Advertisement

Military Posttraumatic Stress Disorder: A Qualitative Systematic Review of the Experience of Families, Parents and Children

  • Violette E. McGawEmail author
  • Andrea E. Reupert
  • Darryl Maybery
Review Paper
  • 13 Downloads

Abstract

Objectives

Research into military-related posttraumatic stress disorder (PTSD) and the impact to families is growing. However, qualitative studies exploring the family life or parenting experiences of military/veteran families living with PTSD appears limited. The current paper aimed to systematically review research that explored different family members’ experiences of living in families where a parent had a military related PTSD.

Methods

Adhering to the PRISMA guidelines for systematic reviews, six online databases were comprehensively searched, along with manual searches of relevant journals, reviews and reference lists. Interrater reliability for identifying papers was established through blind co-screening of 20% of search results, with minimal initial discrepancy. Eleven studies were identified. Each study was critically appraised for quality using the RATS (relevancy, appropriateness, transparency, soundness) qualitative research review guidelines.

Results

Thematic analysis identified six primary themes including: the absent parent; walking on eggshells; still part of the family; children and partners as care givers; making sense and understanding; and long-term impacts upon the family. Quality of the identified research was mixed.

Conclusions

The existing literature is extended by presenting a systematic review of published qualitative research on the subjective experiences of the parent with military-related PTSD, their partner and children. Themes across veteran, partner and child focused papers illustrated interconnected elements of the family experience of PTSD. Future studies might integrate the views of family members. Clinicians need to be mindful of the relational context in which PTSD exists.

Keywords

Qualitative systematic review Posttraumatic stress disorder Veterans Families Parenting 

Notes

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflict of interest.

