To our knowledge, the study findings are the first to show a direct link between increases in PTSD and post-deployment self-reports of couple and parenting difficulties. Reintegration into a family following combat deployment requires renegotiating roles as partner and parent (Faber, Willerton, Clymer, MacDermid, & Weiss, 2008
). Our findings suggest that symptoms of PTSD may exert their influence at multiple levels within the family, making these difficult transitions even more complicated. A growing body of research has produced data showing the association of individual PTSD symptoms with social/family context variables, but research has been slow to examine putative mechanisms
through which this influence is exerted (Monson, Taft, & Fredman, 2009
). The use of a developmental-ecological framework enabled us to go beyond the purely descriptive, by providing an opportunity to study linkages over time between PTSD symptoms and their mechanisms of influence within the family (i.e. parenting behavior and couple adjustment). In this study we have provided preliminary evidence of the importance of PTSD symptoms for self-reported parenting behaviors and couple adjustment, paving the way for more extensive studies examining reciprocal and transactional linkages.
Contrary to our hypothesis, we did not find that couple adjustment mediated the relationship between PTSD symptoms and parenting. Thus, although PTSD had significant direct effects on both self-reported couple adjustment and parenting, as well as an indirect effect on parenting through couple adjustment, the data did not indicate that the influence of PTSD symptoms on perceived parenting was due solely to their effect on the couple relationship.
How and why might PTSD impair parenting behaviors? PTSD symptoms of emotional numbing/avoidance may manifest in detachment from family activities and reduced monitoring of, and involvement with children, and hyper-arousal symptoms may spark volatile or emotionally dysregulated parent-child interactions, particularly in stressful situations, (such as those around discipline or conflict). No research has examined associations with parenting behaviors
, but Samper, Taft, King, and King (2004)
found associations between emotional numbing symptoms of PTSD and parenting satisfaction
in a nationally representative sample of 250 male Vietnam veterans. Similarly, studies with couples have found that symptoms of numbing/avoidance and anger/arousal are particularly related to impaired relationship satisfaction and interpersonal violence (see Galovski and Lyons, 2004
, for a review).
It is important to point out that because couple adjustment and parenting were only measured cross-sectionally (i.e., at Time 2), directionality of effects cannot be parsed out. It is possible that stressors within the family (i.e., parenting and couple adjustment difficulties) increase PTSD symptoms following return from deployment, and/or even likely that the relationships are reciprocal and transactional in nature, such that PTSD symptoms worsen parenting and couple adjustment, which in turn exacerbates PTSD symptoms (Monson et al., 2009
). More complex empirical (developmental-ecological) models are needed to account for the reciprocal and transactional linkages among combat PTSD, parenting, and couple adjustment.
Among secondary hypotheses, deployment injury was not significantly associated with perceived parenting behavior (once other variables were accounted for), but was significantly associated with PTSD symptoms at both time points; PTSD symptoms thus fully mediated the relationship between injury and parenting. This finding confirms the importance of PTSD as a central construct through which injury may be linked to parenting and couple adjustment in returning veterans, and suggests that the emotional impact of an injury (i.e., resultant PTSD symptoms) may be more influential to parenting than the physical impact. In conjunction with our finding of relatively high reports of deployment injury in our National Guard sample, this finding has important implications for the provision of psychological services (and particularly PTSD treatment) to injured National Guardsmen. No published research has investigated the impact of combat deployment injury on parenting behavior, but the importance of understanding this relationship has been noted (Cozza et al., 2005
), particularly in light of medical advances resulting in increased survival rates after injuries in OEF/OIF compared to prior conflicts (Tanielian & Jaycox, 2008
). The absence of information regarding the severity of injuries sustained precludes conclusions about the effects of more severe injuries (such as loss of limb or moderate to severe head injuries) on couple adjustment and parenting; these may have distinct effects obscured by less severe injuries that were also included in our injury variable.
The high rates of alcohol use and PTSD symptoms found among veterans in this study, as well as increases in both over the course of the first year post-deployment, are consistent with those reported in prior studies of the current conflicts (Hoge et al., 2006
; Milliken et al, 2007
). As predicted, PTSD symptoms were associated with higher levels of alcohol use. This finding is particularly important given that most National Guard personnel do not receive treatment in VA settings but in community mental health settings with professionals less familiar with combat PTSD, making it arguably more likely for PTSD to go untreated in favor of other interventions (e.g., alcohol treatment or addressing the psychological effects of an injury).
Consistent with hypotheses, higher perceived social support assessed in-theater predicted more effective perceived parenting behaviors one year later; extent of social support also was negatively associated with subsequent increase in PTSD symptoms. Social support thus appears to be an important protective buffer for National Guard soldiers and their families. Strong perceived social support may be particularly critical for National Guard populations, who are not typically afforded the formal support structures of Active Duty personnel (the military base community, military healthcare, etc). The finding that social support directly influences parenting is not surprising, given prior developmental literature indicating that support systems protect caregiver functioning and parenting (e.g., Campbell & Lee, 1992
). Our data also are somewhat consistent with Kaniasty and Norris’ (2008)
finding that immediately post-trauma, social support buffered the negative effects of traumatic stress but, as time went on, persisting symptoms of PTSD did lead to a longer term erosion in support. Further longitudinal follow-up is needed to ascertain the impact of increase in PTSD on subsequent social support following return from deployment (social support was assessed in this sample only in-theater).
