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Post-Deployment Stress:What Families Should Know,What Families Can Do
Almost everyone who has spent time in Iraq or Afghanistanhas experienced something very stressful. Studies ofpersonnel deployed to these areas find that traumaticexperiences—such as being attacked or ambushed, havingto handle or uncover human remains, and knowing someonewho was seriously injured or killed—are common. If yourfamily member had similar experiences in Iraq orAfghanistan, he or she is not alone.
Feelings, they might feel:SadHopelessWorthlessParanoidAnxiousGuiltyAngry
Behaviors, they might:Avoid situations that trigger flashbacksof their traumatic experiencesNot want to socializeHave low energyUse drugs or drink too much
veryone reacts differently to this kind of stress. But many returning militarymembers have thoughts, feelings, andbehaviors like these:
Thoughts, they might:Be forgetful and have troubleconcentratingRelive bad memories of traumaticeventsHave thoughts of death or suicide
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Someone you care about—perhaps aspouse, child, sibling, or other familymember—who spent time in Iraq orAfghanistan may have these same kindsof thoughts and feelings. It’s important for you to know that these are normalreactions to abnormal events and thatmany military personnel have felt thesame way.
However, these thoughts, feelings, and behaviors could also indicate more serious problems, including post-traumatic stress disorder (PTSD), traumaticbrain injury (TBI), depression, or acombination of these. Dealing with theseconditions is very stressful for a militarymember, but it is also stressful for theirfamily. Fortunately, there are lots of waysto get support. This booklet containsinformation you and your family membercan use now or later to help cope withpost-deployment stress.
Military OneSource1-800-342-9647https://www.militaryonesource.com
National Military Family Associationhttp://www.nmfa.org/ or 1-800-260-0218
Department of Defense (DoD) PTSD and TBI Quick Factshttp://www.pdhealth.mil/downloads/TBI_PTSD_Final04232007.pdf
National Alliance on Mental Illness (NAMI)1-800-950-NAMIhttp://www.nami.org/veterans
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Photo Courtesy of U.S. Department of Defense
Sharon’s daughter Kelly just returnedhome after a year in Afghanistan with the Army National Guard. Sharon thought Kelly would move into her ownapartment after gong back to work, but isconcerned that Kelly seems to barely beable to take care of herself. Kelly refuses to talk about anything that happened in Afghanistan and is angry all the time.Sharon hears Kelly walking around in thehouse at night and twice heard Kellyshout out in her sleep.
Sharon’s daughter Kelly is havingsymptoms like those caused by post-traumatic stress disorder (PTSD), acondition people may have afterexperiencing a disturbing event. Combat experiences—such as being shot at, handling dead bodies, or knowing someone who was killed—can trigger PTSD.
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What Is Post-Traumatic Stress Disorder (PTSD)?
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Reliving the event. Experiencing theevent again—often with the same fearand shock. These kinds of flashbacks can be triggered by loud noises, seeing a traffic accident, or even watching anews report.
Avoiding reminders. Staying away fromplaces or experiences that bring backmemories of the terrible experience.
Feeling numb. Lacking feelings and losing interest in relationships and activities.
Feeling on edge. Getting angry or annoyed very easily and having a hard time sleeping, or overreacting when startled.
Symptoms of PTSD can include:
If your family member has these symptoms and they’reaffecting activities at home or duties at work, it may help to
talk to someone at a local doctor’s office or clinic. You canalso call Military OneSource for confidential information
about getting help: 1-800-342-9647
The Veterans Affairs (VA) National Center for PTSD
http://www.ncptsd.va.gov/ncmain/ncdocs/manuals/GuideforMilitary.pdf
http://www.ncptsd.va.gov/ncmain/ncdocs/videos/emv_newwarr_vets.html
American Psychiatric Association information on PTSDhttp://www.healthyminds.org/multimedia/ptsd.pdf
Center for the Study of Traumatic Stresshttp://www.centerforthestudyoftraumaticstress.org/downloads/CSTS%20Helping%20Your%20Loved%20Ones.pdf
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Bobby’s older brother Jason is a privatefirst class in the Marine Corps. He recentlyreturned from an eight-month deploymentin Iraq, where he was exposed to animprovised explosive device (IED) blast.Bobby is worried about his brother—Jason complains about headaches everyday, has trouble keeping his balance, and
struggles with simple tasks like having aconversation or helping his young kidswith their homework. Bobby can tell thatJason feels frustrated, and isn’t surewhether to tell their parents or Jason’swife that he’s concerned about howmuch Jason has been drinking.