References

  1. *Denotes references of the studies included in systematic reviewGoogle Scholar
  2. Ackerson, B. (2003). Coping with the dual demands of severe mental illness and parenting: the parents’ perspective. Families in Society, 84(1), 109–118.  https://doi.org/10.1606/1044-3894.69.Google Scholar
  3. Al-Turkait, F.A., & Ohaeri, J.U. (2008). Psychopathological status, behavior problems, and family adjustment of Kuwaiti children whose fathers were involved in the first Gulf War. Child and Adolescent Psychiatry and Mental Health, 2(1), 12. http://www.capmh.com/content/2/1/12.
  4. American Psychiatric Association (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.Google Scholar
  5. Banneyer, K.N., Koenig, S.A., Wang, L.A., & Stark, K.D. (2017). A review of the effects of parental PTSD: a focus on military children. Couple and Family Psychology: Research and Practice, 6(4), 274–286.  https://doi.org/10.1037/cfp0000093.Google Scholar
  6. Berz, J., Taft, C., Watkins, L., & Monson, C. (2008). Associations between PTSD symptoms and parenting satisfaction in a female veteran sample. Journal of Psychological Trauma, 7(1), 37–45.  https://doi.org/10.1080/19322880802125969.Google Scholar
  7. Braun, V., & Clarke, V. (2006). Using thematic analysis in psychology. Qualitative Research in Psychology, 3(2), 77–101.  https://doi.org/10.1191/1478088706qp063oa.Google Scholar
  8. Calhoun, P.S., Beckham, J.C., & Bosworth, H.B. (2002). Caregiver burden and psychological distress in partners of veterans with chronic posttraumatic stress disorder. Journal of Traumatic Stress, 15(3), 205–212.  https://doi.org/10.1023/a:1015251210928.Google Scholar
  9. Clark, J.P. (2003). How to peer review a qualitative manuscript. In F. Godlee & T. Jefferson (Eds.), Peer review in health sciences. 2 Edn. (pp. 219–235). London: BMJ Books.Google Scholar
  10. Cohen, E., Zerach, G., & Solomon, Z. (2011). The implication of combat-induced stress reaction, PTSD, and attachment in parenting among war veterans. Journal of Family Psychology, 25(5), 688–698.  https://doi.org/10.1037/a0024065.Google Scholar
  11. Creech, S.K., & Misca, G. (2017). Parenting with PTSD: a review of research on the influence of PTSD on parent-child functioning in military and veteran families. Frontiers in Psychology, 8, 1101.  https://doi.org/10.3389/fpsyg.2017.01101.PubMedCentralGoogle Scholar
  12. Fossey, E., Harvey, C., McDermott, F., & Davidson, L. (2002). Understanding and evaluating qualitative research. Australian and New Zealand Journal of Psychiatry, 36(6), 717–732.  https://doi.org/10.1046/j.1440-1614.2002.01100.x.Google Scholar
  13. *Frederikson, L.G., Chamberlain, K., & Long, N. (1996). Unacknowledged casualties of the Vietnam war: experiences of the partners of the New Zealand veterans. Qualitative Health Research, 6, 49–70.  https://doi.org/10.1177/104973239600600104.Google Scholar
  14. Gerlock, A.A., Grimesey, J., & Sayre, G. (2014). Military-related posttraumatic stress disorder and intimate relationship behaviors: developing a dyadic relationship model. Journal of Marital and Family Therapy, 40(3), 344–56.  https://doi.org/10.1111/jmft.12017.Google Scholar
  15. *Harrison, D., Albanese, P., & Berman, R. (2014). Parent-adolescent relationships in military families affected by post-traumatic stress disorder. Canadian Social Work Review, 31(1), 85–107.Google Scholar
  16. Jobe-Shields, L., Flanagan, J.C., Killeen, T., & Back, S.E. (2015). Family composition and symptom severity among Veterans with comorbid PTSD and substance use disorders. Addictive Behaviors, 50, 117–123.  https://doi.org/10.1016/j.addbeh.2015.06.019.PubMedCentralGoogle Scholar
  17. Jordan, B., Marmar, C.R., Fairbank, J.A., Schlenger, W.E., Kulka, R.A., Hough, R.L., & Weiss, D.S. (1992). Problems in families of male Vietnam veterans with posttraumatic stress disorder. Journal of Consulting and Clinical Psychology, 60(6), 916–926.  https://doi.org/10.1037/0022-006x.60.6.916.Google Scholar
  18. *Kwan-Lafond, D., Harrison, D., & Albanese, P. (2011). Parental military deployments and adolescents’ household work. Studies in Political Economy, 88(1), 163–189.  https://doi.org/10.1080/19187033.2011.11675013.Google Scholar
  19. Leijdesdorff, S., van Doesum, K., Popma, A., Klaassen, R., & van Amelsvoort, T. (2017). Prevalence of psychopathology in children of parents with mental illness and/or addiction: an up to date narrative review. Current Opinion in Psychiatry, 30(4), 312–317.Google Scholar
  20. *Leiner, B. (2009). The legacy of war: an intergenerational perspective. Smith College Studies in Social Work, 79(3-4), 375–391.  https://doi.org/10.1080/00377310903249884.Google Scholar
  21. Lincoln, A., Swift, E., & Shorteno-Fraser, M. (2008). Psychological adjustment and treatment of children and families with parents deployed in military combat. Journal of Clinical Psychology, 64(8), 984–992.  https://doi.org/10.1002/jclp.20520.Google Scholar
  22. *Maloney, L.J. (1988). Post traumatic stresses on women partners of Vietnam veterans. Smith College Studies in Social Work, 58(2), 122–143.  https://doi.org/10.1080/00377318809516639.Google Scholar
  23. Maybery, D., Ling, L., Szakacs, E., & Reupert, A. (2005). Children of a parent with a mental illness: perspectives on need. Australian e-Journal for the Advancement of Mental Health, 4(2), 78–88.  https://doi.org/10.5172/jamh.4.2.78.Google Scholar
