Abstract
Background
The bi-directional relationships between combat-induced posttraumatic symptoms and family relations are yet to be understood. The present study assesses the longitudinal interrelationship of posttraumatic intrusion and avoidance and family cohesion among 208 Israeli combat veterans from the 1982 Lebanon War.
Methods
Two groups of veterans were assessed with self-report questionnaires 1, 3 and 20 years after the war: a combat stress reaction (CSR) group and a matched non-CSR control group.
Results
Latent Trajectories Modeling showed that veterans of the CSR group reported higher intrusion and avoidance than non-CSR veterans at all three points of time. With time, there was a decline in these symptoms in both groups, but the decline was more salient among the CSR group. The latter also reported lower levels of family cohesion. Furthermore, an incline in family cohesion levels was found in both groups over the years. Most importantly, Autoregressive Cross-Lagged Modeling among CSR and non-CSR veterans revealed that CSR veterans’ posttraumatic symptoms in 1983 predicted lower family cohesion in 1985, and lower family cohesion, in turn, predicted posttraumatic symptoms in 2002.
Conclusions
The findings suggest that psychological breakdown on the battlefield is a marker for future family cohesion difficulties. Our results lend further support for the bi-directional mutual effects of posttraumatic symptoms and family cohesion over time.
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References
Combrinck-Graham LA (1985) A developmental model for family systems. Fam Proc 24:139–150
Dekel R, Monson CM (2010) Military related post traumatic stress disorder and family relations: current knowledge and future directions. Aggress Violent Beh 15(4):303–309
Taft CT, Schumm JA, Panuzio J, Proctor SP (2008) An examination of family adjustment among Operation Desert Storm veterans. J Consult Clin Psychol 76:648–659
O’Toole BI, Catts SV, Outram S, Pierse KR, Cockburn J (2009) The physical and mental health of Australian Vietnam veterans 3 decades after the war and its relation to military service, combat, and post-traumatic stress disorder. Am J Epidemiol 170:318–330
American Psychiatric Association (2000) Diagnostic and Statistical Manual of Mental Disorders, 4th edn, text rev. American Psychiatric Association, Washington
Solomon Z, Mikulincer M (2006) Trajectories of PTSD: a 20-year longitudinal study. Am J Psych 163:659–666
Koenen K, Stellman JM, Stellman SD, Sommer JF (2003) Risk factors for course of posttraumatic stress disorder among Vietnam veterans: a 14-Year follow- up of American legionnaires. J Consult Clin Psychol 71:980–986
Zeiss RA, Dickman HR (1989) PTSD 40 years later: incidence a person-situation correlates in former POW’s. J Clin Psychol 45:80–87
Wolfe J, Erickson DJ, Sharkansky EJ, King DW, King LA (1999) Course and predictors of posttraumatic stress disorder among gulf war veterans: a prospective analysis. J Consult Clin Psychol 67:520–528
Port LC, Engdahl B, Frazier P (2001) A longitudinal and retrospective study of PTSD among older prisoners of war. Am J Psychiatry 158:1474–1479
Orcutt HK, Erickson DJ, Wolfe J (2004) The course of PTSD symptoms among Gulf War veterans: a growth mixture modeling approach. J Trauma Stress 17:195–202
Mililiken CS, Auchterlonie JL, Hoge CW (2007) Longitudinal assessment of mental health problems among active and reserve component soldiers returning from the Iraq war. JAMA 298(18):2141–2148
Erbes CR, Meis LA, Polusny MA, Compton JS (2011) Couple adjustment and posttraumatic stress disorder symptoms in National Guard veterans of the Iraq war. J Fam Psych 25:479–487
O’Donnell C, Cook JM, Thompson R, Riley K, Neria Y (2006) Verbal and physical aggression in World War II former prisoners of war: role of posttraumatic stress disorder and depression. J Trauma Stress 19:859–866
