CLINICAL SCHOLARSHIP
Experiences of Military Spouses of Veterans
With Combat-Related Posttraumatic Stress Disorder
Teresa W. Yambo, PhD, MSN Ed, RN1 , Mary E. Johnson, PhD, RN, PMHCNS-BC, FAAN2 , Kathleen R. Delaney,
PhD, PMHNP-BC, FAAN3 , Rebekah Hamilton, PhD, RN, FAAN4 , Arlene Michaels Miller, PhD, RN, FAAN5 ,
& Janet A. York, PhD, PMHCNS, BC, FAAN6
1 Gamma Phi, Instructor, Spouse Employment Program, Air Force Aid Society, Osan Air Base, South Korea
2 Gamma Phi, Assistant Dean for Specialty Education, Professor, Department of Community Systems and Mental Health Nursing, Rush University,
Chicago, IL, USA
3 Gamma Phi, Professor and Program Director, PMH-NP program, Project Director, Graduate Nursing Education Demonstration, Rush University,
Chicago, IL, USA
4 Gamma Phi, Assistant Dean for Specialty Education, Professor, Women, Children and Family Health Nursing, Rush University, Chicago, IL, USA
5 Gamma Phi & Alpha Lambda, Professor, Community, Systems, and Mental Health Nursing, Rush University, Rush University, Chicago, IL, USA
6 Beta Lota, Director, PMHNP Residency Program, Mental Health Service Line, Ralph H. Johnson VAMC, and Adjunct Research Professor of Nursing,
Medical University of South Carolina, Charleston, SC, USA
Key words
Spouse, posttraumatic stress disorder,
phenomenology, military, Colaizzi
Correspondence
Dr. Teresa W. Yambo, Rush University, College
of Nursing, 600 S. Paulina St., Chicago, IL 60612.
E-mail: Teresa w yambo@rush.edu
Accepted July 17, 2016
doi: 10.1111/jnu.12237
Abstract
Purpose: To explore the experiences of military spouses living with veterans
with combat-related posttraumatic stress disorder (PTSD).
Design: Husserlian phenomenology was chosen as the theoretical framework
because it allowed a deeper understanding of the unfolding of the spouses’
daily experience.
Methods: A purposive sample of 14 spouses living with veterans with symptoms of PTSD participated in unstructured interviews. Data were analyzed
using a modification of the Colaizzi phenomenological method.
Findings: Spouses recognized that the veteran was no longer the same person, with life becoming one of living with the unpredictability of PTSD. The
spouses bore the burden to maintain normalcy in the family and eventually
created a new life.
Conclusions: Military spouses endure psychological stress and strain, while
living with a veteran with PTSD. There is a need for more programs to support
the resilience of military spouses.
Clinical Relevance: Life for military spouses of veterans with PTSD is everchanging and unpredictable. Practitioners need to be aware of the stress that
spouses experience and develop programs and interventions that bolster the
resilience of military families.
Spouses are a major support to married veterans who are
experiencing symptoms of combat-related posttraumatic
stress disorder (PTSD; Dekel, Goldblatt, Keidar, Solomon,
& Polliack, 2005). Symptoms of PTSD may occur after
exposure to a traumatic event, such as threatened death
to oneself or others, the death of others, serious or
threatened injury to oneself, or actual or threatened
physical or sexual violence (U.S. Department of Veterans
Affairs, 2015). Although there have been international
studies (Ahmadi, Azampoor-Afshar, Karami, & Mokhtari,
2011; Dekel et al., 2005; Dirkzwager, Bramsen, Adèr, &
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van der Ploeg, 2005; Franciskovié et al., 2007; McLean,
2006; Westerink & Giarratano, 1999; Woods, 2010) in
spouses of veterans from previous combat operations,
a recent review of the literature (Yambo & Johnson,
2014) revealed no published studies of the essence of
the experience in U.S. spouses living with veterans who
developed symptoms of PTSD from post-9/11 overseas
contingency operations (OCO).
