The Ordinary Life of a Military Woman

A study of Navy sailors assigned to carriers showed that concerns about the children, and especially the marriage and the spouse, were expressed by substantially more participants during deployment and following return than before deployment McNulty, Hurley observed in a study of Army spouses that a substantial proportion developed heightened rejection sensitivity partway through deployment, fearful that their deployed partners had decided to leave the marriage.

These fears were significantly and negatively related to relationship adjustment, even though participants could identify no precipitating reason for their fear; fears also appeared to increase with cumulative months of separation. According to the participants, each partner's worry about the other led them to withhold information because of fears about revealing their own vulnerability or exposing vulnerability in their partner. The diminished familiarity with one another's day-to-day lives created a sense of disconnectedness and additional difficulties between spouses. When spouses chose not to disclose stressors they had experienced, they foreclosed the possibility of receiving support from their partners.

Similarly, Lara-Cinisomo et al. Earlier, Bowling and Sherman suggested that service members and their family members coped with the stresses of deployment by suppressing their emotional responses and that this suppression could impede processes of reconnecting with one another after return. During the current conflicts, the prospect of possible future deployments and separations might complicate the reestablishment of intimate relationships. Although it offers a practical and immediate way for service members to participate in family life, it also might involve service members in solving problems that could be resolved without their attention.

The authors suggested that service members and spouses be taught strategies to determine how to make the best choices of methods, content, and timing of communication. Many of the couples exchanged emails, instant messages, and phone calls daily and typically exchanged letters and care packages once or twice per month.

More than half also used video instant messaging once per month. Results showed that service members reported lower levels of PTSD symptoms following deployment when they had communicated more frequently with their spouses during deployment but only when marital satisfaction was high and only when delayed forms of communication, such as letters, emails, and care packages, were used. Plans to divorce or separate also appeared to be inversely correlated with pay grade: They found that both family problems death or illness of a loved one, financial problems, or problems with children and home and relationship breakdowns were negatively related to mental health by a large amount.

Although high military-unit cohesion and effective military leadership fully mediated the relationship between relationship breakdown and mental health, family problems at home could not be completely compensated for by unit cohesion or military leadership. In addition, perceptions of poor military support for families at home were negatively related to mental health regardless of combat exposure, unit cohesion, or effective leadership. Several studies have presented empirical data regarding the logistic, psychologic, and economic challenges experienced by marital partners during deployment.

Logistic challenges include maintaining a household with only one adult present, such as management of maintenance, repair, and financial activity; providing all necessary care for children; maintaining employment; and arranging medical care or other services that are affected by military regulations for example, reserve-component families may need to change medical providers when TRICARE coverage begins and ends SteelFisher et al. Some of them had experienced an unexpected extension of their partners' deployment. Deployment-induced logistic problems included difficulty in communication sent and received with the deployed members Baseline data were gathered during the summer of ; followups were conducted 6 and 12 months later.

More than half of the caregivers surveyed reported one or more of the following logistic challenges associated with deployment: Proximity to extended family members increased, but it meant leaving local military services and causing children to change schools and living arrangements Flake et al. Psychologic challenges experienced by both service members and their spouses include fears for the safety of the service member, feeling anxious and overwhelmed by deploymentrelated challenges and responsibilities, worry about children, and concerns about military leadership, as well as vulnerability to additional stressors that might arise.

In SteelFisher et al. A notable minority of the sample reported adverse perceptions of the military, the most commonly cited problem being lack of accurate information surrounding the timing of deployment, given that an unexpected extension had occurred According to Wright et al. Existing data suggested that these concerns and fears tended to center on military training and leadership, the possible injury or death of service members, and concerns about managing on their own if that occurred. In Chandra et al. In addition, difficulties associated with new household duties were associated with increased anxiety and feelings of being overwhelmed Lara-Cinisomo et al.

Rocking Ordinary:Army Wife Style!

Overall, there were several indications in Lara-Cinisomo et al. For example, caregivers in both National Guard and reserve families reported significantly greater household and relationship hassles, and caregivers in National Guard families reported poorer emotional well-being.

Top concerns during the year for both husbands and wives were exposure to combat and the effects of the deployment on children. Husbands' other strongest concerns pertained to sexual frustration; wives' other strongest concerns pertained to loneliness and staying in touch, injury and fear of death, and reintegration and fears about potential changes in the service member.

Infidelity was not a major concern reported by either husbands or wives. Economic challenges associated with deployment can include loss of spousal employment or difficulty paying for child care or other household services usually provided by the deployed family member. Reserve-component members experience small income increases on average, although some lose income during deployment Angrist and Johnson, In the SteelFisher et al. Many of the same adjustments and role reallocations that must be completed as deployments begin must be completed again when service members return home Bowling and Sherman, ; Pincus et al.

