1.2 - Impact of veteran's experiences on their families

The family experience within the Australian Defence Force

Having a family member in the Australian Defence Force (ADF) can involve a great deal of pride and provide a strong sense of community. Members and their families often describe the military in familial terms, due to the strong bonds, shared values and sense of belonging afforded by Defence careers. These positive identifications can also extend to ex-ADF members, veterans and their families.

Military life can also involve difficulties for families, particularly in managing the expectations of military and civilian cultures. Values that may be important in a military context such as discipline and obedience to authority may not always mesh with civilian behaviours and values, such as negotiation and compromise. The practical realities of military life have perhaps the most significant impacts on family functioning, including long absences during training and deployments, changes in roles and responsibilities, adapting to regular relocations, and managing upheavals in partners’ careers and children’s schooling. Military families have to cope with the potential for exposure to extraordinary risks, such as the injury or death in combat of a family member. A potentially challenging period for some is the transition out of the military. Separation from Defence can involve changes in location, finances and family roles (e.g., the partner of a veteran becoming the main income earner).

The emotional and physical impact of exposure to combat, humanitarian, peacekeeping and peacemaking experiences for veterans can have long-term consequences for many families. For example, recurring depression, chronic substance abuse or posttraumatic stress disorder (PTSD) may lead to long-term conflict or disengagement within the family. Anxiety about the veteran’s mental health and taking on the role of carer can also take a toll on family members.

The difficulties encountered by military families have had varied impacts across generations and for different conflicts. For example, the Vietnam War involved conscription as well as deployment of full-time professional forces. Many families of conscripted veterans were shaped by the unexpected impact of the war and what often turned out to be well over 300 days of absence. It was not unusual for Vietnam veterans to have started a relationship or a family just before being conscripted, and to return markedly changed by their war experience. For more than half of recent veterans, their families have had to cope with multiple deployments, which can place significant strains on relationships, change parenting roles, and impact on the whole family’s social networks

There are significant generational differences in how families respond to service related stress. The divorce rate of Vietnam veterans is slightly lower than that of the general population, though high rates of depression, substance use and PTSD amongst Vietnam veterans have affected the subsequent mental health of their partners and children (Australian Institute of Health and Welfare, 1998). In contrast, the rate of marital separation is higher for recent veterans, who are also more likely to have blended families.

When working with veterans, it is important to consider the experiences of family members and their role in the veteran’s recovery. A sense of connection and belonging is essential for recovery from mental health problems, and a treatment approach that includes family is likely to lead to more successful outcomes for veterans. It also mitigates risks associated with mental health problems, as relationship breakdown and social isolation are significant risk factors for suicidal behaviour (Van Orden et al., 2010).

The impact of training and deployment

When a serving member is deployed (or absent for long periods during pre-deployment training) the whole family is affected. During deployment, family members have to cope with the absence of the serving member and uncertainty around his or her safety. They also have to adapt by taking on new roles. For example, partners may have to take sole responsibility for managing budgets, and older children may have to care for their siblings. The nature of military postings may mean that additional support from friends or family is not readily available. These roles and relationships, as partners and parents, often have to be renegotiated once the serving member returns. Reintegration into family life can also be hampered by mental health issues exacerbated or developed since deployment

Further Information

Veteran's families: provides further information on the impact of military service and PTSD on veterans's families.

Impact of mental health issues on family members

As in any family environment, mental health issues can have a significant impact upon individual family members and the functioning of the family unit.

Mental health issues can impact on a person’s ability to parent effectively. For example, a parent with depression may find he or she has little motivation or energy, and therefore struggles to interact with the children; he or she may become irritable and less patient with children or may lack the confidence to set limits. Children who have a parent with a mental health issue are more likely to experience behavioural problems, difficulties in forming and maintaining relationships, poor coping skills, academic difficulties, and are more likely to develop mental health issues themselves. These issues can continue into adulthood. For example, adult children of Vietnam veterans have a higher rate of accidental death and suicide than other Australians (Australian Institute of Health and Welfare, 1999).

Veterans’ mental health can also significantly impact upon partners. In addition to dealing with problems associated with mental health issues such as emotional withdrawal, substance abuse or suicide threats or attempts, partners may have to take on additional responsibilities in the family home, or adapt to unwanted lifestyle changes such as increased isolation from their friends and community (Evans et al., 2003). This can lead to strain in relationships, inhibit intimacy, and can isolate not only the veteran but the whole family from potentially valuable social support. Partners of veterans with a mental health problem are more likely to experience mental health problems (particularly anxiety disorders and severe depression) than the general population (O'Toole, Outram, Catts, & Pierse, 2010).