Veterans who supported OCO had unique experiences
when compared to veterans from previous combat. What
makes OCO unique is that they are the first sustained
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ground combat, since the Vietnam War (Hoge et al.,
2004), with 75% of veterans wounded by explosive devices (Helwick, 2011), more married veterans in families
with more children, and accessible cutting-edge medical
care (Glasser, 2011). Further what makes OCO different
from previous operations for the spouses is that more
military families are negatively impacted by PTSD, which
contributes to weakened family bonds and hostility
toward partners and military children (Peterson, Lester,
Calohan, & Azad, 2014). To fill this gap in knowledge,
the purpose of this study was to describe the experiences
of military spouses living with a veteran with PTSD
from OCO. According to the World Health Organization
(WHO, 2013a), it is critical to not only meet the mental
health needs of individuals, but to employ integrated
strategies to coordinate holistic care to support mental
well-being. Understanding the spouses’ perspective will
be useful to international clinicians and researchers who
are funding, developing, and testing interventions that
could potentially prevent mental health problems among
military families. Further, this study may benefit mental
health practitioners who care for veterans and their
spouses as they manage the symptoms of PTSD.
Background
Globally, PTSD prevalence rates span from 0.3% to
6.1% in the general population and 15.4% in conflictaffected populations (WHO, 2013b). In the United States,
PTSD impacts about11% to 20% of the 2 million veterans returning from OCO (U.S. Department of Veterans
Affairs, 2015) and almost 1.1 million military caregivers
provide care to post-9/11 veterans (RAND Corporation,
2013). Living with a veteran with PTSD can have a
negative impact on the mental health of military partners. Secondary traumatic stress, psychological distress,
burden (Yambo & Johnson, 2014), marital and relationship dis-satisfaction, difficulty coping (Hamilton, Nelson
Goff, Crow, & Reisbig, 2009), and domestic violence
(Dekel et al., 2005) have been documented. Despite
the emerging evidence in family resiliency (Peterson
et al., 2014), most research is limited to investigations
on the impact of trauma on the primary victim—the
veteran with symptoms of PTSD. However, the spouse’s
perspective is critical to enhance family resiliency.
Philosophical Framework
To investigate the phenomenon of interest, Husserlian
phenomenology was employed. Phenomenology is a
research methodology that is used to understand the
essence of a phenomenon (Munhall, 2007), in this case,
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the participant’s perspective of living with a veteran
with PTSD. This philosophical framework stems from
Husserl’s posit that consciousness is connected to human
experiences. Thus, phenomenology refers to the study
of the participant’s perspective of their lived experience.
The researcher must therefore strive to set aside his or
her personal preconceptions, partialities, and beliefs to
acquire consciousness of the experience (Munhall, 2007).
Developing consciousness of the phenomenon as one
who does not know is referred to as existential interaction. Existential interaction requires the researcher
to participate in transcendental subjectivity (Wojnar &
Swanson, 2007). When a researcher participates in transcendental subjectivity, he or she must make endeavors
to relinquish presumptions and portray the genuine
consciousness of the phenomenon. To achieve transcendental subjectivity, bracketing must occur. Bracketing is
defined as purposefully surrendering previous encounters, beliefs, and prejudices to prevent obstruction of the
phenomenon (Tymieniecka, 2003). Previous encounters,
beliefs, and prejudices must be exposed by the researcher.
Intentionally setting aside preconceptions is referred to
as decentering, which allows the researcher to become
an authentic and effective instrument of research. These
concepts are essential for the researcher to acknowledge
the essence of the participant’s experience (Munhall,
2007).
Methods
Recruitment Procedures and Participants
Participants included in the study were married to
Active Duty, Guard, Reserve, retired, or medically discharged veterans. The participants reported that their
husbands had a presence of PTSD symptoms or were diagnosed with PTSD as a result of deployment to an OCO.
Additionally, the inclusion criteria were (a) between the
ages of 21 and 60 years, (b) English-speaking, and (c)
having the capacity to reflect upon and discuss their personal experiences. Exclusion criteria included individuals
who were unable to participate due to mental or physical
illness, hospitalization, inability to communicate, residing
outside of the United States, or unmarried partners.