Kulka RA, Schlenger WE, Fairbank JA, Hough RL, Jordan BK, Marmar CR, Weiss DS (1990) Trauma and the Vietnam War Generation. Brunner/Mazel, New York
Taft CT, Pless AP, Stalans LJ, Koenen KC, King LA, King DW (2005) Risk factors for partner violence among national sample of combat veterans. J Consult Clin Psychol 73:151–159
Allen ES, Rhoades GK, Stanley SM, Markman HJ (2010) Hitting home: relationships between recent deployment, posttraumatic stress symptoms, and marital functioning for army couples. J Fam Psychol 24(3):280–288
Zerach G, Ben-David A, Solomom Z, Heruti R (2010) Posttraumatic symptoms, marital intimacy, dyadic adjustment and sexual satisfaction among ex-prisoners of war. J Sex Med 7:2739–2749
Renshaw KD, Rodrigues CS, Jones DH (2008) Psychological symptoms and marital satisfaction in spouses of Operation Iraqi Freedom veterans: relationships with spouses’ perception of veterans’ experiences and symptoms. J Fam Psychol 22:586–594
Riggs DS, Byrne CA, Weathers FW, Litz BT (1998) The quality of the intimate relationships of male Vietnam veterans: problems associated with posttraumatic stress disorder. J Trauma Stress 11:87–101
Hendrix CC, Jurich A, Schumm WR (1995) Long-term impact of Vietnam war service on family environment and satisfaction. Fam Soc 76:498–506
Sutker PB, Davis JM, Uddo M, Ditta SR (1995) War zone stress, personal resources, and PTSD in Persian Gulf War returnees. J Abnorm Psychol 104:444–452
Solomon Z, Mikulincer M, Freid B, Wosner Y (1987) Family characteristic and posttraumatic stress disorder: a follow-up of Israeli combat stress reaction casualties. Fam Proc 26:383–394
Galovski T, Lyons JA (2004) Psychological sequelae of combat violence: a review of the impact of PTSD on veteran’s family and possible interventions. Aggress Violent Beh 9:477–501
King DW, King LA, Foy DW, Keane TM, Fairbank JA (1999) Posttraumatic stress disorder in a national sample of female and male Vietnam veterans: Risk factors, war-zone stressors, and resilience-recovery variables. J Abnorm Psychol 108:164–170
Vogt D, Smith B, Elwy R, Martin J, Schultz M, Drainoni M, Eisen S (2011) Predeployment, deployment, and postdeployment risk factors for posttraumatic stress symptomatology in female and male OEF/OIF veterans. J Abnorm Psych 120:819–831
Hosek JR, Kavanagh J, Miller L (2006) How deployments affect service members. The RAND Corporation, Santa Monica
Warner CH, Appenzeller GN, Warner CM, Grieger T (2009) Psychological effects of deployments of military families. Psycihat Ann 39:56–63
Figley CR (1983) Catastrophes: An overview of family reactions. In: Figley CR, Hamilton IM (eds) Stress and the Family, II: Coping with Catastrophe. Brunner/Mazel, New York, pp 3–36
Silver SM, Iacono C (1986) Symptom group and family patterns of Vietnam veterans with Post-traumatic strees disorders. In: Figley CR (ed) Trauma and its wake, II: Traumatic stress, theory, research, and intervention. Brunner/Mazel, New York, pp 78–96
Nelson-Goff BS, Smith DB (2005) Systemic traumatic stress: the couple adaptation to traumatic stress model. J Marital Fam Ther 31(2):145–157
Benotsch EG, Brailey K, Vasterling JJ, Uddo M, Constans JI, Sutker PB (2000) War Zone stress, personal and environmental resources, and PTSD symptoms in Gulf War Veterans: a longitudinal perspective. J Abnorm Psychol 109:205–213
Evans L, Cowlishaw S, Hopwood M (2009) Family functioning predicts outcomes for veterans in treatment for chronic posttraumatic stress disorder. J Fam Psychol 23(4):531–539
Whisman MA, Uebelacker LA, Bruce ML (2006) Longitudinal association between marital dissatisfaction and alcohol use disorders in a community sample. J Fam Psychol 20(1):164–167
Horowitz M, Wilner N, Alvarez W (1979) Impact of Event Scale: a measure of subjective stress. Psychosom Med 41:209–218
