Dissertation/Thesis Abstract

Couple functioning and posttraumatic stress in Operation Iraqi Freedom and Operation Enduring Freedom veterans and spouses
by Melvin, Kristal Celeste, Ph.D., The Johns Hopkins University, 2011, 212; 3483401
Abstract (Summary)

Background: Combat-related posttraumatic stress symptoms (PTSS), with or without a diagnosis of Posttraumatic Stress Disorder (PTSD) can negatively impact soldiers and their families. PTSS has been linked to increased domestic violence, divorce and soldier suicides, yet few studies have examined the marital relationships of military couples with PTSS.

Objectives: To (a) understand and explain how PTSS affects couple functioning in Army soldiers returning from combat, and their spouses/partners, (b) test the moderating effects of age, gender, rank, resilience, coercion in the relationship and previous history of trauma on the relationship between PTSS and couple functioning, (c) examine the prevalence of secondary traumatic stress (STS) in civlian spouses, (d) analyze whether the relationships between PTSS and couple functioning differ for male versus female soldiers and their spouses/partners, and (e) explore experiences of couples with high levels of couple functioning in spite of clinically significant levels of PTSS in one or both partners.

Design and Methods: A cross-sectional descriptive sequential mixed-methods design was employed for this dyadic research study. Mailed surveys on PTSS and couple functioning were sent separately to interested couples, along with optional written consent forms for further contact for the purpose of in-depth interviews. Quantitative data were analyzed using a generalized linear model controlling for interdependence of couple dyads. Qualitative data were analyzed using a multiple case study approach. Sample: Data were collected among male (n = 43), and dual (both spouses served in the armed forces) (n = 30) Army couples. From this total sample (N = 73 couples), using a maximum variation purposive sampling design, 14 consenting couples were then selected for in-depth semi-structured interviews. The interview couples were further stratified based on their couple functioning scores, and the five highest functioning couples with clinically significant levels of PTSS were selected for a multiple case study analysis.

Findings: In twenty-four percent of the couples (n = 17), both members had PTSS above the clinical cut-off for suspected Posttraumatic Stress Disorder (PTSD). In an additional 48% of the couples (n = 35), one member of the couple had a high level of PTSS. Major findings were (a) higher post-traumatic stress was associated with more marital difficulties and lower resilience and (b) despite high levels of post-traumatic stress, some couples employ a variety of creative strategies for maintain good marital quality. Although female gender, low resilience and high coercion were significant predictors of lower couple functioning, none of the hypothesized moderators of the relationship between PTSS and couple functioning (age, gender, rank, resilience, coercion and trauma history) were statistically significant. No differences in couple functioning, resilience, PTSS or abuse were found between male and dual military couples. Case study participant couples (n = 5 couples) provided a rich description of the best practices of strong, resilient Army couples during reintegration.

Conclusion: The inclusion of both spouses in this dissertation study allows for a richer, fuller understanding of the couple in the context of PTSS. These findings could be instrumental in the development of interventions designed to mitigate, or even prevent, negative outcomes such as divorce, violence and suicide for military couples facing combat deployment.

Indexing (document details)
Advisor: Gross, Deborah
School: The Johns Hopkins University
School Location: United States -- Maryland
Source: DAI-B 73/01, Dissertation Abstracts International
Subjects: Nursing, Clinical psychology, Military studies
Keywords: Military couples, Posttraumatic stress disorder, Resilience, Trauma
Publication Number: 3483401
ISBN: 978-1-124-99225-9
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