A pilot study was conducted to refine the methodological issues (Yambo, Hamilton, & Johnson, 2014).
Participants were recruited through purposive sampling.
Further recruitment was conducted through social networking and participant referral. Each participant was
asked to pass along the information to other spouses
living with veterans with PTSD until the investigator
reached study saturation. Recruitment ended when, via
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Yambo et al.
Table 1. Participants’ Sociodemographic Characteristics (N = 14)
Variable
n (%)
Age (years)
21–29
30–39
40–49
50–56
4 (29)
6 (43)
3 (21)
1 (7)
Ethnicity
Caucasian
Caucasian-Hispanic
Hispanic
Employment
Caregiver
Employed∗
Homemaker
Volunteer
Children
None
1–5
6–10
Current health
Fair
Good
Very good
Excellent
10 (71)
2 (14)
2 (14)
3 (21)
8 (57)
3 (21)
1 (7)
2 (14)
11 (79)
1 (7)
3 (21)
4 (29)
3 (21)
4 (29)
Variable
Length of marriage (years)
10
n (%)
2 (14)
6 (43)
6 (43)
Number of deployments
1
2
3
4
PTSD symptoms
Diagnosed
Undiagnosed
12 (86)
2 (14)
Traumatic brain injury
Diagnosis
No diagnosis
7 (50)
7 (50)
PTSD symptoms (years)
5
2 (14)
9 (64)
3 (21)
Relationship status
Married
Divorcing
6 (43)
3 (21)
4 (29)
1 (7)
11 (79)
3 (21)
Note. Caregiver = recognized as provider of personal care to the veteran.
PTSD = posttraumatic stress disorder.
∗
One caregiver worked outside the home.
coding and examination of the interviews, it was determined that redundancy had been achieved (Morse,
2006).
The purposive sample (N = 14) included 2 spouses of
veterans with PTSD symptoms (without formal diagnosis) and 12 spouses married to a veteran with a diagnosis
of PTSD. In this study, participants (n = 7) reported living
with a veteran with a codiagnosis of PTSD and traumatic
brain injury (TBI). The TBI, as reported by the spouses,
was the result of a traumatic event that occurred during
the veteran’s deployment. Table 1 includes additional
sample demographic characteristics. The participants felt
that their participation in the study might aid others
living with veterans with PTSD.
Ethical Considerations and Data Collection
Rush University Institutional Review Board approval
was obtained for this dissertational study. Before the
interviews took place, each participant gave written
informed consent. Data collection took place from
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September 2013 to December 2014 until redundancy
and data saturation were achieved after the 14th interview. Data were collected through interviews with
each participant individually at a mutually agreed upon
time. Twelve participants were interviewed face to face.
Per their request, two participants were interviewed via
telephone. Interviews were unstructured with openended questions that began by asking the participants to
describe an experience that exemplified what it was like
to live with a veteran with PTSD symptoms. For parts of
the story that needed clarification, more detail, or deeper
exploration, probing questions, such as, “Can you say
more about that?” were utilized. Individual questions
were used to further explore what makes living with
someone with PTSD symptoms either more difficult
or easier. The interviews were audio-taped and field
notes were written following each interview. Recordings
were transcribed verbatim by a professional transcription
service. Each transcript was quality checked for accuracy
by the first author.
Data Analysis
The transcripts were uploaded into the qualitative data
management program, ATLAS.ti (Scientific Software Development, Berlin, Germany). Data were analyzed using
a modification of Colaizzi’s phenomenological analysis
(Colaizzi, 1978). The modification included contacting
three participants for validation of the findings, rather
than all participants, to ensure that their words had
the same meaning as the investigator understood. The
Colaizzi (1978) analytical steps involved (a) reading each
participant’s description of the experience, (b) formulating the meaning of each significant statement, (c) organizing the formulated meaning into clusters of themes,
(d) integrating the results into a description of the phenomenon, (e) validating the findings by revisiting three
participants, and (f) integrating modifications provided
by the participants into the final description. Three participants compared their experience with a summary of the
findings of the study. Participants reviewed the findings
separately and expressed agreement that the findings
accurately described their experiences. To preserve confidentiality, each participant was assigned a pseudonym.
