Psychosocial Functioning of Partners of Australian Combat Veterans

Abstract

Combat veterans do not always come back from a military zone damaged, but they do come back changed. Their families, particularly their partners and wives, can be affected greatly. The change is detrimental to family relationships and takes a toll on the family's physical and psychosocial wellbeing. Research has shown that partners of combat veterans have poorer mental and social health and higher somatic and physical illness than their counterparts whose partners have not actively served in the military. There is a lack of research on the effects of living and/or caring for a veteran with Post Traumatic Stress Disorder (PTSD). Most research has used standard measures that apply to those caring for someone for example with Dementia, Multiple Sclerosis or a severe psychotic disorder. Those who live and care for someone with PTSD can testify to the swings of highs and lows and the multitude of emotional symptoms that can occur not only on a weekly basis, but also on a daily basis. This work attempts to examine more closely what issues cause the most distress and the interplay between the PTSD symptoms and the effects on the partner, as a conduit to more in-depth research for future reference. Chapter 1 reviewed the relevant literature from Australia and overseas that examines the psychosocial functioning of partners of combat veterans. Most studies in 'caregiving' literature arise from living and working with the elderly suffering from mental health problems or dementia. While the studies were from varying countries and cultures, there was a similarity of patterns of poorer health and well-being outcomes among partners. There was no common measure to assess the unique problems that partners faced when living with a current serving or retired combat veteran; that is, most research looked at caring for the aged or non- military population. Chapter 1 also described the theoretical model of trauma, and critically evaluated caregiving and stress appraisal literature for an in-depth understanding of the context of living and caring for someone with combat/war-related mental health problems. Chapter 2 examined qualitative data surrounding major issues that female partners of Australian Vietnam veterans face. This was investigated via focus groups conducted across New South Wales. The partners of combat veterans compared their lives to living in their own war zone at home. Major themes of negative outcomes were identified, including mental and physical health. All partners were searching for a meaning in life; most identified themselves as primary carers. The participants in this study were wives of Vietnam veterans. Chapter 3 investigated the specific causes of distress in partners of Australian combat veterans and quantified how much distress about each of these specific factors was felt by the partners. Subjective burden was measured and exploratory and confirmatory factor analyses were conducted to develop a measurement tool, known as Partners of Veterans-Distress Scale (POV-DS), for assessing specific caregiving distress experienced by partners of Australian combat veterans. Chapter 4 explored the role of distinctive dimensions of partners' distress, as assessed by a revised version of the POV-DS (POV-DSR) in the relationship between the veterans' level of impairment (posttraumatic stress disorder [PTSD] symptoms) and the partners' psychological functioning (marital adjustment, mental health and satisfaction with life). Following from Chapter 3 and previous research, we predicted that greater levels of PTSD symptoms experienced by veterans would be associated with higher levels of caregiving distress in their partners, which, in turn, would result in poorer psychological functioning in partners of combat veterans. Our findings suggested that partners reported distress related to exhaustion and intimacy problems which significantly mediated the relationship between veterans' PTSD symptoms and their partners' satisfaction with life. Furthermore, partners' distress associated with intimacy problems was the sole significant mediator for their dyadic adjustment, and exhaustion was the only significant mediator for partners' mental health. Chapter 5 compared the mental health outcomes (depression, anxiety and stress) of four groups of partners with Australian normative data: (a) partners of older Australian combat veterans, (b) a random sub sample of partners of Australian combat veterans from the previous sample, (c) partners of current serving Special Air Service Regiment (SASR) and (d) partners of current serving non-SASR. The sample comprising current serving SASR personnel partners reported significantly lower levels of depression and anxiety, while the sample consisting of non-SASR personnel partners reported significantly higher levels of stress. In addition, partners of Vietnam veterans reported significantly poorer depressive, anxiety and stress symptomatology. Finally, Chapter 6 examined the interrelationships between veterans' PTSD symptomatology and six POV-DSR indices (Exhaustion, Hypervigilance, Social Isolation, Intimacy Problems, Financial Problems and Sleep Problems for Time 1 and all of the latter with Negative Affect for Time 2 and Time 3). Using Structural Equation Modeling, we tested the Actor-Partner Interdependence Model (APIM) examining interrelations between veterans' PTSD symptoms and six dimensions of partner distress at three time points (collected over a 2-year period). The APIM is a model of dyadic relationships that integrates a conceptual view of interdependence in a two-person relationship. Findings highlighted the interdependence between veterans' PTSD symptomatology and distress in the partner over time. Actor Effects measure how much a person's current behaviour is predicted by their past behaviour, while the Partners Effect measure how much a person is influenced by the partner. Significant Actor Effects were found at Times 1 to 2 and Times 2 to 3 for all POV-DSR items, plus Negative Affect which is an item from the original POV-DS. There were no significant partner effects at Times 1 to 2, but significant Partner Effects were present at Times 2 to 3. Significant Partner Effects were evident for Intimacy Problems at Time 2 to PTSD symptomatology at Time 3; Negative Affect Time 2 to PTSD symptomatology at Time 3; Financial Problems at Time 2 to PTSD symptomatology at Time 3; Hypervigilance at Time 2 to PTSD symptomatology at Time 3 and vice versa; and Sleep problems at Time 2 with PTSD symptomatology at Time 3. This project hopes to add to the literature on the effects of living with a combat veteran. We hope to show that there are consequences for the psychosocial functioning (for example: distress, mental health, satisfaction with life and dyadic adjustment) for those partners in addition to the PTSD symptoms of the veteran.