Studies conducted after return from deployment emphasize the implications of psychologic symptoms of service members, but many other aspects of the reintegration experience may be consequential for adults and children. Following World War II, Hill recognized that families' experiences following reintegration were partially a function of their experiences and behavior during deployment. Families who seemed to function best were those that closed ranks only enough to fulfill important tasks but not so much that there was no place for the service member upon his return.

Research conducted during the Vietnam era reinforced these observations, demonstrating that families who maintained the service members' psychologic presence during deployment seemed to adapt more effectively when difficulties occurred McCubbin et al. Although most studies fail to measure positive consequences of deployment, the Rosen et al. All positive events were reported by at least one-third of the sample. Following deployment, the couples in Baptist et al. Religious faith and belief in the importance of the military mission also were helpful. However, participants also reported suppressing, avoiding, or restraining sexual behavior with their spouses, all of which interfered with marital closeness Baptist et al.

In a review of existing literature about reintegration following war-related separations, Vormbrock found that longer separations were related to more distress, detachment, and damage to the attachment relationship. Although both service members and spouses tended to engage in contact-seeking behavior, home-based spouses were more likely than service members to display detachment and anger.

Both Vormbrock and Rosen et al. After deployment, Sahlstein et al. In most couples, however, there were mismatches between the service member's willingness to share and the spouse's willingness to hear. Wives reported continuing to perform household duties following husbands' return from deployment when they would have preferred greater involvement by husbands, and both husbands and wives reported restraining sexual desires.

Although well intentioned, these decisions usually were made without consulting the partner about his or her preferences. Nelson Goff and Smith also observed that couples who were unable to reconnect following deployment were a function of both prior marital problems, such as infidelity, and difficulties in sharing information, exchanging comfort, and supporting each other. Although reintegration processes are typically described as occurring over time, few studies have empirically documented the sequence, durations, or content of these processes, particularly as they relate to families.

In several studies, members of families affiliated with the National Guard and reserves have reported greater difficulties or poorer outcomes associated with deployment Chandra et al. Civilian spouses and children might need to change medical providers, and civilian communities might be poorly prepared to serve military families Huebner et al.

In summary, as a result of deployment, marital quality is affected by psychologic challenges, including worry and uncertainty, that appear more prevalent than logistic issues for example, managing the household or economic difficulties for example, loss of spousal employment. Some stressors are specific to a particular phase of the deployment cycle that is, predeployment, during deployment, and postdeployment , and may dissipate as families move through the deployment cycle for example, worries about a service member's safety during deployment may lessen upon returning home.

Others stressors are evident throughout for example, communication issues and may be a chronic symptom in a couple's relationship. Male service members and their wives share many of the same concerns, such as concerns about the well-being of children and the service member's safety, but also have separate ones. Dominant concerns among male service members include worries about the impact of separation on their families and worries about their spouses' ability to cope with deployment-related challenges, including loneliness and household responsibilities.

The concerns of female service members are probably similar; however, there is a lack of studies of female service members to confirm the similarity. The most common stressors among female spouses include feelings of loneliness, fears about their spouses' death or injury, raising children alone, and problems communicating with their spouses. Spouses who are depressed and families that are members of the reserve component are more likely to experience deployment-related challenges. Families may also have positive experiences as a result of deployment, such as family bonding and increase competence in family functioning.

Important to the understanding of the impact of deployment on marital quality is knowledge about what issues—individual or relational—may have been preexisting and not a symptom of deployment per se. Epidemiologic research that characterizes military spouses irrespective of their experiences with deployment is lacking. Other gaps in the research base are related to the normative course, duration, and sequence of stressors experienced by military families as a result of deployment. The empirical evidence so far is mixed, possibly because insufficient time has elapsed for the consequences of deployment to have become fully evident.

As noted earlier, military divorce rates have risen in the past decade. This section examines several investigations that have been conducted to determine the role of deployments in these increases. Two explanations have been proposed to explain divorce rates in the military. According to the stress hypothesis, the stressors of military life erode the stability of marriages, suggesting a positive relationship between deployment and the likelihood of divorce. In contrast, the selection hypothesis suggests that the likelihood of divorce is tied to characteristics of the partners and their relationships Karney and Crown, and thus would not increase because of deployments.

Data from prior wars are inconsistent. For example, Ruger et al. Veterans married prior to the Vietnam War were no more likely to divorce than those married after, failing to support the stress hypothesis at least with regard to deployment-related separation. A consistent finding across wars and robust to statistical controls, however, was that exposure to combat did increase the likelihood of marital dissolution, consistent with the stress hypothesis.

More recently, a large representative survey of military members 59, showed that deployment to Operation Desert Storm was associated with a statistically significant increase, by 4. Contrary to the view that longer deployments raise the risk of marital dissolution, Karney and Crown, , found in a study of personnel records of over , service members who married in — that the longer a service member was deployed, the lower the risk of divorce or separation.

