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William Satterfield, Ph.D. LCDR, US Public Health Service

Senior Policy AnalystOffice of the Assistant Secretary of Defense for Health Affairs

Force Health Protection & Readiness

Impact of Post Traumatic Stress Disorder on Children and Families

Malaysia Gresham, LICSW, BCD LCDR, US Public Health Service

Special Assistant to theUnited States Surgeon General

United States Department of Health and Human Services

June 20, 2012

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• Scope of the problem• Factors related to impact on families/children• Impact of Post Traumatic Stress

Disorder (PTSD) on children• Impact on relationships• Intervention• Resources

Outline

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• Presidential Initiative – “Strengthening Our Military Families: Meeting America’s Commitment”– Priority #1 – Enhance the overall well-being and

psychological health of the military family• National Leadership Summit on Military Families

– Priority #3 – Strengthen the Department’s ability to provide for the psychological well-being of military personnel and their families (with a particular focus on the health of children in these families)

Scope of the Problem

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• Over 2 million Service members have deployed– As many as 1 in 5 with post-traumatic stress or depression

(Rand 2008)– Prevalence of PTSD between 5-15%

• 55% of Service members are married– Approximately 700,000 military spouses

• 40% have 2+ children– Over 700,000 children have experienced parental

deployments• 220,000 had parent deployed at single time (Jan 2011)

Scope of the Problem

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• Preparation/pre-exposure• Pre-existing Mental Health concerns• Development age• Strength of relationships• Communication• Community/social support

Factors Related to Impact

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• Re-experiencing Symptoms– Nightmares, flashbacks, physical/emotional reactivity– Impact: Confusion, fear, anxiety, perceive environment as unsafe and

unpredictable

• Avoidance Symptoms– Avoidance of activities, emotional numbing, withdrawal– Impact: Loss of intimacy, interpreted as lack of caring

• Hyper-arousal Symptoms– Sleep disruption, irritability, exaggerated startle– Impact: Overprotective parenting, low frustration tolerance,

increased risk for violence

Impact of Parent PTSD on Children

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• Increased risk for behavioral, academic, and interpersonal problems

• May be viewed by parents as more depressed, anxious, aggressive, hyperactive

• Impact of physical/emotional well-being– Children – deployment-related emotional difficulties

• 11% increase in outpatient visits for behavioral health issues*• 18% increase in behavior disorders*• 19% increase in stress disorders*

Impact of Parent PTSD on Children

*Among a group of 642,397 children 3- to 8-years old with a military parent deployed

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• Those with PTSD 2X as likely to divorce; 3X more likely to divorce two or more times– 4X greater likelihood of marital distress– 2nd highest diagnosis associated with marital distress

• Increased incidence of intimate partner violence• Poorer communication• Increased incidence of sexual dysfunction• Partners with PTSD

– May be less self-disclosing and less expressive– Have more anxiety related to intimacy

Impact on Relationships

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• Impact of PTSD on partners:– Lower subjective well-being– Somatic complaints– Neurotic symptoms – up to 50% of partners (N=376)

reported feeling “on the verge of a nervous breakdown”– Depression– Sleep problems– Poor social relations and support– Caregiver burden

Impact on Relationships

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• Couples therapies– Cognitive-Behavioral Conjoint Therapy– Emotion-Focused Therapy

• Pre-deployment preparation• Psycho-educational intervention• Supportive interventions

Recommendations/Intervention

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• Office of Military Community Outreach (Military Community and Family Policy)– Military OneSource (www.militaryonesource.mil)– Military HOMEFRONT (www.militaryhomefront.dod.mil)

• Defense Center of Excellence for Psychological Health and Traumatic Brain Injury– 24/7 Outreach Center– Sesame Street Workshop– Family and Friends of Service members Handbook– Real Warriors Campaign

Resources

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• Deployment Health Clinical Center (www.pdhealth.mil)– One-week educational program for family members of Service

members with PTSD

• Center for the Study of Traumatic Stress (www.cstsonline.org)

• AfterDeployment.org• FOCUS Program (Families OverComing Under Stress)

(www.focusproject.org)• National Center for PTSD (www.ptsd.va.gov)

Resources

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• Pre-existing mental health conditions have impact on responses during traumatic events and subsequent post-traumatic symptoms

• Understanding family dynamics can improve prevention and intervention efforts

• Disaster response personnel are vulnerable to traumatic exposure and development of PTSD– Self-aid/buddy care– Seeking professional intervention

• Training needs– Listen, Protect, Connect– Psychological first aid

Implications for Response Teams

QuestionsQuestions?