The servicemen and women who protect our country deserve our admiration and respect for their courage and sacrifice. Fully appreciating their degree of commitment means not only understanding the risks and struggles of soldiers on the battlefield, but also the stress experienced by military families, who often endure tremendous hardship when their loved ones are deployed. More, the stress does not necessarily end when troops return home. Reintegration into society can bring physical and mental health problems, as well as difficulties with finances and employment, placing severe strain on families. It is wrong for us to ask our service members to risk their lives for our freedom without properly considering all of the costs involved with that privilege, and what we as a nation can do to support our troops and their families.
To be sure, there is a long history of research demonstrating that military families adjust quite well to the stress of war. Military children appear to function as well or better than civilian children on many indices of well-being, including lower rates of mental disorders and juvenile delinquency, as well as good peer relationships and self-esteem. Further, recent evidence suggests that divorce rates in military families are comparable to or even lower than rates for civilian marriages. These findings are a testimony to the strength of military families.
However, soldiers are now being deployed and redeployed at record rates, further depriving families of the joy of spending time with their loved ones, increasing the loss of the emotional and functional support of having a family member at home, and exacerbating the reality of loved ones possibly never returning home. And this increased strain has health consequences. One study examining mental health in a sample of 250,626 Army wives found that wives with a deployed spouse reported higher rates of depressive (18 - 24 percent) and anxiety disorders than those without a deployed spouse. Further, higher rates of mental health issues were associated with longer deployments (more than 11 months).
But the problems that can plague military families do not magically disappear even when a soldier is fortunate enough to return home. To start, returned service members are often re-deployed, which clouds families’ joy on getting their loved ones back. One study of nearly 200 families of active duty Army and Marine Corps personnel shows, for children, anxiety may not go away. A year after parents returned from combat, 30 percent of the children exhibited clinical levels of anxiety. This anxiety often centers around fears of parents being re-deployed. More, many returned veterans face a range of physical and mental health issues, such as traumatic brain injury, depression and post-traumatic stress disorder, that cause suffering and limit functioning. These issues are often compounded by difficulty finding employment and associated financial stress. The dire consequences of the issues facing veterans is captured in the soaring rates of suicide among young veterans.
All of these factors can put a severe strain on families. In the most extreme cases, lengthy deployment results in divorce. One study examined divorce rates among 462,444 enlisted service members who got married while serving in the military between March 1999 and June 2008. Researchers found that couples who married before September 11, 2001 were 28 percent more likely to divorce within three years of marriage if one or both spouses experienced a deployment to Afghanistan or Iraq that lasted at least one year. Further, evidence suggests that mental health issues such as post-traumatic stress disorder and depression are associated with lower marriage and family quality. One recent study examined the effects of depression and alcohol abuse on family functioning of 661 National Guard service members returning from combat zone redeployment and their spouses. Both service member and spouse/partner depression and alcohol abuse was significantly associated with negative family outcomes.
In turn, poor family functioning can worsen already existing health issues for veterans. One study examined the relation between post-traumatic stress disorder (PTSD) symptoms and family functioning in veterans (N = 1,822) and their partners (N = 702). Assessments were conducted at intake into a treatment program at 3 months and 9 months post-treatment. Poor family functioning for veterans at intake predicted higher PTSD symptoms such as hyperarousal and avoidance at three months post-treatment; poor family functioning at three months post-treatment similarly predicted hyperarousal and avoidance at nine months.
Soldiers and their families can be incredibly resilient, but the high levels of redeployment of recent servicemen and women creates a risk for a cycle of chronic stress and associated poor health, as well as the risk of damaged family functioning. So what can be done?
It goes without saying that the difficulties discovered with the Veteran’s Administration health care system require serious and immediate attention. The importance of receiving adequate medical and psychological care is self-evident. We currently have several empirically supported treatments in the form of medication and psychotherapy for issues such as depression and PTSD facing veterans. But soldiers and their families need to receive timely assessment and treatment in order for these treatments to be effective.
Contrary to what we know about directly treating mental health issues, there has been a dearth of empirical research examining the effects of couples and family interventions on family functioning, health and well-being. Thus even with additional funding and improved care, we are still not able to say definitively what helps military families. A good place to start, of course, would be the empirically supported couples and family-based interventions already in place for couples in general. But issues facing military families are unique and require specialized treatment; more work needs to be done to examine how couples and family therapies can be most effective among veterans and their families.
Mike Landers, Captain United States Navy (Retired), and President and CEO of the Armed Services YMCA told me, “As resources supporting our military families decrease at the federal level and military families are reintegrating into civilian communities, local resources will become increasingly important in meeting the needs of military families and veterans. Communities, federal agencies, non-profits and the private sector must all play a bigger part to assist in the transition from active duty to the civilian sector.” More, he said, “The current messaging related to our veterans and military families is frequently too negative (portraying them as victims rather than showcase their strengths) and inadvertently projecting an image as needy or deserving of pity or charity. Messaging focused on helping the civilian community better understand the challenges faced by our veterans and the military should include a focus on integrating veterans and families into the civilian community before, during, and after transition from active duty.”
Promising new programs and nonprofits exist that recognize the gravity of this situation and are attempting to provide military families with the support they need. A recent study by the RAND Corporation described the possible role of health care providers in increasing knowledge and understanding of issues facing veterans. Other programs are trying to identify factors that allow some families to effectively cope with the stresses of military life so as to promote these behaviors among all military families. Further, organizations such as the Armed Services YMCA provide programs like childcare, before and after school care, clothing, food, gas cards, tutoring, mentoring, counseling and weekend retreats to help families reconnect after returning from service.
Everything about military service creates stress for families. Service members may be removed for years at a time, often under perpetual risk of injury and death. While there are certainly several issues that form the moral core of our country, how we care for our veterans and their families should get special attention. After all, every one of us is asking veterans and their families to sacrifice – for us. And just as we could argue that soldiers are volunteers who “know what they are getting into,” we can now safely say that if we accept the service of our soldiers, we also know what we are getting into.
And we need to honor our military members by supporting our troops and their families even after they come home.
Dr. Mike Friedman is a clinical psychologist in Manhattan and a member of EHE International’s Medical Advisory Board. Follow Dr. Friedman onTwitter @DrMikeFriedman and EHE @EHEintl.