Risk was lowest for individuals who would normally be thought of as the most vulnerable—those who had married younger and who had children in the home. These results were not consistent with the hypothesis that the stress of deployment undermines otherwise healthy marriages. The findings were preliminary, however, because they focused only on relatively recent marriages that were followed for only a short period. The most recent analyses were conducted by Negrusa and Negrusa , who calculated the likelihood of marital dissolution as a function of deployment, using a military longitudinal dataset spanning from to They found that deployment substantially increased the risk of divorce, with the effect being stronger for female service members and for service members who were sent on hostile deployments typically, to Iraq and Afghanistan.

In summary, results are mixed regarding the reasons for the rise in divorce rates in the military over the past decade. Both selection effects preexisting characteristics of couples and stress effects increasing operational tempo and more hostile deployments appear to be relevant factors. Family violence, which includes spousal abuse 1 as well as child maltreatment, has become a focus of concern in the military. This section covers spousal violence in terms of prevalence, types of abuse, risk factors, health consequences of abuse, and treatment.

In , the rate of substantiated incidents of spousal abuse was This rate extends an upward trend that began in FY Because each report of spousal abuse reflects a single incident, there can be more than one report for a single victim. The abuser could have been an active-duty service member or a civilian.

Rate of spousal-abuse reports per 1, couples to the Family Advocacy Program, — Spousal abuse is distributed as follows: The occurrence of spousal abuse, as compiled by the FAP, is probably an underestimate: Deployment is perceived as the foremost stressor in the military, according to a DOD survey of some 16, male and female active-duty service members Bray et al.

Not surprisingly, deployment has been identified in the medical literature as a risk factor for spousal aggression in the aftermath of deployment. This finding was reported in a random sample of 26, deployed and nondeployed married active-duty members in the Army McCarroll et al. The study also found that the likelihood of severe aggression rose with the length of deployment. With a short length of deployment 6 months , deployment was not found to be a risk factor in the first 10 months after return from deployment, but younger age was a risk factor Newby et al.

PTSD first emerged as a risk factor for intimate partner violence in Vietnam veterans. In a recent study of Navy recruits, PTSD also was identified as a risk factor, having an odds ratio of 2. Having PTSD symptoms of arousal and feeling a lack of control were the most robust predictors of aggression Taft et al.

Substance use also has been found to be a risk factor for spousal abuse, according to a study of two Army databases of offenders, the Army Central Registry and the Drug and Alcohol Management Information System. They were more likely than nonsubstance abusers to be physically violent and to exert more severe spousal abuse Martin et al.

A separate study found that the odds ratios for spousal abuse were 1. However, in another study, alcohol use was unrelated to intimate partner violence among married enlisted female soldiers, regardless of whether they were perpetrators or victims Forgey and Badger, In the only study on spousal abuse specifically in OIF and OEF service members, experiential avoidance—a coping strategy that seeks to avoid emotionally painful events—was associated with physical aggression perpetration and victimization in a study of 49 male National Guard members who returned from deployment to Iraq Reddy et al.

Although data on the consequences of spousal abuse specific to military families are not available, in civilian studies, spousal abuse has been found to be associated with numerous negative outcomes. Similar findings were reported in a community sample of 94 women who were evaluated by diagnostic interviews Nathanson et al. In the latter study, psychologic abuse was more likely to be associated with a mental disorder than with physical abuse.

The committee found little information about treatment of spousal abuse, which is a service provided by the FAP itself or in conjunction with local treatment providers. The DOD monitors spousal abuse treatment by this one metric: Yet, no information is given about the content of the treatment program, how programs are evaluated, and their impact on the mental health of victims. The civilian literature indicates that many treatment programs for spousal-abuse victims or perpetrators are only minimally effective Babcock et al.

In summary, a service member's psychologic issues are related to increases in marital distress, divorce, and disruptions in family life. Findings also suggest that the reverse is true: Moreover, relationship quality may have an impact on treatment seeking by a service member. A spouse's perception of a service member's psychologic health for example, perceptions of the apparent cause for symptoms or of the service member's control over symptoms influences the level of personal and marital distress experienced by the spouse.

Service members' deployment is associated with increases in mental-health problems, particularly depression and anxiety, among spouses. Length of deployment and cumulative months of deployment predict increases in the likelihood of distress, but the number of deployments does not. Pregnant women with deployed partners experience high levels of stress and depression, particularly if they have other children.

Although overall rates of spousal abuse in the military do not appear to be higher than those in the civilian population, there is evidence that the risk of spousal physical violence is higher after deployment, the risk increasing with the length of deployment. The impact that the presence of children has on the psychologic well-being of a parent with a deployed spouse is somewhat ambiguous. Some studies have found that a parent's worry about the well-being of their children and concerns over the logistics of providing care add to deployment-related stress.