The impact of PTSD on relationships

The symptoms associated with PTSD (intrusive memories, hyperarousal and avoidance) can lead to particular difficulties in family relationships. Hyperarousal can contribute to aggression and domestic violence (Monson, Taft, & Fredman, 2009). Avoidance can inhibit intimacy between a veteran and their partner, and reduce satisfaction with the relationship (Evans, McHugh, Hopwood, & Watt, 2003). Partners of veterans have also been said to experience vicarious trauma as a result of being exposed to their partner’s PTSD (Lambert & Morgan, 2009). Partners can also experience anxiety, depression, social isolation and feelings of hopelessness as a result of their partner’s trauma and subsequent symptoms (Hutchinson & Banks-Williams, 2006). Partners have talked about ‘walking on eggshells’ around their veteran partner and being afraid of the veteran’s symptoms.

Impact of being widowed or losing a parent

There are currently approximately 95,000 dependents of veterans, including widows and widowers of veterans and children who have lost a veteran parent, with the majority from the World War II generation. Widows and widowers and their children may have experienced the death of their veteran in quite different ways. They may have lost their family member during a deployment, or months or years later from a war-caused injury, physical illness or suicide.

The needs of widows, widowers and children of deceased veterans vary depending on the circumstances of their loss. If a veteran has died at a comparatively young age, especially under unexpected and sudden circumstances, their family will not only be experiencing intense grief, but may also have to face unplanned-for problems such as managing financial arrangements or adapting to a single-parent household. For many families, grief reactions may still be present years after the veteran has died, and mental health issues such as depression and anxiety associated with the death may be longstanding.

Veterans with mental health issues have an increased risk of death by suicide (Dunt, 2009). Families who experience the death of a family member by suicide may encounter additional difficulties due to the nature of the death. Family members may be angry that their parent, spouse or child has taken their own life and confused about why it happened. They may feel that they need to conceal the nature of the death and may feel stigmatised and ashamed (Sveen & Walby, 2008). Families of a veteran who has committed suicide may find it difficult to talk to other people about their experience and may find it difficult to access help to assist them in adjusting to life without their family member.

Providing care in a family sensitive way

The involvement of partners and family in the assessment and treatment of a veteran can have positive impacts on a veteran's recovery and helps identify the needs of family members so that they can be adequately supported or referred. Involvement of family members in assessment and treatment allows accurate, hopeful messages about support and treatment to be shared. Family members are invaluable sources of helpful information about the veteran’s mental health, providing more objective assessments of changes in veteran’s mood and behaviour. Families can also provide support and motivation to seek help and maintain involvement in treatment. In addition, veterans may be more likely to seek help and engage with mental health services alongside their families if they believe it is of benefit to their family (Batten et al., 2009). Veteran recovery from mental health issues can be significantly impeded by increased stress, poor relationships and lack of perceived social support. Conversely, being supported by family, whether in practical ways (e.g., partner coming to appointments with veteran) or emotional ways (e.g., being listened to, feeling part of the family), has been shown to lead to better mental health outcomes.

There are several ways of providing family sensitive mental health care. At the most basic level, it is important for the practitioner to ask questions about family members. Establishing family structures (who are the veteran’s closest family members) is the first step, and this may include not only partners and children, but parents and siblings, especially with younger veterans. Asking general questions such as, “How are things with your partner and your children?” can help to provide important information about possible needs and sources of support. Sensitive assessment of potential for family violence (followed by a separate interview of a veteran’s partner or children if there is an indication of violence) is particularly important given the higher incidence of family violence in veterans’ families.

It may be useful to ask the veteran if they would like a family member to attend a session with them with the aim of helping conduct a thorough assessment and providing psychoeducation. A psychoeducation session with families usually involves assessing the impact of the veteran’s symptoms on the family, providing education about mental health problems, addressing the beliefs family members may have about the veteran’s symptoms, and exploring aims and goals of counselling.

Many mental health practitioners are comfortable involving partners at some point in their treatment of veterans but it is far less common to involve children. Mental health issues are often not discussed with children out of concern that the discussion may frighten or upset children. Children are astute observers of their environment and are often aware of even subtle differences in a parent’s behaviour, but may not have the vocabulary to express their awareness. Discussing mental health problems with a child can reduce confusion and worry, enhance communication within the family and improve mental health outcomes for children. With regard to adult children of veterans, veterans can be sensitive about the possibility that their own mental health issues have harmed, or are harming their children, and may not want their mental health issues discussed with their children (Galovski & Lyons, 2004) even if their children are adults.