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What is Traumatic Brain Injury (TBI)?
If your family member had a blow or shock to the head andhas one or more of these symptoms, he or she could besuffering from the long-term consequences of TBI. If thesymptoms persist, encourage your loved one to talk to
someone at a local doctor’s office or clinic. You can also callMilitary OneSource for confidential information about
getting help: 1-800-342-9647
Defense and Veterans Brain Injury Center1-800-870-9244http://www.dvbic.org/
Department of Veterans Affairshttp://www.va.gov/environagents/docs/TBI-handout-patients.pdf
National Center for Injury Prevention and Control information on TBIhttp://www.cdc.gov/ncipc/tbi/tbibook.pdf
National Institute of Neurological Disorders and Stroke information about TBIhttp://www.ninds.nih.gov/disorders/tbi/tbi_htr.pdf
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Jason’s feelings and behavior could meanthat he has traumatic brain injury (TBI). TBI can be caused when something hits a person’s head very hard or whensomething goes through the skull andenters the brain. Even the blast wavesalone from an IED can cause TBI.Traumatic brain injury can causeproblems long after the injury actually
happens. Symptoms can include:Constant headachesConfusionLight headedness or dizzinessChanges in mood or behaviorTrouble remembering or concentratingRepeated nausea or vomitingProblems with seeing or hearing.
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Elena’s husband, Antonio, is a sergeant inthe Army. He has just returned from a 15-month deployment in Iraq. While he wasaway, she gave birth to their daughterand cared for their three-year-old son, andshe is exhausted from living as a singlemother. Elena is thrilled to have herhusband back, but Antonio seems verysad and mostly wants to be alone. Hehasn’t shown much interest in playing
with his children, and Elena is worriedbecause he doesn’t want to spend timewith their friends or family.
Antonio has many of the commonsymptoms of depression. Depression caninterfere with the ability to work, sleep,eat, interact with others, and enjoy doingfamiliar things. Depression can also havelong-term chronic effects that can make it hard to function and feel good.
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What Is Depression?
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Here are some of the most common signsof depression:
Feeling hopeless, sad, or “empty” mostof the timeLosing interest or pleasure in activitiesthat used to be enjoyableLacking energy or feeling very tired
Thinking about death or suicideHaving ongoing physical problems—such as headaches, stomach problems,and pain—that don’t get better evenwhen they have been treated.
If your family member has these kinds of symptoms and theyare affecting activities at home or duties at work, encourage
your loved one to talk to someone at a local doctor’s office orclinic. You can also call Military OneSource for confidential
information about getting help: 1-800-342-9647
Department of Defensehttps://www.qmo.amedd.army.mil/depress/Web%20Depression%20Brochure.doc
Uniformed Services University of the Health Sciences depression fact sheethttp://www.usuhs.mil/psy/CourageToCarePatientFamilyDepressionFactSheet.pdf
National Institute of Mental Health information on depressionhttp://www.nimh.nih.gov/health/publications/depression/nimhdepression.pdf
Families for Depression Awarenesshttp://familyaware.org/admk/wellnessguide.pdf
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Being part of or seeing shocking eventscan cause PTSD, TBI, or depression, so it ispossible to have more than one of theseproblems at the same time. Be sure thatyour family member describes all of his or her symptoms to someone at a localdoctor’s office or clinic, or call MilitaryOneSource (1-800-342-9647). Treatmentfor combined problems may be differentfrom treatment for just one of them.
SUBSTANCE USE AND ABUSEPTSD, TBI, or depression can affect manyparts of a person’s life. Like Jason, yourfamily member may be drinking or usingdrugs to deal with his or her problems.This might help for a little while, butalcohol or drugs can actually make theproblems worse.
It’s often hard to know when alcohol ordrug use is becoming a problem. Here are some signs to look for:
Feelings of guilt about alcohol or druguseFamily and friends commenting onhow much he or she is drinkingDrinking or drug use that makes it hard for him or her to live up toresponsibilities at home or at workMore alcohol or drugs are needed toget the same effectHe or she has tried to cut down on use but can’t.
If you think your family member has an alcohol or drug problem, encouragehim or her to see a health care providerfor help.
HELPING MANAGE THE TRANSITIONThe transition from deployment to homecan be hard for everyone, especially ifyour family member is having problemslike the ones described above.