CHARACTERISTICS OF MILITARY FAMILIES

Other studies indicate that mothers and female spouses without children experience similar levels of distress. At least one study found that the presence of children is protective against depression in the stay-at-home parent. More studies are needed to understand the specific stressors faced by single parents serving in the Armed Forces. Little attention has been paid by researchers to single service members who have experienced deployment and the degree to which family formation processes have been delayed or disrupted as a result. However, some of the same themes relating to deployment and marital quality discussed above are evident in a study of single service members living with their parents following return from deployment.

In most cases, veterans described their experiences as positive, and parents were helpful in recognizing health and adjustment problems. Distinct from the experiences of couples, adult children sometimes struggled with feeling treated as a child by their parents. Some service members were motivated by conflict with their parents to pursue school, a relationship, or work with undue haste. Few programs were available to educate or support parents in their efforts to assist their adult children. Among service members whose deployment experiences result in personality changes or psychologic symptoms and diagnosis, particularly PTSD, there are consequences for marital quality as well as specific psychologic effects on spouses and children.

These are discussed below. Several studies have examined the prevalence of psychologic symptoms among military spouses in relation to deployment-related stressors. According to both broad and strict screening criteria, spouses and service members reported similar levels of major depression or generalized anxiety disorders using broad screening criteria, An analysis of medical records of over , military wives done by Mansfield et al. After controlling for background characteristics age, number of deployments, pay grade, and years of service of the military member and mental-health history, there were Overall, wives whose husbands were deployed were significantly more likely to have diagnoses of depression, anxiety, acute stress reaction, adjustment disorders, and sleep disorders than wives whose husbands had not been deployed.

Spouses of deployed service members also used mental health services at higher rates, which increased with deployment length. In a study by SteelFisher et al. Half of the spouses reported frequent feelings of anxiety, and almost half reported frequent feelings of depression. In a sample of National Guard members and partners, Gorman et al.

Barriers encountered by partners included cost, difficulty getting time away from work or scheduling appointments, and not knowing where to get help. Across studies, most military spouses who reported psychologic symptoms also reported seeking care Eaton et al. Barriers reported by active-duty and reserve-component spouses were similar.

Two small studies focused on spouses' stress and coping with the demands of their service members' military duties. In one, spouses evaluated their partners' deployment as one of the most stressful experiences of recent years in their lives Dimiceli et al. In turn, spouses' perceived stress was positively related to their levels of well-being Padden et al. Consistent with the broader literature on stress, coping strategies focused on problem-solving, and taking action appeared to predict better psychologic health Dimiceli et al.

Another topic that has received attention from researchers is the psychologic health of parents or caregivers of children in military families. Consistent with studies of civilian families Luthar, and military families during the first Gulf War Jensen et al. In addition, adults' distress was found to be a function of cumulative exposure to deployment but not to number of deployments Lara-Cinisomo et al. In the Lara-Cinisomo et al. Current deployment was significantly and positively related to caregiver mental health and relationship difficulties.

Caregivers of children affiliated with the National Guard reported significantly greater difficulties than caregivers of children affiliated with the reserves or the active component. Similarly, in another study contrasting parents with currently deployed and recently returned military spouses in the Army and Marine Corps, distress—specifically, anxiety—was significantly greater among parents whose partners were currently deployed.

Emotional distress measured by global severity, depression, and anxiety scores on the Brief Symptom Inventory were significantly increased among both at-home civilians and active-duty parents. For example, global severity was 0. It is not clear, however, that parenthood exacerbates stressors related to military service. Hopkins-Chadwick and Ryan-Wenger compared junior enlisted women serving in the Air Force with and without children 50 of each younger than 5 living at home. Mothers and nonmothers reported similar levels of role strain, stress, health, and military career aspirations.

The literature on stress and the military has focused primarily on two-parent families, and research on single parents is scare. What little does exist about single parents in the military was published approximately two decades ago, so it might not represent experiences from the more recent conflicts. A small number of studies have investigated the possible impact of deployment on the health of military spouses during pregnancy.

To date, few differences in physical health have been found. For example, a cross-sectional survey of postpartum mothers at Camp LeJeune during revealed no differences in gestational age, likelihood of vaginal delivery, number of previous children, or weight gain between those with deployed or nondeployed partners. Mothers whose partners were deployed were more likely to report having changed their eating habits during pregnancy and had infants who were on average almost grams heavier Haas and Pazdernik, Differences were found regarding the psychologic health of pregnant military spouses.

For example, a survey of pregnant women seeking services at the Naval Hospital at Camp LeJeune in revealed that women reported significantly higher levels of stress if their partners were deployed, if they themselves served on active duty, if they were farther along in their pregnancy, or had more than one child at home Haas and Pazdernik, Finally, an examination of screenings of 3, women with military spouses conducted at the first obstetrics visit during pregnancy, at the week visit, and at 6 weeks postpartum between and revealed that mothers were significantly more likely to exceed clinical cutoffs for depression during the initial obstetrics visit if their spouses were preparing to deploy or had recently returned from deployment.

