The Effects of Multiple Combat-Related Military Deployments on Post Traumatic Stress Symptoms

The purpose of this study was to learn the effects of multiple, combat-related military deployments upon post traumatic stress symptoms. This subject has particular importance given that the protracted conflicts in Iraq and Afghanistan have been fought by a military that is much smaller than in previous wars. A review of the literature showed that the effects of combat related deployments on post traumatic stress symptoms are significant. The impact is felt by both the veterans and their families. This has implications for clinical social workers working in systems that provide treatment and services for veterans and families affected. This was a qualitative study. Interviews were conducted with seven subjects, all of whom are credentialed at the level of either Licensed Independent Clinical Social Worker or Licensed Psychologist. The interviews concerned the post traumatic stress symptoms of those clients for whom each clinician has provided treatment that has experienced multiple combatrelated military deployments. The data was analyzed and four themes were noted with respect to the effect of multiple deployments on post traumatic stress symptoms: 1) effect on emotional arousal, 2) distinguishing aspects of multiple deployments, 3) effect on relationships and 4) selfdestructive behavior. Issues of dysregulation of emotional arousal and negative impact on families also emerged in the literature review. Running Head: Multiple Combat Deployments and Post Traumatic Stress 4 Acknowledgments The researcher wishes to thank Tamara Kincaid, LICSW and Jenny Jendro, LICSW for their participation on the research committee. Their time, encouragement and input throughout the evolution of this project served as strong impetus to move it toward its completion. Acknowledgment must also be given to Kari L. Fletcher, MSW, for valuable suggestions with respect to conducting the recruitment process. Finally, for her patience, guidance and mentorship, sincere thanks are given to Andrea A. Nesmith, Ph.D., the committee chair. Running Head: Multiple Combat Deployments and Post Traumatic Stress 5 The phenomenon of multiple deployments among armed forces personnel is fairly unique to the most recent conflicts in Afghanistan and Iraq. The impact of multiple deployments upon common mental health outcomes such as Post Traumatic Stress Disorder (PTSD) for affected military personnel is presently unknown. The intent of the present study is to examine the effects of recurring combat deployments upon post traumatic stress symptoms. The experience of the men and women in the contemporary military is one of long and repeated deployments in conditions in which direct exposure to combat is common (Hosek, Kavanagh and Miller, 2006). The United States military forces are currently comprised entirely of volunteers. A reduction of approximately one third of active duty troops, from 2.1 million to 1.4 million, has occurred since the end of the cold war (Hosek, Kavanagh and Miller, 2006). Combat operations have been and continue to be conducted in Iraq, Afghanistan and, to a much smaller degree, Libya. The conflict in Iraq is now in its ninth year. These factors have combined to place an immense strain on both the physical and mental health of the men and women currently enlisted in the armed forces. Among the common psychic wounds incurred by military personnel with direct exposure to combat are those associated with Post Traumatic Stress Disorder (Fear, et al., 2006). This study seeks to answer the question of what impacts multiple military deployments have upon post traumatic stress symptoms. The trend toward multiple deployments has created circumstances in which military personnel may experience direct exposures to traumatic events in greater numbers than their historical counterparts. There may be grave consequences to the mental health of soldiers who have served in these circumstances. Specifically, an entire generation of combat veterans may Running Head: Multiple Combat Deployments and Post Traumatic Stress 6 return from active duty with more severe post traumatic stress symptoms than has heretofore been encountered. The implications for society are significant. McFarlane and Van der Kolk (2006) observed that society tends to respond to traumatized people with “conservative impulses in the service of maintaining the belief that the world is essentially just, that ‘good’ people are in charge of their lives and that bad things only happen to ‘bad’ people” (p. 28). They further argue that the presence of pain and suffering in human experience is more easily ignored by the larger society if those of its members who have experienced trauma are ignored. One is reminded of the contempt with which veterans of the Vietnam War were greeted upon their reintegration into society. Kessler (2000) discussed the severe impairments associated with PTSD and its costs to society. Individuals affected by post