Findings
Four major themes emerged. A description of the
themes along with supporting quotes follows to reflect
the essence of the spouses’ experience.
Military spouses living with veterans with PTSD
described the experience of reintegration, a period of
time immediately following the deployment, as a time
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of noticing changes in their husbands. Outwardly, their
husbands looked the same, but their reactions and
behaviors were different. For instance, Sara, spouse
of a veteran with PTSD and TBI, recalled how she
initially noticed the change in her husband’s behavior
but only later realized that it was a symptom of PTSD.
She stated, “We had a lot of fights over him just being
self-absorbed with video games all the time. Now I know
that that’s a common symptom of PTSD, the isolating
and withdrawal. It’s still a struggle.”
The spouses struggled to understand the change in
their husbands’ behavior and attitudes. These changes
were often observed, but sometimes they were simply
hunches that something about their husband was different. Over a period of time, the spouses began to realize
that certain conditions or events triggered a memory of a
traumatic experience from their husband’s deployment.
Alice, a spouse of a veteran with symptoms of PTSD,
shared that the subtle changes in her husband’s behavior made her aware that he was no longer the same.
She said,
It started clicking to me, um, that he was having some
PTSD because just like the locking of the doors. And
later he told me that was because he felt like he was
being followed or, you know, he got paranoid that
people were after him.
When their husbands returned from deployment, the
spouses expected their husbands to resume their previous roles and responsibilities and that life would return
to “normal.” However, the more time the spouses spent
with their husbands, the more they recognized that their
husbands were no longer the same. Recognizing their
husbands were no longer the same made many of them
realize that they, not their husbands, needed to readjust.
Living With Unpredictability
Living with their veteran spouse was turning into a life
of unpredictability. The spouses often referred to the predictability of unpredictability as “walking on egg shells.”
In other words, they knew their husband would react,
but they did not know when or where the reaction would
occur. Not knowing what new experience was going to
trigger a reaction coupled with the uncertainty of their
husbands’ reactions was stressful to the spouses. Isabelle
reflected on the unpredictability. She explained, “Sometimes, it feels like walking on eggshells. You don’t know if
he’s having a good day or not. Small things could trigger
him.”
All of the spouses were trying to become more attuned to their husbands’ moods and triggers. Although
the spouses were feeling stressed from the continual
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exposure to PTSD symptoms, this stress was compounded
by the loss of predictability in their lives. Leah shared her
viewpoint on the impact of unpredictability on her life.
She explained,
It’s very unpredictable because you don’t know. We
could be shopping and be fine and then somethin’
catches his eye. Like I know crying children and
women in balaclava or whatever the headdress.
Certain things if he catches it, it puts him back there
in whatever happened; the aggression comes out or
whatever he needs to do to get out of the situation. It’s
a daily stress, unpredictable.
The spouses dealt with the daily challenges of unpredictability. Many of them recognized that their husbands
would have good days that made everyone feel good.
However, when their husbands had bad days, they felt
the loss of predictability in their lives. The loss of predictability created an emotionally unstable environment
that left the spouses wanting to recreate peace in their
homes.
Bearing the Burden
The spouses perceived two types of burdens, a tangible
one from assuming the duties and responsibilities of their
relationship, and an invisible psychological burden. With
regards to the tangible burden, the spouses felt that it was
their responsibility to manage the changes in their lives
that were sparked by their husbands’ medical condition.
For example, shifting roles, assuming their husbands’
chores, or reintegrating their husbands into the family
became part of their responsibility. Megan, whose spouse
had symptoms of PTSD, reflected on how shifting roles
helped her to support her husband. She stated, “That
sense of you’re dealing with—you know that this person
can’t deal with the regular stuff. You step in. You take
care of it for them. Cleaning, the dishes, all these little
things. Even filling up the car.”