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At 28 weeks gestation, depression scores were higher for women whose partners were deployed or returning from deployment. Postpartum, depression scores were significantly higher for women whose partners were deployed de Burgh et al. Note, however, that already having children at home was more strongly related to perceived stress among pregnant spouses than deployment of partners in most of these studies. Death is an inevitable accompaniment of war, and the OEF and OIF wars have left behind thousands of spouses, children, and other family members to mourn the loss of a loved one.

To date, however, there are no comprehensive studies of bereavement in US military families. To address this gap, the Center for Traumatic Stress is currently undertaking a 5-year study of bereavement in about 3, family members, including spouses, parents, and siblings of deceased service members—the first scientific study of the impact of US military deaths on surviving family members. The focus will be not only on combat deaths but also on homicides, suicides, and accidents Jowers, The largest area of research related to deployment and families pertains to the implications of service members' combat- or deployment-related psychologic symptoms and diagnoses, particularly PTSD, for the quality and stability of relationships with intimate partners and children.

Data collected from the through National Surveys on Drug Use and Health SAMHSA, , which surveyed veterans ages 21 through 39 deployment history not known , showed that three-quarters of those who had experienced a major depressive episode the previous year reported being severely or very severely impaired in at least one of four role domains: Half reported severe or very severe impairment in role functioning with respect to close relationships with others.

Recent studies also are revealing ways in which relationship dynamics may influence vulnerability to and severity of psychologic symptoms among service members, and the likelihood of seeking treatment. In this section, we deal with the relationships between service members' psychologic symptoms and marital quality; in a later section, we consider the implications of service members' injuries for caregivers' own well-being and functioning.

According to a review by Monson et al. Specific symptom clusters might be linked to specific types of relationship problems. For example, the arousal cluster of symptoms is found to be related to greater hostility and violence directed by service members or veterans toward their partners, while the numbing and avoidance cluster is related to difficulties with intimacy, including sharing and receiving communication about emotions, as well as general relationship satisfaction.

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For male service members but less so for females, the effects of combat exposure are mediated through psychologic symptoms. Other possible mechanisms of influence include secondary traumatization and caregiver burden experienced by partners, but many research questions are yet to be answered. Almost all studies have focused on the effects of PTSD on interpersonal relationships, but there also are reasons to expect that relationships can affect the occurrence of and prognosis for PTSD Erbes, ; Monson et al.

For example, social support, of which family relationships are a primary source, is negatively related to PTSD symptoms. In addition, relationship patterns among intimate partners may prolong or reduce avoidant behavior or support or discourage emotional expression, each of which can affect the course of PTSD.

For example, intimate-relationship partners might be helpful in keeping service members engaged with others rather than withdrawing. Conversely, strain or distance in intimate relationships might reinforce service members' negative cognitions associated with PTSD Erbes, Several studies from both current and previous conflicts revealed positive relationships between service members' deployment-related psychologic symptoms and disruptions in family life. Most of these studies were cross-sectional, and many were conducted with samples recruited from health clinics or hospitals.

For example, Sayers studied veterans of service during OEF and OIF who had been referred for behavioral health specialty care. Three of four of those who were married or living with a partner reported family problems in the past week, including feeling like a guest in their own home One of four reported that their children were acting afraid or distant. Johnson studied 60 spouses of veterans of OEF and OIF service in a mixture of branches and components, most of whom had been deployed multiple times.

MILITARY FAMILIES - Returning Home from Iraq and Afghanistan - NCBI Bookshelf

On average, the spouses reported significant negative change in 13 of 18 characteristics, including increases in veterans' tendencies to be quick-tempered, irritable, unhappy, cold, lifeless, mean, cruel, unreasonable, insensitive, and changeable. When service members' personalities had changed more, spouses reported higher levels of grief, which in turn were associated with more frequent arguments and less social support. These relationships appeared robust to a variety of demographic characteristics. Conducted as a partnership of the Minneapolis VA, the University of Minnesota, and the Minnesota National Guard, the studies' participants were composed of members of the Minnesota Army National Guard and their partners.

In a factor analytic study, Erbes et al. The dysphoria cluster appeared to be the most important factor explaining intimate-relationship adjustment within the 6 months following service members' return from deployment and the only significant predicting relationship adjustment 1 year later. Thus, much of the impact of PTSD on couple adjustment may be because of the generalized distress that accompanies the disorder, rather than specific symptoms related to reexperiencing or arousal. The extent to which some PTSD symptoms predicted relationship disruption was substantially greater for female soldiers.

