Post Deployment on Family Life Literature Review Chapter

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[. . .] Thus, the impact of post-combat mental disorders may extend beyond the lifespan of the afflicted service member to stretch across generations. (Karney, et al., 2008)

Karney et al. (2008) makes recommendations for future research including the following areas:

(10 Address causal relationships. The model proposed here suggests that the experience of a post-combat mental disorder is a cause of negative outcomes for service members, in that they account for the experience of negative outcomes that the service member would not have experienced in the absence of the disorder. The research reviewed in this report is consistent with this position, but the vast majority has not been capable of ruling out alternative interpretations. Most of this research has relied on cross-sectional and retrospective designs, i.e., research participants have been contacted on a single occasion and asked to report on their experience of psychiatric symptoms and their functioning in other life domains. Supporting causal statements about the impact of mental illness will at minimum require longitudinal research, i.e., studies that assess individuals on multiple occasions to determine the temporal ordering of symptoms and outcomes. Longitudinal research that successfully follows service members from pre-deployment, through post-deployment, and into post-service would provide crucial insights into the etiology and consequences of combat-related mental illness. In the absence of such data, the existing research supports conclusions about how mental disorders are associated with subsequent negative outcomes for service members, but not about whether the disorders may be considered causes of those outcomes."

(2) Assessment and diagnosis. Although research on the prevalence of PTSD, depression, and TBI after service in OEF and OIF has relied on only a small number of assessment tools, research on the consequences of these disorders has used a vast array of instruments and strategies. Some research has examined associations between each disorder and outcomes shortly after combat, whereas other research, especially research on veterans of Vietnam, have examined these associations years or even decades after the veterans had their combat experiences. Understanding how mental disorders affect the lives of afflicted service members will require greater attention to how and when these disorders are assessed.

(3) Generalizing across services and components. Research on the implications of mental disorders in veterans of Vietnam rarely specifies the component of the military (i.e., active duty or Reserves) or the service within which the veteran served. Because different segments of the military are likely to have different experiences and have access to different sources of support, careful attention to service and component will be important in future research to understand the mental health implications of OEF and OIF. To inform the future allocation of resources between Reservists and active duty members, research that directly compares the prevalence and consequences of mental disorders across the services and across the components is needed.

(4) Gathering population data. Virtually all of the data on the implications of post-combat mental disorders come from treatment, clinical, and help-seeking samples. Because those who seek treatment are likely to differ from those who do not, these samples form an inadequate basis from which to draw conclusions about the military as a whole. Systematic assessments of the entire military population will provide a more accurate sense of the distribution of post-combat mental disorders and their consequences, and thus a more accurate view of the true costs of the current conflicts." (Karney, et al., 2008)

Recommendations stated by Karney et al. (2008) for policy and intervention include the following:

(1) Facilitate service members seeking and receiving treatment.

(2) Early interventions are likely to pay long-term dividends.

(3) Policies that promote resilience may be as effective as programs that target the symptoms of mental disorders directly. (Karney, et al., 2008)

The work of Finley, Pugh, and Jeffreys (2010) entitled "Talking, Love, Time: Two Case Studies of Post-Deployment Coping in Military Families states that the question of how "… how individuals engage in coping has gained increasing notice over the past decade." The study reported by Finley, Pugh and Jeffreys (2010) is of the nature that conducts an in-depth study of two couples who have experienced extended deployment. The post=deployment challenges of: (1) Derek and Laticia; and (2) Josh and Laurie are examined. Derek is a disabled veteran and college students who was a communications specialist in the Army before he was wounded in Iraq resulting in his leg being amputated and in him receiving an early discharge. Derek and his wife are African-American and have two sons, by Laticia's previous marriage. Josh is a former marine who was wounded in Iraq and suffered a traumatic brain injury. He is also attending college. Josh and Laurie's son is an infant. Josh and Laurie are both Euro-American. The amount of communication between family members was stated to vary during the deployments of both Josh and Derek and there was very little communication through email or telephone. Laticia dealt with Derek's deployment through taking a heavy coarse load and Derek was going out on patrol each day with Laticia watching the kids and studying for her tests. Derek had not been honest with Laticia about his assignment and she was shocked when she got the call that his leg had been amputated. It is reported that Josh:

"… articulated the challenge of reconciling such a chasm of unshared experiences when he said of his post-deployment relationship with Laurie that, "It's hard to live with another person again after a [deployment], because you've had six months of different experiences. After being away for so long, each person has their own expectations of what the other is going to be like." (Finley, Pugh, and Jeffreys, 2010)

There is noted in the study that while Josh found everything at home somewhat recognizable, for Laurie, the alterations in Josh were "dramatic enough to reshape their relationship entirely. It is common for family members to find their service member has been changed by his or her experience of deployment. Laurie said that after the first of two deployments, Josh was, "Just different." (Finley, Pugh, and Jeffreys, 2010 ) The different noted that rather than being the one who wanted to get things done that Josh just wanted to sleep when he got home. According to Laurie the couple almost switched roles. This is not unusual according to Finley, Pugh, and Jeffreys who states that "…both the personal changes wrought by combat deployment and the necessity for family members of functioning without the service member can create a situation in which it is necessary to reconsider pre-deployment patterns of behavior and responsibility. Prior to his first deployment, it had been Josh's role to calm Laurie down when she became anxious over worries or household tasks. Now they reversed roles. They found themselves, as Josh described, in a period of "getting to know each other again," sorting through each partner's "expectations of what the other is going to be like." (Finley, Pugh, and Jeffreys, 2010 ) Finley, Pugh, and Jeffreys relate that Derek spent four months living in an outpatient house on base. Derek states that Laticia's biggest complaint was that "…for a long time I was extra clingy. I wanted her by my side at all times. I had missed her for eight months. I had gone through being blown up three times in one day, any day can be the last one. So I was already mentally trying to figure out that I might never see her again. And then being in an explosion and getting injured myself, and seeing that I was still here and feeling like it was on borrowed time...and it drove her nuts." (Finley, Pugh, and Jeffreys, 2010 ) Laticia states that Derek was very clingy and this coming from a man who had formerly been independent and self-sufficient was hard to adjust to for Laticia.

When Josh was redeployed he got caught in an explosion and sustained a significant Traumatic Brain Injury (TB) and the consequences have included the following:

"Long-term memory is dicey. Speech is dicey. There are times, especially if I get emotional, that I have to search for words. I hesitate. I stumble. Hearing's screwed up. I can technically hear perfectly, but there's something where it gets jumbled in my brain and I can't figure it out, or I just don't hear it. Other problems like balance." He is unable to drive at night because he has a hard time judging distances and lacks concentration. He cannot pay bills because he forgets them. He says, with some bitterness, "The most I can do is to play with my son, and that's about it." (Finley, Pugh, and Jeffreys, 2010)

The outcome is that Laurie is saddled with the responsibilities that Josh cannot fulfill and this is in addition to "overseeing his frequent medical appointments and the paperwork associated with his veterans' disability claims, trying to supplement his disability compensation with a part-time job, watching out for him - with his impaired balance, everything from taking a shower to walking down stairs requires supervision - and caring… [END OF PREVIEW]

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