You and your family member have manyways to get help—some of them listed inthis booklet. But there are also somesimple things that you can doimmediately.
USE THE RESOURCES AVAILABLE TO YOUThe military is committed tosupporting the health, well-being, and job performance of militarypersonnel and to helping militaryfamily members deal with post-deployment stress. Use the many organizations whosegoal is to help your family make asmooth transition from your familymember’s deployment to home. They can suggest ways to cope withsymptoms of PTSD, TBI, and depressionand to get you all back on track faster.
TAKE CARE OF YOURSELFIf your family member is dealing withPTSD, TBI, or depression, he or she may
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Combined Problems
Substance Abuse and Mental Health Services Administration1-800-662-HELPhttp://getfit.samhsa.gov/Drugs/http://getfit.samhsa.gov/Alcohol/
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need your help—but it’s important toremember that you’ll be best able to help your loved one if you take care ofyourself, too.
Exercise and eat well (stay away fromjunk food).Get enough sleep by keeping a regularsleep schedule and avoiding vigorousexercise before bed.Stay away from alcohol, tobacco, and caffeine.Think about the things you like to do,and make time to do them.Set realistic goals and don’t take onmore than you can handle. If you find it hard to tackle large problems, breakthem into smaller ones. Then start withthe small tasks that are most important.Try to find a time soon after your familymember returns home when the twoof you can spend time alone together.
PAY ATTENTION TO YOUR FEELINGSYou may expect to feel nothing buthappiness when your family membercomes home, but post-deploymentstress can bring up other feelings, too,like anger and frustration. It is natural
to have a mix of feelings while you and your family adjust to post-deployment life.Manage your anger by walking awayfrom situations that make you angry or talking things over with people who have made you angry. Exercisecan also help.Post-deployment stress affects militarymembers and their families—if you are feeling depressed and are thinkingabout hurting yourself, ask for helpfrom a family member or health careprovider or call the National SuicidePrevention Lifeline (1-800-273-TALK). If you need immediate help, call 911.
TALK WITH OTHERSCommunication is key to dealing withpost-deployment stress and can helpmake the adjustment easier for everyone.
Your Family Member. Talking with yourreturning family member is an importantway to become comfortable with eachother again after a separation, and talkingcan provide very important support foryou both. Your family member may notwant to talk about deployment, and youmay not want to talk about your ownpost-deployment stress. But often thebest thing for families is to talk openlyabout thoughts, feelings, and behaviors.This will let you work together to moveforward. It is normal for families to needtime to adjust when a military memberreturns home. Keeping the lines ofcommunication open can help. It may
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be helpful to set aside a time every day to check in; for example, in the morningbefore your day begins or before going to sleep at night.
Children. Children are usuallycomfortable with routines, so they mayhave a hard time with the changes thatoccur when your family member comeshome. Depending on their age, they mayhave questions and concerns. It is oftenmore scary for children when they feelkept in the dark, so if your child asksquestions, you can explain what is goingon in a way that they will understand.Children need to know that it’s okay toask questions—a lot will be changingwhen your family member comes home,but expecting children to follow the samefamily rules is important, too. As with yourreturning family member, think aboutscheduling a regular time with yourchildren to check in. Reassure them thatsomeone will always be available to takecare of them.
Health Care Providers. If you are feelingoverwhelmed after your family membercomes home, you can talk in private witha health care provider, such as a doctor,nurse, psychologist, or other mentalhealth professional. They will be familiarwith the ups and downs that families can experience when a military member
returns home. Make an appointmentspecifically to discuss how you are feeling.
Don’t feel like you’ve got only one chanceto ask a health care provider for help. Afteryour first appointment, set up anotherappointment so that you and the providercan follow up on your progress. If youdecide to meet with a mental healthprofessional, you may meet on a regularbasis (likely once a week) until thingssettle down and you feel lessoverwhelmed.
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Church or Religious Leaders. Somepeople feel that religious leaders or elderscan offer helpful advice. Set up a timewith a church or religious leader whomyou trust to discuss what you are goingthrough, and use their advice tocomplement the help you may be gettingfrom health care providers and family.
Other Family Members of Veterans. Itcan be helpful to connect with otherpeople who have recently welcomed amilitary family member home. Your localVA may have a network you can use tocontact other military family members.
