Family Psychoeducation for Military Veterans: A Pilot Study

Context

The capacity of military and veteran families to develop and maintain positive mental health and well-being is challenged by contemporary operational imperatives. Since 1990, the Canadian Armed Forces (CAF) has engaged in more than 20 major international operations, involving multiple rotations of members serving in complex missions including Rwanda, Bosnia, Afghanistan, and, more recently, Mali. The intensified operational tempo is associated with an increase in the prevalence of operational stress injuries (OSIs). OSIs are persistent psychological difficulties resulting from operational duties performed while serving in the CAF. OSIs span a spectrum, including diagnosed psychiatric conditions such as anxiety disorders, depression, and post-traumatic stress disorder (PTSD) as well as other conditions that may be less severe, but still interfere with daily functioning. In a recent iteration of the Life After Service Study (LASS), a national survey of CAF veterans receiving services from Veterans Affairs Canada (VAC), 23% reported a diagnosis of one or more mental disorders, 5.8% reported suicidal ideation, and 1.1% reported a suicide attempt in the previous year. Specialized OSI clinics are now in place to support treatment-seeking veterans who qualify for care through VAC. An increase in mental health diagnoses requiring clinical management in these clinics has been documented.

The effects of OSIs in members and veterans ripple through their families. Results of a recent study focusing on the impacts of OSIs on the mental health and well-being of families of CAF veterans suggest that the imperative to care for the veteran becomes the central, organizing facet of family experience. In response, family structure, including family role redefinition and reallocation, shifts. Spouses assume full responsibility for family functioning and adapt routines, as required, while providing care to the veteran. Some spouses describe themselves as caregivers to the veteran, performing daily work that involves mediating and buffering the internal and external stresses affecting him/her. Consequently, spouses report burn out and specific health conditions attributed to the stress emerge. These health outcomes develop in an environment characterized by loss of identity and social and geographic isolation for some. Emotional stress, relationship tensions, and financial concerns resulting from changes in employment impact the whole family. Throughout, family members must reconcile the loss of the veteran as he/she once was. In some cases, children share these burdens, enacting role behavior incompatible with their developmental stage. Children may also experience emotional and behavioural problems.

Some veteran families cope with these challenges successfully, developing resilience through practical task management, problem-solving, and social support. Family resilience results from the interplay of individual assets and the social contexts in which they develop. Maintaining shared family beliefs, facilitating family organization, and communicating are processes that facilitate resilience through stress and adversity. Maintaining shared beliefs helps family members make sense of stress and adversity. Shared beliefs can be introduced or reintroduced to the family system through religious, spiritual practice, artistic expression, or through connection with family rituals or the natural environment. Furthermore, some research suggests that agency and self-determination are mobilized through shared belief systems and are instrumental in efforts to reinterpret adversity as a challenge that can be mastered.

Family organization enables families to manage the impacts of OSIs on both the veteran and the family system. Clear and consistent organizational patterns reassure family members, particularly vulnerable family members such as children, that, notwithstanding the adversity and stress, the structure of the family is continuous, dependable, and strong.