Among the socio-demographic control variables, ethnic/racial differences were noted in relation to outcome variables, with African American fathers reporting higher levels of effective parenting, and Hispanic Americans reporting lower levels of couple adjustment, both relative to European Americans. More research is needed to confirm these findings, particularly because the sample proportions of both minority populations were very small (5 and 6% respectively). Few studies have examined family functioning among minority groups in the US military; none have examined parenting (Drummet, Coleman, & Cable, 2003
; McCubbin & McCubbin, 1988).
We acknowledge several limitations to this study. By recruiting from a specific Army National Guard combat brigade team we were able to assess participants who returned home at around the same time, preserving the temporal homogeneity and the internal validity of the study. However, these factors, coupled with the 49% response rate, also constitute threats to the external validity of the study. Thus, this mid-western sample may not necessarily be representative of all Army National Guard brigades, and results may not generalize to other military components (e.g., Active Duty service members, who are more likely to be younger, unpartnered and without children). Although baseline scores indicated no significant differences between respondents and non-respondents, it is possible that they differed in other aspects of functioning not measured here. Given the survey nature of the study and sample size, we relied on self-report measures of parenting and PTSD, but in doing so we were unable to gather multi-informant data (i.e. from spouses and children) or multi-method data (e.g., observational measures of parenting). This mono-method bias means that the observed relationships may be due in part to the effect of PTSD on perceptions of parenting rather than actual parenting behaviors. Study resource limitations prevented us from asking respondents to report on child behavior, which is an important associated factor of parenting. Finally, while aspects of this study were longitudinal (i.e., measurement of PTSD), the assessments of parenting and couple adjustment were only conducted at Time 2, post deployment. Thus, relations between couple adjustment and parenting are cross-sectional.
Data from this study indicating the influence of increases in PTSD symptoms on perceived parenting behaviors highlight the need for further research, given the importance of parenting for child adjustment, particularly in risk contexts (Collins, Maccoby, Steinberg, Hetherington, & Bornstein, 2000
). No studies to date have examined relationships between combat related PTSD, parenting behaviors, and child adjustment in military families (Palmer, 2008
), although prior studies have shown associations of parental PTSD symptoms with children’s externalizing problems, hostility and aggression (e.g. Caselli & Motta, 1995
; Glenn et al, 2002
). However, associations between parenting behaviors and children’s adjustment have been examined in other contexts. Parenting behaviors have been shown to mediate the impact of external stressors on children’s externalizing
problems across a range of circumstances, including parental mental illness, substance abuse, family transitions, poverty, and family violence (Belsky, 1984
; Conger et al., 1992
; Conger et al., 2002
; Elder et al., 1986
; Patterson, 1982
; Patterson, 2005
). Future research will need to use multiple informant ratings and methods to assess parenting behaviors and child adjustment in order to better elucidate the relationship between those constructs and PTSD.
Given the overwhelming number of fathers (compared with mothers) in the US Military, far more research is needed to answer questions about the impact of PTSD on fathers’ parenting, the influence of fathers’ parenting on mothers’ parenting, and their combined influence on child adjustment. The higher incidence of combat PTSD, and associated risks among the large military sub-populations who are more likely to be parenting (i.e. NG/R populations) provides a strong impetus for advancing this research agenda.
Although an emerging focus of clinical research and practice examines the impact of PTSD on couples and couple interventions (e.g., Erbes, Polusny, MacDermid, & Compton, 2008
; Monson, Price, Rodriguez, Ripley, & Warner, 2004
), there is a serious dearth of literature on interventions to support parenting among veterans and no published studies of parenting interventions for NG/R families. We speculate that effective parenting preventive interventions for families affected by combat stress – and particularly National Guard families - might enhance parenting practices and improve parent-child relationships as well as increase social support, protecting parenting in the face of family stress, role overload, and conflict for fathers (DeGarmo, Patras, & Eap, 2008
). Indeed, prior data from randomized prevention trials of effective parenting programs have indicated benefits to parents’ mental health (reductions in depression) as well as improvements in parenting and child adjustment (Forgatch & DeGarmo, 1999
; Forgatch, Patterson, DeGarmo & Beldavs, 2009
). The field is in its early stages and much research remains to be done, but with significant numbers of OEF/OIF veterans suffering from PTSD and other mental health problems who are caring for dependent children, there is a clear need for further research in this area (Palmer, 2008
). The need is particularly relevant for populations at higher risk for PTSD such as National Guard and Reservists, who are less likely to seek out VA services, who may be more socially isolated, and who often lack the supports available to active duty families.