In addition, three spouses bore the psychological
burden of guilt for their husbands’ traumatic deployment
experience, the impact of PTSD on their life, or for
starting a new life without their husband. Cassie, a
spouse of a veteran with PTSD and traumatic injuries
expressed her guilt for encouraging her husband to
take the place of another military member when it was
not his turn to deploy. She was feeling guilty for her
husband’s traumatic experience that resulted in PTSD
and a traumatic injury. She shared, “I asked my husband
to volunteer to go this third time to Afghanistan. I guess
I feel guilty because he did go and 3 months later came
home with 45% burns to his body, you know, PTSD.”
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Maintaining the peace. Ten of the spouses felt
responsible for maintaining peace in the family. They
tried to avoid conflict, but often felt unsuccessful in their
endeavors. For those spouses with children, maintaining
peace between their husbands and their children was
emotionally exhausting because their husbands angered
easily and quickly. One tactic they used to maintain the
peace was to help the children understand their father’s
medical condition. The spouses also tried to model
behavior for their children. Yet, keeping the peace was
an ongoing challenge for them. Lily expressed concern
about the emotional fragility of her family. She said,
I feel like I’m the peacemaker in our home and it gets
exhausting. Sometimes you just want to lock yourself
in the room and really just want to run away, but you
can’t because if you do then he might hurt himself or
the kids will be scared.
Dealing with spouse’s emotions. The spouses
experienced a myriad of emotions as they tried to navigate the journey of PTSD with their husbands. Six of the
spouses shared that they were struggling with dealing
with their husbands’ coexisting mental health concerns.
Three spouses reported struggling with their husband’s
plan to commit suicide. To keep their husbands safe,
each spouse described encouraging their husbands to
seek mental health treatment. All three of these spouses
discussed intervening at times to prevent their husband’s
suicide attempt. Maria was feeling afraid that she might
not be able to keep her husband safe. She said, “I’m terrified of the snap. There’s been a couple of times he’s had to
take himself to the [hospital] because he’s suicidal. ‘Cause
he’s suicidal and he snaps; things make him so angry
that I can’t calm him down.” Many of the spouses were
dealing with their husband’s volatile emotions without
seeking assistance from external sources. In other words,
they were silently struggling with their own emotional
needs, while tending to their husband’s emotions.
Protecting the children. Twelve of the spouses
had children and many of them expressed concern about
how PTSD symptoms were impacting their children.
Therefore, they were taking measures to shield their
children from hostility and to prevent the children from
triggering a symptom of PTSD. The mothers were also
attempting to nurture the father–child bond. Six spouses
noticed that their husbands were unable to relate to
them or the children during a flashback. A flashback,
the mothers expressed, posed a significant fear for their
children’s safety and their own. Thea, a spouse of a
veteran with PTSD and TBI, recalled protecting herself
and their children when her husband experienced a
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flashback. She stated, “You had to clear all the kids
to one room, and lock yourself in the room ‘cuz your
husband has a knife and he’s trying to kill you, but he
doesn’t know that he’s in that mind frame.”
Creating a New Life
The return to life before the deployment was not happening the way the spouses anticipated it would when
their husbands returned home. Therefore, each spouse
created new ways to function around the veteran’s PTSD
symptoms. Bree described how she altered the way
she tended errands. She said, “We have to change our
shopping schedule around a lot. He doesn’t like to be
where there’s a lot of people. When we do, he just—he
has anxiety.” Kathy reflected on the changes in their
social life. She recalled, “We could never go out, ever.
We couldn’t go out to crowded places. We couldn’t go
to restaurants or couldn’t go even grocery shopping.
Couldn’t go anywhere where there were crying kids and
babies because that set him off, too.”
Not seeing old friends; creating new friends.
Despite having a network of friends, six of the spouses
described feeling alone in dealing with their husband’s
symptoms of PTSD. Lily described why she sought support from like-minded spouses. She remarked,
I enjoyed being around other spouses that were
experiencing similar situations because they
understood. They didn’t judge and they didn’t look
down on you. They understood exactly what you were
going through, and sometimes you’d hear their stories
and you’re like, “Oh, my day wasn’t that bad today
then.” As silly as it sounds, it helps you get through.
All of the spouses were gravitating towards individuals
who accepted their experience. The spouses cultivated
relationships with individuals who shared ongoing
emotional encouragement. Receiving emotional encouragement became a lifeline, linking them to those who
understood their plight.