traumatic stress are often unable to fully accomplish their goals with respect to education, relationships and career. This in turn impacts the ability of the trauma survivor to contribute to society and may in some cases result in utilization of publicly funded services. There are public health concerns as well. Psychiatric hospitalizations and suicide attempts occur with greater frequency among individuals with PTSD. The impact on the families of military personnel affected by post traumatic stress must also be considered. In their review of the literature, Galovski and Lyons (2004) noted that PTSD is the critical mediating element in the development of the emotional difficulties that cause damage to family relationships. In their study, Sayers, Farrow, Ross and Oslin (2009) found “robust associations of a range of family problems with psychiatric distress in a cohort of relatively healthy, recent military veterans referred for mental health evaluation” (pp. 168-169). Role related adjustment difficulties were noted, for example, with 25% of the respondents Running Head: Multiple Combat Deployments and Post Traumatic Stress 7 reporting that their children were either afraid of them or did not behave warmly toward them. In addition, relatively high rates of domestic violence, over 50%, were reported. There are a number of possible implications for clinical social workers who work with military personnel who have experienced multiple deployments. Social workers in those settings will need to have a strong familiarity with post traumatic stress symptoms and be skilled in making accurate assessments. It will be necessary to be accomplished at clinical practices for which empirical data demonstrates effectiveness in treating those symptoms. There will further be a need for clinical social workers to keep apprised of emerging behavioral technologies that show promise in the efficacious treatment of post traumatic stress symptoms. This study examined the severity of the post traumatic stress symptoms experienced by the current and former military personnel who have been deployed in combat-related situations in the conflicts in which the United States Armed Forces is presently involved. The impact of multiple, direct combat deployments upon post traumatic stress symptoms was investigated. The experience of post traumatic stress symptoms on affected military personnel was examined from the perspective of the clinicians that provide care and treatment. Literature Review The United States Armed Forces have been engaged in military operations in both Afghanistan and Iraq since the start of Operation Iraqi Freedom in March 2003. Two factors, the sheer length of these two wars, as well as the staggering numbers of troops deployed, over 180,000 in late 2007 and again in late 2009, have created circumstances in which multiple deployments of individual soldiers are common. In this context, the potential exists for recent combat veterans to experience more severe post traumatic stress symptoms than those experienced by earlier generations. Running Head: Multiple Combat Deployments and Post Traumatic Stress 8 Combat experience and post traumatic stress disorder The association between direct exposure to combat conditions and post traumatic stress symptoms has been well established. The National Vietnam Veteran’s Readjustment Study (NVVRS), conducted in 1990, estimated that the lifetime prevalence of full PTSD is 30.9% among male theater veterans and 26.9% among female theater veterans (Weiss et al., 1992). In a study by Seal, Metzler, Gima, Bertenthal, Maquen and Marmar (2009), a diagnosis of posttraumatic stress disorder was made for 21.8% of veterans of deployments to Iraq and Afghanistan. Etiology of Post Traumatic Stress Disorder An event that carries a tangible threat of serious injury or death to one’s self or others can potentially evoke a strong response of fear in the affected individual and produce in that person a perception of inescapable vulnerability (Yehuda, 2002). An event that elicits a response of this nature can be characterized as traumatic. Among the disorders that result from exposure to traumatic events are depression, anxiety, substance misuse and PTSD. In a meta-analysis, Ozer, Best, Lipsey and Weiss (2003) found that a number of factors were predictive of PTSD and its associated symptoms for an individual exposed to a traumatic event. The factors delineated by the authors include prior experiences of trauma, prior psychological adjustment, the historical presence of psychopathology in the affected soldier’s family, the perception of an actual threat to life, the emotional responses that occur simultaneously with the traumatic event, an episode of dissociation that occurs simultaneously with the event as well as social support following the trauma. Running Head: Multiple Combat Deployments and Post Traumatic Stress 9 Bisson (2007) observed that the predictive factors for PTSD occur prior to, concurrent with and following the traumatic event. He no