There was a trend for PTSD avoidance symptoms to have a greater impact on couple relationships among female soldiers than male soldiers. Evidence from both the Erbes study and others suggests that spouses' attributions about their partners' symptoms influence the spouses' levels of personal and marital distress. Specifically, when spouses cannot see an obvious cause for their partners' symptoms or when they perceive their partners as being able but choosing not to exert control over symptoms, they may respond with less support and more distress.

In two small studies of the OEF and OIF conflicts, wives were more distressed when they could not see an obvious cause for their husbands' symptoms, whether because wives perceived symptoms that their husbands failed to acknowledge or husbands reported more severe symptoms than their wives expected, given what was known about their combat experience Goff et al. Pietrzak and Southwick observed similar patterns in a sample of members of the National Guard and reserves, averaging 34 years of age, in that the group who experienced high exposure to combat and high levels of PTSD symptoms also reported the most problems in psychologic and social functioning, while the group of service members who experienced high exposure to combat but reported low levels of PTSD symptoms were significantly more likely than others to report receiving support and understanding from their families and to perceive a sense of purpose and control.

Erbes and Renshaw and Campbell concluded that generalized distress was a prominent feature of couples' experiences related to PTSD. Erbes found that general dysphoria in service members, including irritability and numbing, was more strongly related to relationship adjustment than either reexperiencing or arousal, perhaps because dysphoria is less obviously connected to service members' combat experiences than other symptom clusters. Renshaw and colleagues investigated the degree to which spouses' psychologic symptoms reflected a form of secondary traumatization related to their partners' symptoms, as opposed to a more generalized form of distress, and found greater support for the generalized form of distress among most spouses Renshaw et al.

Controlling for prior exposure to trauma and prior PTSD symptoms but not prior relationship distress , levels of negative emotionality among service members before deployment significantly predicted levels of PTSD symptoms following return. In turn, the PTSD symptoms were significantly related to lower relationship quality. Symptom severity of PTSD and relationship quality may interact to influence the likelihood of seeking treatment and the nature of treatment sought. Partners perceived the main barriers as service members' denial, fear, and stigma about disclosing their symptoms. Partners' strategies included offering support and patience, making suggestions that treatment be sought, initiating treatment themselves, or issuing ultimatums.

At higher levels of relationship adjustment, more severe PTSD symptoms predicted use of individualoriented treatment, and relationship quality was unrelated to seeking couple or family care. At lower levels of PTSD symptoms, poorer relationship adjustment significantly predicted seeking couple or family care.

These results suggest that once PTSD symptoms reach a certain yet unknown threshold, service members may be less willing to simultaneously deal with relationship issues and their symptoms. Or perhaps beyond this threshold, relationship difficulties are such that couple-oriented treatment does not seem possible.

Researchers are only beginning to sort out these issues as they pertain to returning veterans and their families. Children in military families have the advantage of a number of resources that help to buffer them from risks that many nonmilitary children might experience Sheppard et al. Although military children face the risk of traumatic events happening to their parents, so do many nonmilitary children. Military families have access to child care and health services that are often far superior to those available to civilian families at similar income levels.

Housing is related to family size, and military installations tend to have good schools, good sports, and recreation facilities, and a system of support services, including ones targeted for the families of deployed or injured personnel. On the other hand, military children may also have to cope with circumstances specific to military families, such as parents leaving for and returning from deployments which can be unexpected, prolonged, and repeated , and the medical, psychologic, and economic consequences of deployment.

The family may have to relocate frequently, either because the military member gets stationed at a new location, because the family members wish to relocate temporarily during a deployment for example, to stay with relatives who can help with child care , or because the child of a single custodial military parent must go to live with another caretaker while the parent is deployed. Military families are more than four times as likely as civilian families to move to international locations, requiring them to adapt to unfamiliar cultures Reinkober Drummet et al.

Access to health care can also change if the family relocates during deployment, especially if they are no longer living near a military base. Relationships with peers, as well as local institutions including schools , may also be disrupted. Parents may come back damaged, physically or psychologically. Or, tragically, they may not return at all.

Any review of military children and families dealing with deployment of a parent must take into account that these additional stressors occur against a background of exposure to the ordinary risks of daily life. Thus, before discussing the specific needs of children of parents deployed in OEF or OIF, it is useful to think about the stressors military children might experience irrespective of whether their parent or parents have deployed and the levels at which those stressors can occur in the general population. Stressors include parental absence, having to move multiple times, parental psychopathology, and death of a parent, as well as the effects on children of having to deal with the other parent's reactions to such events.

These stressors give a sense of the ordinary level of stress and strain that military families might experience, beyond which is the need to cope with the challenges presented by deployment. Like children in military families, children in civilian families might experience the absence of a parent. Parental absence most often refers to the absence of the father; this is certainly true in military families, where—despite the increasing number of women in the military—the deployed service member is still much more likely to be male.