  24. *McCormack, L., & Devine, W. (2016). Childhood and the imposition of war: self-blame, absolution/nonabsolution, and vicarious growth in adult children of Vietnam veterans. Traumatology, 22(4), 278–287.  https://doi.org/10.1037/trm0000097.Google Scholar
  25. *McCormack, L., & Sly, R. (2013). Distress and growth: the subjective “lived” experiences of being the child of a Vietnam veteran. Traumatology, 19(4), 303–312.  https://doi.org/10.1177/1534765613481855.Google Scholar
  26. Moher, D., Liberati, A., Tetzlaff, J., Altman, D.G., & the PRISMA Group. (2009). Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Medicine, 6(7), e1000097.  https://doi.org/10.1371/journal.pmed1000097.PubMedCentralGoogle Scholar
  27. Ouzzani, M., Hammady, H., Fedorowicz, Z., & Elmagarmid, A. (2016). Rayyan—a web and mobile app for systematic reviews, Systematic Reviews, 5. https://systematicreviewsjournal.biomedcentral.com/articles/10.1186/s13643-016-0384-4.
  28. Pemberton, J.R., & Kramer, T.L., & Borrego, J.Jr., & Owen, R.R. (2013). Kids at the VA? A call for evidence-based parenting interventions for returning veterans. Psychological Services, 10(2), 194–202.  https://doi.org/10.1037/a0029995.Google Scholar
  29. Perry, A., & Hammond, N. (2002). Systematic reviews: the experiences of a PhD student. Psychology Learning and Teaching, 2(1), 32–35.  https://doi.org/10.2304/plat.2002.2.1.32.Google Scholar
  30. Reupert, A., & Maybery, D. (2009). Fathers’ experience of parenting with a mental illness. Families in Society: The Journal of Contemporary Social Services, 90(1), 61–68.  https://doi.org/10.1606/1044-3894.3846.Google Scholar
  31. Reupert, A., & Maybery, D. (2016). What do we know about families where parents have a mental illness? A systematic review. Child & Youth Services, 37(2), 98–111.  https://doi.org/10.1080/0145935X.2016.1104037.Google Scholar
  32. Reupert, A.E., & Maybery, D.J. (2015). Stigma and families where a parent has a mental illness. In A. Reupert, D. Maybery, J. Nicholson, M. Gopfert & M. Seeman (Eds.), Parental psychiatric disorder: distressed parents and their families (pp. 51–60). Cambridge, UK: Cambridge University Press.Google Scholar
  33. *Rosenheck, R.A. (1986). Impact of posttraumatic stress disorder of World War II on the next generation. Journal of Nervous and Mental Disease, 174(6), 319–327.  https://doi.org/10.1097/00005053-198606000-00001.Google Scholar
  34. Ruscio, A., Weathers, F., King, L., & King, D. (2002). Male war-zone veterans’ relationship with their children: the importance of emotional numbing. Journal of Traumatic Stress, 15(5), 311–315.Google Scholar
  35. Samper, R., Taft, C., King, D., & King, L. (2004). Posttraumatic stress disorder symptoms and parenting satisfaction among a national sample of male Vietnam veterans. Journal of Traumatic Stress, 17(4), 311–315.Google Scholar
  36. Scharf, M. (2007). Long-term effects of trauma: psychosocial functioning of the second and third generation of holocaust survivors. Development and Psychopathology, 19(2), 603–622.  https://doi.org/10.1017/0S0954579407070290.Google Scholar
  37. *Sherman, M.D., Gress Smith, J.L., Straits-Troster, K., Larsen, J.L., & Gewirtz, A. (2016). Veterans’ perceptions of the impact of PTSD on their parenting and children. Psychological Services, 13(4), 401–410.  https://doi.org/10.1037/ser0000101.Google Scholar
  38. *Sherman, M.D., Larsen, J., Straits-Troster, K., Erbes, C., & Tassey, J. (2015). Veteran-child communication about parental PTSD: a mixed methods pilot study. Journal of Family Psychology, 29(4), 595–603.  https://doi.org/10.1037/fam0000124.Google Scholar
  39. Smith-Osborne, A., Wilder, A., & Reep, E. (2013). A review of reviews examining neurological processes relevant to impact of parental PTSD on military children: implications for supporting resilience. Journal of Aggression, Maltreatment & Trauma, 22, 461–481.  https://doi.org/10.1080/10926771.2013.785454.Google Scholar
  40. Thanhauser, M., Lemmer, G., de Girolamo, G., & Christiansen, H. (2017). Do preventive interventions for children of mentally ill parents work? Results of a systematic review and meta-analysis. Current Opinion in Psychiatry, 30(4), 283–299.  https://doi.org/10.1097/YCO.0000000000000342.Google Scholar
  41. Thomas, J., & Harden, A. (2008). Methods for the thematic synthesis of qualitative research in systematic reviews. BMC Medical Research Methodology, 8(1), 45.  https://doi.org/10.1186/1471-2288-8-45.PubMedCentralGoogle Scholar
  42. Tong, A., Flemming, K., McInnes, E., Oliver, S., & Craig, J. (2012). Enhancing transparency in reporting the synthesis of qualitative research: ENTREQ. BMC Medical Research Methodology, 12(1), 181.  https://doi.org/10.1186/1471-2288-12-181.PubMedCentralGoogle Scholar
  43. Weissman, M.M., Berry, O.O., Warner, V., Gameroff, M.J., Skipper, J., Talati, A., ... Wickramaratne, P. (2016). A 30-year study of 3 generations at high risk and low risk for depression. JAMA Psychiatry, 73(9), 970–977.  https://doi.org/10.1001/jamapsychiatry.2016.1586.PubMedCentralGoogle Scholar
  44. *Yambo, T.W., Johnson, M.E., Delaney, K.R., Hamilton, R., Miller, A.M., & York, J.A. (2016). Experiences of military spouses of veterans with combat‐related posttraumatic stress disorder. Journal of Nursing Scholarship, 48(6), 543–551.  https://doi.org/10.1111/jnu.12237.Google Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Faculty of EducationMonash UniversityClaytonAustralia
  2. 2.School of Rural HealthMonash UniversityMoeAustralia

Personalised recommendations