1. The Impact of Deployment on Service Members and their Families
Presented by:
Jim Messina, Ph.D.
Licensed Psychologist
Lead Trainer: Florida ARC-
Coping with Deployment PFA for Military Families
Lead Disaster Mental Health Services
Tampa Bay Chapter of American Red Cross
Psychologist with: St. Joseph’s Hospital, Vericare, Argosy University
Presentation Available on:

2. Most current statistics on make up of Deployed Military
Men = 90%
Women = 10%
Married = 53%
with children = 68%
without children = 32%
Single = 47%
with children = 13%
without children = 87%
CTS Deployment File Baseline Report, Defense Manpower Data Center, Aug 31, 2007

3. Major Stressors for Military Families
Frequent moves and separations
Individual augmentees
Risk of injury and death
Expectations
Long and unpredictable Foreign residence

4. Risk Factors for Military Families
Younger spouses
Younger children
Socially isolated and dependent families
Families undergoing major transitions
Families with multiple needs and problems before deployment
Children with school history of special education
How well children show coping skills prior to deployment

5. Risk Factors for Military Families
Family history of mental health issues
Families of junior enlisted
Single parents
Foreign-born spouses
Pregnant spouses
Prior deployments
Dual military
Newly married

6. Stressors in the Deployment Cycle

7. Pre-Deployment Stressors
Preparedness – Practical preparation
Power of attorney/Will/Financial plan
Location of important papers
Emergency contact procedures
Child care arrangements
Emotional preparation
Prepared to cope with unexpected problems
Trust service member will be protected
Support mission

8. Pre-Deployment Stressors
Lack of Preparation Time
Unit Preparation vs. Family Preparation
Shifting expectations
Length of upcoming deployment
Open-ended deployments
Deployment date
Clarifying changes in family dynamics
Anticipation of threats to service member
Perception of mission purpose
Lack of information
Rumors

9. Deployment Stressors on Spouses
PRE-DEPLOYMENT
Confusion
Denial
Resentment
Arguing
Worrying
Planning
DURING DEPLOYMENT
Busier than usual
Crying
Loss of sleep, appetite
Engrossed in war news
Self-growth
Independence
Decision maker
Less angry, but lonelier

10. Deployment Stressors on Children
PRE-DEPLOYMENT
Confusion
Regression
Anger Outbursts
Sadness
Surprise
Guilt
Behavioral problems
DURING DEPLOYMENT
At higher risk for problems than the national norm.
Parenting stress during deployment is more than the national norm.
Boys and younger children may experience more symptoms than girls.
Internalizing symptoms may be more common than externalizing symptoms

11. Pre-Deployment Stressors on Adolescents
“I don’t care”
Fear of rejection
Denial of feelings
Anger
Higher value on friends

12. Children’s Reaction to Deployment

13. Stressors in the Deployment Cycle

14. Deployment Stressors for Service Members
Operational-heat, dehydration, lack of comforts, desert, noises, fumes
Cognitive-boredom, monotony, unclear role or mission, experiences that defy beliefs, info overload
Emotional-fear of failure, guilt, horror, fear, anxiety, feeling devalued
Social-separation from loved ones, lack of privacy, public opinion and media
Spiritual-change in faith, inability to forgive, loss of trust
Charles Figley and William Nash, Combat Stress Injury (2007)

15. Trauma descriptions offered by Soldiers and Marines
Friends burned to death, one killed in blast
A friend was liquefied in the driver’s position on a tank
A huge bomb blew my friends’ head off like 50 meters from me
Marines being buried alive
Seeing, smelling, touching, dead, blown-up people

16. Tough Realities about Combat
Fear in combat is ubiquitous
Unit members will be injured and killed
There will be communication breakdowns
Leadership failures will be perceived
Combat impacts every soldier mentally and emotionally
Combat has lasting mental health effects
Soldiers are afraid to admit that they have a mental health problem
Deployments place a tremendous strain upon families
Combat environment is harsh and demanding
Combat poses moral/ethical challenges
WRAIR Land Combat Study Team

17. Challenges of Operation Iraqi Freedom (OIF) & Operation Enduring Freedom (OEF)
No “front line”
Highly ambiguous environment
Complex and changing missions – combat, peacekeeping, humanitarian
Long deployments
Repeated deployments
Environment is very harsh – extreme heat
24 hour operations
constant movement by ground or air
limited down time
crowded uncomfortable living conditions
difficult communications

18. Combat Exposure in Iraq

19. Common Reactions to Trauma
Fear and anxiety
Intrusive thoughts about the trauma
Nightmares of the trauma
Sleep disturbance
Feeling jumpy and on guard
Concentration difficulties