Absence of fathers, although an expected concomitant of military life during wartime, is thus not an uncommon experience for civilian children, although the nature of that absence may be different. Examples for children are temporary absence due to deployment to a war zone of fathers in intact households or in households where custody is shared after a divorce versus the ongoing absence of noninvolved fathers with whom the children have limited or no relationship.

An estimated one-third of military families relocate annually, with families commonly moving every 3 years Orthner and Rose, Just as periodic moves are an expected part of military life, it is also common for civilian families to move NRC and IOM, Whether moving is for positive reasons for example, relocation for a higher paying job or to be closer to family or negative ones for example, following eviction or foreclosure or breakup of a family , it is potentially disruptive for children. It can, for example, interrupt their learning in school, disrupt peer relationships, and disconnect children from important relationships with adults and institutions in the community NRC and IOM, Impacts can also vary, depending on the age and developmental stage of the child, as brain development, capacities for dealing with stress, and behavior all change over time in ways that can affect a child's ability to manage a move.

National longitudinal studies that examine the impact of relocation on school achievement are sparse, and it is difficult to disentangle the effects of mobility from other factors for example, poverty and family characteristics. However, although the impact of a single move may be negligible overall, the negative impact on achievement is cumulative and increases with the number of moves especially above a threshold of three to four or more moves. The impact is greater for some groups of children, especially certain ethnic minority groups, those at lower socioeconomic status levels, and those whose families are downwardly mobile NRC and IOM, In the civilian population, multiple moves are thus positively associated with social disadvantage in a way that is not the case in military families who have both stable employment and guaranteed housing.

The number of children in either military or civilian families who live with a parent with a mental disorder is unknown. However, mental illness clearly occurs in both military and civilian families. Screening at the recruitment stage acts to limit the entry of individuals with serious mental illness into the military; however, mental illness can still develop later for example, PTSD resulting from deployment experiences , and nonmilitary spouses may also have mental illness. National survey data on child exposure to parental mental illness are sparse, and most studies that look at children of people with mental illness focus only on clinical populations, making it difficult to estimate exposure in the general population.

However, a Canadian study that extrapolated from the Canadian Community Health Survey and the Canadian census data Bassani et al. The National Survey on Drug Use and Health reported similar results for child exposure to parental alcohol-use disorder, finding that an average of approximately 7. The death of a parent is a highly traumatic event for any child. Like military deaths, civilian deaths may be sudden, such as in the case of a suicide or a car accident, or may follow long drawn-out illness or be the eventual consequence of a serious injury.

Again, like military children, civilian children lose more fathers than mothers. Although precise figures cannot be found, about 3. In December , more than 1. According to the report of the Census Bureau's Survey of Income and Program Participation, 49, mothers and 36, fathers who were living with their children had been widowed in the previous year Kreider and Ellis, As of February , an estimated , children had experienced a parental absence because of deployment in OEF or OIF, sometimes for multiple periods Engel et al.

Since then, the number of children affected by the deployment of a parent has increased. Many parents, service providers, and policy makers are concerned about the implications of parental deployment for children. However, research evidence remains sparse, and the use of more powerful longitudinal or quasi-experimental designs has been rare.

In this section, we review the literature on children from military families, with special reference to children with one or both parents deployed in OEF or OIF. This review is limited to adequately powered studies that use sound research methods. Two main methods are used in the research to date: Most studies of prior conflicts have suggested that deployment is associated with a variety of internalizing such as sadness, depression, and anxiety and externalizing such as aggressiveness and irritability symptoms in children that in most cases are not clinically significant Cozza et al.

Studies from the current wars have generally been consistent with that earlier research. Studies have also been consistent in finding that longer cumulative time spent deployed is associated with more problems. Reviewing electronic medical records, Mansfield et al. Having a deployed parent was associated with an excess of all major diagnoses in comparison to being a child without a deployed parent.

The excess was greater in older children and boys and those whose parent had been deployed for a year or more. As in most record-based analyses, it is not possible to conclude from this study whether children of deployed parents suffered more psychiatric disorders or whether 1 parents were more anxious or vigilant and more likely to bring their children to a medical provider and 2 medical care providers were more likely to diagnose disorders in children of deployed parents.

However, the study does provide preliminary evidence that longer periods of deployment may put children at greater risk. One of the largest studies of military parents and their children included interviews of over 1, caregiver-and-child pairs from military families in all branches of the military and reserve forces who were recruited from applicants for a military summer camp Chandra et al. Followup interviews were conducted at 6- and month intervals. The study found that military children experienced significantly higher levels emotional and behavioral difficulties than those reported from the US Census Bureau's National Health Interview Survey, a large national sample.