Schwartwald J, Solomon Z, Weisenberg M, Mikulincer M (1987) Validation of Impact of Event Scale for psychological sequelae of combat. J Consult Clin Psychol 55:251–256
Horowitz MJ (1976) Stress Response Syndromes. Jason Aronson, New York
Horowitz M (1982) Stress response syndromes and their treatment. In: Goldberger L, Breznitz S (eds) Handbook of stress: Theoretical and Clinical Aspects. Free Press, New York, pp 711–732
Sundin EC, Horowitz MJ (2002) Impact of Event Scale: psychometric properties. Br J Psychiatry 180:205–209
Moos RH, Moos BS (1986) Family Environment Scale Manual, 2nd edn. Consulting Psychologists Press, Palo Alto
Olson DH (1999) Circumplex model of marital and family systems. In: Walsh F (ed) Normal Family Processes, 2nd edn. Guilford Press, New York
Bollen KA, Curran PJ (2006) Latent Curve Models. A Structural Equation Perspective. Wiley-Interscience, Hoboken
Bentler PM, Wu EJ (1995) EQS for Windows User’s Guide. Multivariate Software, Encino
Anderson TW (1960) Some stochastic process models for intelligence test scores. In: Arrow KJ, Karlin K, Suppes P (eds) Mathematical Methods in the Social Sciences. Stanford University Press, Stanford
Nash WP (2007) Combat/operational stress adaptations and injuries. In: Figley CR, Nash WP (eds) Combat Stress Injury: Theory, Research, and Management. Routledge, New York, pp 33–64
Creamer M, Burgess P, Pattison P (1992) Reaction to trauma: a cognitive processing model. J Abnorm Psychol 101:452–459
Horowitz MJ (1997) Stress Response Syndromes, 3rd edn. Jason Aronson, New York
Sundin EC, Horowitz MJ (2003) Horowitz’s impact of Event Scale evaluation of 20 years of use. Psychosom Med 65:870–876
Ehlers A, Clark DM (2000) A cognitive model of Posttraumatic stress disorder. Behav Res Ther 38:319–345
Hackmann A, Ehlers A, Speckens A, Clark DM (2004) Characteristics and content of intrusive memories in PTSD and their changes with treatment. J Trauma Stress 17:231–240
Koren D, Arnon I, Klein E (2001) Long term course of chronic posttraumatic stress disorder in traffic accident victims: a three-year prospective follow-up study. Beh Res Ther 39:1449–1458
Solomon Z, Zur-Noah S, Horesh D, Zerach G, Keinan G (2008) Contribution of stressful life events throughout the life cycle to combat-induced psychopathology. J Trauma Stress 21:318–325
Boss P, Couden BA (2002) Ambiguous loss from chronic physical illness: clinical interventions with individuals, couples, and families. J Clin Psychol 58:1351–1360
Beckham JC, Moore SD, Reynolds V (2000) Interpersonal hostility and violence in Vietnam combat veterans with chronic posttraumatic stress disorder: a review of theoretical models and empirical evidence. Aggress Violent Beh 5:451–466
Solomon Z (1988) The effect of combat-related posttraumatic stress disorder on the family. Psychiatry 51:323–329
Harkness LL (1993) Transgenerational transmission of war- related trauma. In: Wilson JP, Raphael B (eds) International Handbook of Traumatic Stress Syndromes. Plenum, New York, pp 635–641
American Psychiatric Association (1994) Diagnostic and Statistical Manual of Mental Disorders, 4th edn. American Psychiatric Association, Washington
Weiss S, Marmar CR (1997) The Impact of Event Scale-Revised. In: Wilson JP, Keane TM (eds) Assessing psychological trauma and PTSD: A handbook for practitioners. Guilford Press, New York, pp 399–411
Sherman MD, Zanotti DK, Jones DE (2005) Key elements in couple’s therapy with veterans with combat-related posttraumatic stress disorder. Prof Psychol Res Prac 36:626–633
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Zerach, G., Solomon, Z., Horesh, D. et al. Family cohesion and posttraumatic intrusion and avoidance among war veterans: a 20-year longitudinal study. Soc Psychiatry Psychiatr Epidemiol 48, 205–214 (2013). https://doi.org/10.1007/s00127-012-0541-6
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DOI: https://doi.org/10.1007/s00127-012-0541-6