20. Common Reactions to Trauma
Avoiding trauma reminders
Feeling numb or detached
Feeling angry, guilty, or ashamed
Grief and depression
Negative image of self and world
The world is dangerous
I am incompetent
People can not be trusted

21. BATTLEMIND TRAINING
Battlemind skills helped you survive in combat, but may cause you problems if not adapted when you get home
Buddies (cohesion) vs. Withdrawal
Accountability vs. Controlling
Targeted Aggression vs. Inappropriate Aggression
Tactical Awareness vs. Hypervigilance
Lethally Armed vs. “Locked and Loaded” at Home
Emotional Control vs. Anger/Detachment
Mission OPSEC vs. Secretiveness
Individual Responsibility vs. Guilt
Non-Defensive Driving vs. Aggressive Driving
Discipline and Ordering vs. Conflict

22. Social
Support
Initial
Reactions
Trauma
PTSD
Symptoms

23. The Role of Families
In general, families provide a primary source of social support.
Spouses and intimate partners are typically identified as the chief source of social support.
Approximately 50% of service members deployed to OEF/OIF are married at the time of deployment.

24. Background Invisible Wounds of War Rand Corporation (2008)
Since October 2001, approximately 1.64 million U.S. troops were deployed to Operation Enduring Freedom (OEF; Afghanistan) and Operation Iraqi Freedom (OIF; Iraq).
Pace of deployments is unprecedented in the history of the all-volunteer force (Belasco, 2007; Bruner, 2006).
Higher proportion of armed forces are being deployed & deployments have been longer, redeployment to combat has been common, and breaks between deployments have been infrequent (Hosek, Kavanagh, and Miller, 2006).

25. Background Invisible Wounds of War Rand Corporation (2008)
OEF & OIF have employed smaller forces & produced lower casualty rates of killed or wounded than Vietnam and Korea. More service members are surviving due to advances in medical technology & body armor (Regan, 2004; Warden, 2006).
However, casualties of a different kind have emerged—invisible wounds, such as mental health conditions and cognitive impairments
These deployment experiences may include multiple deployments per individual service member and exposure to difficult threats, such as improvised explosive devices (IEDs).

26. Invisible Wounds of War Rand Corporation (2008)
Data from phone survey of approximately 2000 OIF & OEF veterans
14% PTSD
14% depression
19% TBI
33% PTSD, depression or TBI
5% symptoms of all 3

27. Invisible Wounds of War Rand Corporation (2008)
Top 3 barriers to mental health treatment
1. Treatment not confidential; could constrain future job assignments and military career advancement
2. Medications may have unpleasant side effects
3. Even good mental health care is not effective

28. Invisible Wounds of War Rand Corporation (2008)
Costs of PTSD, depression and TBI–Other psychiatric diagnoses
Risk of attempting suicide
Higher rates of unhealthy behaviors (smoking, overeating, unprotected sex)
Higher rates of physical health problems and mortality
Missed more days of work or less productivity
A relationship to being homeless

29. Invisible Wounds of War Rand Corporation (2008)
Service members not on active duty (Reserve Corps, discharged, retired)
Enlisted personnel
Females
Hispanics
More lengthy deployments
More extensive exposure to combat trauma

31. Summary of Findings Invisible Wounds of War Rand Corporation (2008)
About 10-15% of Soldiers develop PTSD after deployment
An additional 10-15% have significant symptoms of depression, anxiety, or PTSD
Alcohol misuse also increases post-deployment
Prevalence varies as a function of deployment experiences
MH problems associated with functional impairment, attrition, and physical health problems
One-third of Soldiers use MH services after deployment (includes screening and prevention services)
Perceptions of stigma may be improving. However, many Soldiers don’t seek help, due to stigma and other barrier

32. Financial Stressors of Deployment
Most do not experience serious financial difficulties – Potential loss of income offset by supplements
Substantial minority does face financial hardships– 18% of spouses report serious financial difficulties
29% of spouses report trouble paying bills
1/2 reporting difficulties are from junior enlisted grades
Increased expenses– Supplies for deployed service member
Shipping costs
Communication
Additional childcare costs

33. Stressors in the Deployment Cycle

34. Typical Course of Reintegration
Family resilience is the rule, not the exception.
Usually, families return to the normal routine.
Common to incorporate changes without major disruption in family functioning.
HOWEVER…

35. Reunions can be stressful
Changed roles/responsibilities
New independence of spouse
Lack of time
Tug on loyalties
Extended family
Health/Mental health problems
Unresolved marital issues haven’t vanished

