar issues. A study could be conducted to investigate the
benefits of belonging to such a small support group. Additional research should examine
the efficacy of workshops on a variety of topics to support spouses to accomplish their
goals, such as time management, financial planning, setting boundaries, how to take care
of their personal and/or educational needs, etc.
62
Conclusion
Clearly, the results of this study offer suggestions for the current university to
establish services that may assist the needs of wives of veterans diagnosed with PTSD
who are pursuing higher education. The findings of this study indicate that the wives of
veterans with PTSD could benefit from on and off campus small groups, workshops on
PTSD from which they may learn coping skills. Other results from this study
demonstrate that the wives need to learn how to take care of themselves in terms of
major life activities as well as to gain knowledge and skills to enhance their learning
experience.
63
APPENDICES
64
APPENDIX A
Consent to Participate in Research
Educational Challenges of Wives of Traumatized Veterans
You are being asked to participate in research which will be conducted by Alma
Mendoza, a graduate student in the Department of Special Education, Rehabilitation,
School of Psychology, and Deaf Studies at California State University, Sacramento. She
is conducting her master’s thesis with faculty sponsorship from Dr. Jean Gonsier-Gerdin.
The purpose of this study is to explore the influences of secondary-traumatization and
caregiver burden on wives of war veterans with post-traumatic stress disorder (PTSD)
and to examine the types of services which may help facilitate wives in achieving their
educational goals while attending college.
As a participant in this study, you will be asked questions during three individual
interview sessions with the researcher. Each session will be approximately one-hour and
sessions will be held on a bi-weekly basis over a period of six weeks. With your
permission, this interview will be tape recorded to allow for future transcription of the
conversation during data analysis. Questions will address your current role as a wife to a
war veteran with PTSD and challenges that may exist and act as barriers to wives of
veterans reaching their educational goals.
The risk that the participants may experience during this research may include:
sadness and/or sense of loss when responding to questions about their experiences as a
wife of a veteran with PTSD. The participant may also experience internal emotional
distress, physical exhaustion, resistance to disclosure, anxiousness, dreading the
discussion, depression, anger and a desire to cry. Please see attach referral list of contacts
and telephone numbers for any who may experience psychological distress.
The study will have an emphasis on anonymity and confidentiality, so that all
names of participants will be replaced with pseudonyms and any identifying information
on interview transcripts, notes and other documents will be removed. All materials will
be kept in a locked file cabinet in the researcher’s home office with access by the
researcher only and will be destroyed on completion of the thesis.
If you have any questions or concerns about this research, you may contact Alma
Mendoza at (916) 316-4994 or via email at chefalma@gmail.com and/or Dr. Jean
Gonsier-Gerdin at (916) 278-4619 or via email at jgonsiergerdin@csus.edu.
By signing below, you indicate your consent to participate in the research
described above. Continued participation is voluntary. During the interview you may skip
or decline to answer any questions that you do not feel comfortable answering. You may
also stop the interview at any time. You may decline to participate in this study without
any consequences. Each participant will receive one $50.00 dollar gift card at the
conclusion of the final interview.
65
The deadline to return this consent form is July 15, 2010.
______________________________________
Signature of Participant
__________________
Date
66
APPENDIX B
Interview Questions
1) What do you enjoy about being a student?
2) Do you have a major and why did you choose it?
3) What are some reasons that have motivated you to attend college?
4) Tell me about your support system on or off campus?
5) Tell me about your study habits?
6) How long ago was your husband diagnosed with PTSD?
7) What type of services do you use on campus?
8) What types of veteran services do you or your husband use?
9) How do you feel your spouse’s diagnosis with PTSD affects your typical day?
10) Do you feel like your spouse’s needs due to being diagnosed with PTSD affect
your study habits?
11) Do you feel like you need more on campus supports as a spouse of a veteran with
PTSD?
12) What are the challenges you feel spouses of veterans might face as students?
13) In what ways do you feel supports or other academic services on campus may
help yourself or other spouses of veterans in their academic careers?
14) How do you cope with being a caregiver, student and spouse?
15) Tell me about your experience as a student married to a veteran with PTSD.
16) If you could create a support system on campus that could meet your needs, what
types of services would you create and why?
17) Compare your previous educational experiences prior to having a spouse with
PTSD to your current educational experiences and how do they compare?
18) What have your experience with chapter 35 benefits been like?
67
APPENDIX C
Demographic Questionnaire
1.) Age:_______
2.) Ethnicity
_______Hispanic
_______African-American
_______European-American (Caucasian)
_______Asian
_______Pacifica Islander
_______Native American
_______other
3.) Current relationship status: _____Married _____Separated
4.) How many children do you have? ______________
5.) Ages of children: _______________________________________
6.) How many years have you attended college?_________
8.) What is your major?______________________
9.) How many units are you currently enrolled in?
10.) Are you currently employed?________________________
11.) How many hours do you work a week?_______________________________
12.) What branch of the military did your husband serve in?___________________
68
13.) Where and when did your husband
serve?_________________________________
14.) When was your husband diagnosed with PTSD?_________________________
15.) Has your husband received counseling or treatment in the past for PTSD?
_____Yes _____No
16.) Is your husband currently receiving counseling or treatment for PTSD?
_____Yes ______No
17.) Have you received any family, group, or individual type counseling in the past in
regards to you husbands diagnosis with PTSD?
_______Self
_______Family _______Group
18.) Are you currently receiving any family, group, or individual type counseling in
regards
to you husbands diagnosis with PTSD?
_______Self
_______Family _______Group
19.) Have you ever experienced any of the following? (Please put a checkmark next to
each symptom you have ever experienced while attending college).
___
___
___
___
___
___
___
___
___
___
___
___
___
___
___
Anger
Anxiety
Depression
Sadness
Low self-esteem
Emotional exhaustion
Trouble making decisions
Difficulty concentrating
Difficulty remembering things
Fatigue
Headaches or body aches
Changes in sleep habits
Changes in eating habits
Increase in addictive behaviors
Withdrawing from others
20.) Would you like to share anything about you that you think is important for me to
Know so that I may understand your experience better.
69
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