It is important to note that many veteran specific treatment and support programs, including inpatient programs, have specific programs for involving families in treatment. The VVCS - Veterans and Veterans Families Counselling Service (VVCS) has a family sensitive practice program which informs the provision of family consultations, family counselling, and the provision of individualised care to eligible partners and children of veterans. There are also community based family services and resources listed at the end of this chapter.

Further Information

Caring for veterans in a family: Provides further information, recommended readings and online resources to assist health practioners to deliver the most effective treatments for veterans and their families.

Relationships and families: Provides further information, support services, recommended reading and online information, relating to providing service for veterans, carers and veteran's families.

Case studies

The following case studies illustrate some of the common themes in the presenting problems of veterans’ families, including concerns about the veteran’s wellbeing, their relationships, the wellbeing of children and the family member’s own mental health.

Amanda: 37 year old daughter of a Vietnam veteran and partner of a current serving member and veteran of Iraq/East Timor.

Amanda is a stay at home mother who has sought counselling following deterioration in her mood, and difficulties with her relationship and parenting following a recent move from interstate. Amanda describes escalating feelings of anxiety and stress, sometimes manifesting as panic. At times she has difficulties managing her anger and is concerned that she is yelling at her children (three and six year old boys), and failing to manage what she terms “their acting out behaviours”. Her eldest son has become aggressive at school, and her younger son more withdrawn at childcare. Amanda feels ashamed of having to speak frequently with the school counsellor.

She also describes estrangement from her partner, Sean, who also works long hours and has a demanding job with the ADF. Amanda explains that she understands the importance of his role and the sacrifices of military family life, as her father was a Vietnam veteran. She also values the positive role model her husband usually presents for their sons. However, she reports that, recently, Sean has become more avoidant of intimacy with the family, and appears to be relying on alcohol to manage stress.

Amanda describes recent difficulties with feeling isolated from her extended family who are located interstate, and has had difficulty navigating through the health system in the new area. Amanda is keen to involve her partner, Sean, in finding strategies to manage their sons’ behaviour, but is doubtful that counselling will be able to help with their relationship.

Danielle: 28 year old widow of an Afghanistan veteran.

Danielle is an accountant who has presented to a counsellor with difficulties coping following the death of her husband two years ago when he died in a car accident soon after returning from a deployment in Afghanistan. Danielle presents with difficulties getting to sleep and staying asleep, and reports she experiences significant stress managing a single-parent household and keeping on top of bills and other expenses.

Danielle is still unsure of how to manage her husband’s death when discussing it with her nine year old son. Danielle says she has difficulty "finding the right words" to talk with her son about his father, and finds it difficult to talk about even positive memories involving her husband. Danielle also reports that her son used to be a "caring, sweet boy who always shared", and that since her husband's death, there has been a sharp increase in aggressive behaviour at school and at home. Danielle avoids news items on car accidents, and becomes distressed and tries to ignore significant days such as her husband’s birthday or the date of his accident. When alone, Danielle reports repeatedly thinking about the way her husband may have died. She also experiences intense longing for him. Danielle is concerned that at times she can't stop thinking about his death, and reports she still has difficulty concentrating at work.

Danielle has sought solace by talking with her friends and other mothers from school. However, although she appreciates their support, she feels they are not able to identify with her situation.

John: a 65 year old father of an East Timor veteran deployed to Aceh.

John is a software developer who has presented to his GP for advice regarding his son Matthew, who returned from Aceh after being deployed there for humanitarian efforts following the tsunami in 2004. John and his wife Linda live interstate, and their contact with Matthew is mainly over the phone. John is concerned that, since returning from Aceh, Matthew has been un-characteristically irritable and "moody" over the phone, and is less likely to return their phone calls. John is also aware that although Matthew used to smoke cannabis "every now and then", his friends have told John that Matthew is smoking cannabis more regularly, and that Matthew becomes agitated when John enquires about his cannabis use. Matthew's friends have also advised John that they are seeing "less and less" of Matthew and that, when Matthew does go out, he is withdrawn and appears disinterested in being with friends.

John is aware that whilst in Aceh, Matthew witnessed scenes of destruction and extreme poverty. Matthew's fiancée also ended their relationship whilst he was deployed, and Matthew says he is still unsure why the relationship ended, and at times becomes tearful when discussing it with John.

John reports that he and Linda feel extremely helpless about Matthew's changes in behaviour, and simply do not know what to do to help their son return to his "happy-go-lucky" self again. John stated that he was not sleeping well and was starting to have arguments with his wife about Matthew

Resources and referral options