BE PATIENT WITH YOURSELFDon’t expect improvementovernight—if your family member isdealing with PTSD, TBI, or depression, it can take time for him or her torecover and time for you to adjust.Things will probably feel a little easierevery day.It may help to slowly return to yournormal routines as a family.After the reunion, it can sometimes feel like you are making mistakes ordoing things “wrong.” Try not to blame yourself. Rememberthat readjustment after deployment is complicated and that everyone—family members and returningveterans—can make mistakes, evenwhen they are doing the best they can.
Military OneSource1-800-342-9647https://www.militaryonesource.com
National Military Family Association1-800-260-0218http://www.nmfa.org/
Sesame Workshophttp://www.sesameworkshop.org/wpad/
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If you are a family member of a persondealing with PTSD, TBI, or depression,remember that treatment is available, andthat most people who are in treatment getbetter. Treatment can improve life in manyways. It can lead to better physical healthand job performance. It can also improveyour family relationships.
There are many ways to treat PTSD, TBI,and depression, and there are many waysto treat post-deployment stress so peoplecan feel more like themselves. The kind oftreatment and how long it will be neededwill differ for every individual, but thesooner one takes action to deal with post-deployment stress, the sooner they will beable to feel better again.
Learning About Symptoms. Symptomsrelated to PTSD, TBI, and depression arecommon and can cause stress for militarymembers and their families, but noteveryone experiences post-deploymentstress in the same way. Use this bookletand the resources listed here to learn howto recognize symptoms and stress thatcan be treated by a health care provider.
Learning About Treatment. If you oryour family member has identifiedthoughts, feelings, and behaviors that are part of post-deployment stress, youmight want to learn more about how to get help. Your health care provider will tailor treatment to meet your needs.For example, treatment might involvediscussions with a health care provider in person, medications, or both. Thisbooklet and the resources listed in it give you more information aboutavailable treatments.
Getting Treatment. If you or your familymember has concerns about getting carefor a personal or emotional problem, youcan talk to someone at Military OneSource (1-800-342-9647) or at a Veteran’sCenter. Call 1-800-905-4675 (Eastern) or 1-866-496-8838 (Pacific) to get contactinformation for the Veteran’s Centernearest you. The call will be confidentialand will not be shared with militaryauthorities.
If you or your family member wants to getcare, entry into the medical system maydepend on current military status:
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Treatment
Military OneSource: Confidential information, support, and counseling available free to military personnel (regardless of activation status) and their families1-800-342-9647https://www.militaryonesource.com
Vet Centers: Confidential readjustment counseling for combat veterans and their families1-800-905-4675 (Eastern) or 1-866-496-8838 (Pacific)http://www.vetcenter.va.gov/
To get more copies of these and other materials, and to find links to more than 20 helpful resourceshttp://veterans.rand.org
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If your family member is on active duty,he or she can go directly to the unit’smilitary medical provider. He or shecan contact a mental health providerthrough normal TRICARE channels andcan specify either a civilian or militaryprovider, though there may be waittimes for the next available appointment.If your family member served in a theaterof combat operations after November11, 1998 and has since left the military,he or she may be eligible to receive carefor up to five years following dischargeat a local VA medical treatment center.You can call 1-877-222-8387 or go tohttp://www.va.gov/directory for moreassistance. If it has been more than fiveyears since your family member left theservice, he or she may still be eligiblefor care at the VA.If your family member is a Reservist orin the National Guard, he or she cancontact the unit or a nearby unit tofind out about local resources. He or
she can also find out about treatmentoptions at a local VA medical treatmentcenter (call 1-877-222-8387 or go tohttp://www.va.gov/directory) or cancontact Military OneSource (1-800-342-9647) to learn abouteligibility for benefits through TRICARE Reserve.If you are interested in gettingtreatment for yourself, and you are the spouse or child of a militarymember, you can learn about yourmedical benefits by following the steps above, depending on the militarystatus of your family member. You can also contact the National MilitaryFamily Association (1-800-260-0218 orhttp://www.nmfa.org/ and follow the“Health Care” link). Finally, if you will be using civilian health insurance,contact your insurer to find out moreinformation about mental health carecovered by your plan.
CP-535 (3/08) Cover Photo Courtesy of U.S. Department of Defense
RAND is a nonprofit institution that helps improve policy anddecisionmaking through research and analysis.
Note: Persons shown in the images throughout this booklet arefor illustrative purposes only and are not associated with any ofthe psychological and cognitive problems presented.