Spouses of reserve-component service members were especially likely to report that their children were experiencing difficulties. Although the study was limited by using participants from a service-seeking group, it provides valuable insight into the concerns of children of deployed service members over the course of deployment and reintegration. A cross-sectional study of a convenience sample of children ages 6 to 12 from families with a deployed or recently returned parent found that anxiety scores were higher than community norms for both deployment groups Lester et al.

No mean differences were found in depressed mood or behavioral symptoms for the children in the study compared with population norms. In multivariate analyses, mood and behavioral symptoms were higher in children whose military parent was deployed for longer periods and for whom either parent reported higher levels of psychologic symptoms; the effects of long parental deployment were seen even after the parent returned. Using input from parents and child care providers, a study of preschoolers in child development centers at a large Marine Corps installation compared children of parents deployed in OIF or OEF with other military children and with national norms and found that children of deployed parents had significantly higher scores on both internalizing mood and externalizing behavior measures Chartrand et al.

Among the small number of children who scored in the clinical range, the only significant differences were in the area of internalizing problems. Although this study was cross-sectional and did not measure change from predeployment to deployment or postdeployment, it provides some evidence for an effect of parental deployment on children's mood and behavior. Another concern is the effect on children of a custodial parent's reaction to the other parent's death, injury, disability, absence, or psychopathology. Studies during the first Gulf War demonstrated that children's psychologic symptoms were more severe when their mothers' own well-being was seriously compromised Cozza et al.

Similarly, parents who reported high levels of stress were much more likely to report symptoms in their children Flake et al. In research focused on deployments during the current wars, Chartrand et al. However, the mean overall scores were not higher than those of the community samples on which the instruments were set at the norm.

In another study of children of deployed parents Chandra et al. The study also found that youth whose nondeployed parent was doing worse emotionally reported having more difficulties during deployment; parents doing less well emotionally were likewise more likely to report that their children had greater emotional, social, and academic difficulties.

Parents who access military support services report less child psychologic morbidity. This finding suggests that use of services might ease parenting stress and underscores the necessity of providing military families with the support they need to cope with and adjust to deployment. Families considered more vulnerable to adjustment difficulties and in need of targeted outreach include families who are simultaneously undergoing other major transitions, such as relocation, pregnancy Haas and Pazdernik, , and bereavement, as well as families who have junior military personnel and families who have multiple needs and problems before deployment Booth et al.

In FY , there were 6, substantiated reports of child maltreatment among approximately 1,, million children in military families. The number represents a rate of 5. Rate of substantiated child abuse and neglect reports per 1, children to the Family Advocacy Program, — During this time, Clay was trying to figure out how to juggle being a Soldier and recruiter at work and husband and Dad when home. It was a struggle for both of us.

I often wondered if I was seen or noticed. How could someone so insignificant make a difference in the world? How could I be a wife and mother who was able to rock the ordinary? I wanted to her. I longed to be her. I felt like I had to have the perfect marriage or at least appear to have the perfect marriage and the perfect children. Not just perfect children, but perfect military children. In my mind, my marriage and my children were imperfect.

All this began to take form when I began making friends with other recruiting wives and volunteering to establish an otherwise dead FRG Family Readiness Group. When I surrounded myself with others with similar experiences, pain and adversities as myself, I felt like I had found my tribe. This group is a bunch of lovely military spouses — from the newest military spouse to the retiree wives.

These ladies range from barely 18 through Titus 2 mentors. We would come together each week for Bible study, food, and fellowship.

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There I would find like-minded believers and friends who understood what my life was like. They understood the good and the bad, the happy and the sad, and being stuck on spin cycle. In the book Rocking Ordinary , Lea shares that many of these are excuses. I am busy at home with my children all day. I work full time. I work from home. My church is too big; my church is too small. The church people are not friendly; there are too many cliques. More small reasons to ignore the greatest working of God through me. We want to Rock this Ordinary life, yet we make excuses for paths that God gives us to share Him in an ordinary way.

Once I finally finished sulking over all my imperfections as a wife and mother, the only way I was going to Rock Ordinary was to bloom where I was planted. I decided to dive in heart first, love people and love the life of the military. I decided to not complain about my less than ordinary life….

I decided to learn to rock the ordinary in a million little ways that made a million little impacts on a million little lives — starting with mine. I never expected recognition, even though the Army did so a few times. I did it because it was the right thing to do. I did it because it gave me a focus and made me feel close to my husband, even if he was half a world away. It was my purpose or, as the Army would say, it was my mission. Some of his old Soldiers from Fort Bliss, Texas made their way up there.

One of them was a Soldier I sent a Bible to while he was deployed to Iraq with my husband. He actually got saved while he was there during Bible study with my husband. I was so excited that he had found the Lord I actually had his name engraved on the Bible before I sent it. While he was there visiting, we had all went out to dinner and he hugged me, thanked me, and told me how much that Bible meant to him.