36. Most frequently identified stressors following soldiers’ return
Readjustment to marital and family relationships
Lack of time for family reintegration
Couple jealousy and suspicions
Ongoing military stressors
Uncertainty about future retention
Teitelbaum (WRAIR,1992) conducted a study with the Army after ODS

37. Post Deployment Stressors of Service Members
Physical: traffic, crowds, unarmed, access to alcohol
Cognitive: loyalty issues to family vs unit, secrecy vs disclosure, boredom, regrets, thoughts of losses
Emotional: grief, anger, feeling unsafe, guilt, withdrawal from war “rush,” numbness
Social: separated from buddies, overwhelmed or misunderstood by family, feelings of alienation
Spiritual: asking why buddies died, lack of purpose, changed faith, conflicting values
Charles Figley and William Nash, Combat Stress Injury (2007)

38. Service Mindset when Deployed
Stay focused on mission /nothing else matters
Truly life or death / always on the edge
Constant adrenaline “rush”
Black or white / all or nothing
Sense of purpose, invincibility
Only trust battle buddies /others are threat
Need to control environment
Real problems and needs exist in Iraq
Adapted from briefing by COL Kevin Gerdes, May 2008

39. Mindset of Returned Service Members at Home
Life is now unfocused and complex
No longer on the verge of life or death
What can replace the “high” of war?
Things aren’t clear cut
No sense of purpose, nothing matters
Can’t trust anybody
Can’t be in control of surroundings
Problems at home pale in comparison to those in Iraq
Adapted from briefing by COL Kevin Gerdes, May 2008

40. Reserve Components Stress after Deployment
Return to civilian life
Job may no longer be available
May experience a reduction in income
Transition of health care or loss of health coverage
Loss of unit/military support system for the family
Lack of follow up/observation by unit commanders to assess needs

41. Changes in Family faced by returning Service Members
FAMILY HAS
New routines
New responsibilities
More independence and confidence
Made many sacrifices
Worried, felt lonely
Gone through milestones that were missed
Adapted from briefing by COL Kevin Gerdes, May 2008

42. Impact of Returning Home
VETERAN’S RETURN CAN
Interrupt routine
Disrupt space
Throw off decision making
Cause family to walk on tip toes
Not make everything perfect
Not replace the sacrifices and missed milestones
Adapted from briefing by COL Kevin Gerdes, May 2008

43. Post Deployment Stressors for Spouses

44. Post Deployment Stressors for Children
Afraid of returning parent /Avoiding
Wants attention
Clingy
Anger
Needs reassurance
Attempts to split parents
Desires recognition
Joy
Excitement
Briefing by Doug Lehman, May 2008

45. Post-Deployment Stressors of Adolescents
Spending more time with friends
School problems
Behavioral problems
Relief
Defiance
Resentment
Avoidance
Withdrawal
Briefing by Doug Lehman, May 2008

46. Tips for both spouses during reintegration
Recognize that readjustment stress is common
Listen to each other’s stories and be curious
Recognize that experiences have changed both partners
Discover new family strengths
Negotiate a new balance, roles, and routine
Make sure each spouse has space

47. Tips for both spouses during reintegration
Don’t play “one-up” games about deployment
Build common interests again
Go slow
Don’t drill the other if there are concerns regarding an affair
Don’t plan sudden romantic getaways
Both spouses may feel unneeded, unwanted - discuss changes and gradually develop solutions

48. Tips for both spouses during reintegration
Expect children to test limits
Be flexible and patient
Communicate respect
Plan for future together
Compliment each other more
Be willing to apologize
Take time outs when things feel out of control

49. Tips for Both Parents during Reintegration
Spend one-on-one time with each child
Be giving of time and energy
Allow child to also have space
Listen and accept child’s feelings
Be realistic and flexible
Avoid excess gift giving
Don’t get upset if child has reactions to you
Don’t give into demands of guilt

50. Tips for Both Parents during Reintegration
Express specific concerns and offer to help but don’t push
Become an expert in available resources
Have honest discussion about financial situation
Use connections made during deployment to develop strategies to help transition
Give your child a chance to talk about war experiences
Have a battle buddy talk to your child
Armstrong, K., Best, S., & Domenici, P. (2006), Courage After Fire

51. References
The Center for Deployment Psychology
Mission of CDP: To train military and civilian psychologists and other mental health professionals to provide high quality deployment-related behavioral health services to military personnel and their families.
CDP's Course Resources:
Introduction to the CDP (powerpoint)  
PTSD and Domestic Violence (powerpoint)  
Families in the Wake of Trauma (powerpoint)
CDP's Links :