Making sense of the relationship. Restructuring
ways of thinking and reacting was important to the
spouses. Two spouses talked about structuring their
“new normal.” However, their new normal was not a
destination, but rather an ongoing journey. Michelle, a
spouse of a veteran with PTSD and TBI, recalled how she
was able to accept her new way of living. She remarked,
“Seeing that MRI made me realize there’s no way he’s
ever coming back. We started our new normal that day
that I was in [treatment facility]. He cannot multitask
anymore. He can only do one thing at a time.” Because
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of the impact of PTSD symptoms on their marriage and
family, the spouses altered their lifestyle to cultivate a
way of living that fit their relationships.
Three spouses shared that they were contemplating divorce as their way of creating a new life. Megan described
how struggling with her husband’s medical condition
impacted her decision. She commented, “I’ve actually
filed for divorce just this month because it’s something
I’ve had to do. ‘Cause I’m at the point with after many
struggles with his PTSD and all the problems that have
come with it.” The three women perceived that their
new normal was to be without their husbands. In spite
of filing for divorce, two spouses felt that they would
reconsider the divorce, if their husbands were willing to
engage in treatment and make progress towards reducing
self-destructive behaviors.
Adjusting the environment. As their lives
unfolded, the spouses were learning to adapt their
surroundings to their husband’s condition. For instance,
Isabelle, a spouse of a veteran with PTSD, discussed
how she was creating structure for her husband. She
mentioned,
I have a dry erase board to write everything down.
If I’m gonna be working, I make sure to write it
on there. I even text him reminders. I always have to
keep reminding him about certain things, so he doesn’t
forget.
One spouse established rapport with her husband’s
medical practitioners to become active in her husband’s
treatment. Several women became advocates for their
husband’s care; they were helpful in creating processes to
ensure their husbands were compliant with their medical
treatment. Hence, spouses were finding ways to adjust
the environment for their husbands.
Understanding PTSD and TBI. The spouses
whose husbands were diagnosed with PTSD and TBI described feeling unprepared to deal with their husbands’
dual medical disorders. Michelle shared her difficulty
with understanding her husband’s dual diagnosis. She
said, “I wish, [my husband], I could have tattooed on
your forehead ‘PTSD’ and ‘TBI’ because you look the
same, but you do not act the same.” Because the spouses
were limited in their knowledge of how to deal with the
veteran’s dual diagnosis, they were experiencing difficulty with the complexity of PTSD and TBI symptoms and
communicating with their husbands.
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Discussion
The essence of the experience of living with veterans
with symptoms of PTSD is that spouses are struggling
to find balance. Finding balance is a primary concern
in postdeployment resiliency for spouses, because prolonged exposure to PTSD symptoms is a predictive factor
of secondary traumatic stress (Ahmadi et al., 2011).
The findings reported here highlight military spouses’
perspective of their daily life with a veteran with PTSD
symptoms. Further, this study adds to earlier descriptions
of the experiences of military spouses living with veterans with PTSD (Dekel et al., 2005; Lyons, 2001; Maloney,
1988; McLean, 2006; Ray & Vanstone, 2009; Woods,
2010); supports marital adjustment findings revealed in
PTSD research conducted with Vietnam veterans’ partners (Evans, McHugh, Hopwood, & Watt, 2003; Jordan
et al., 1992; Koenen, Stellman, Sommer, & Stellman,
2008; Riggs, Byrne, Weathers, & Litz, 1998), ex–World
War II Prisoners of War (POWs; Cook, Riggs, Thompson,
Coyne, & Sheikh, 2004), and former Israeli POWs (Dekel
& Solomon, 2006); and provides a deeper understanding of the impact of combat-related traumatic stress
on family relationships (Canfield, 2014; Frederikson,
Chamberlain, & Long, 1996; Maguen, Stalnaker,
McCaslin, & Litz, 2009; Ray & Vanstone, 2009). The
findings of this study support the evidence that spouses
struggle to balance their day-to-day life due to the
symptoms of PTSD (Mansfield, Schaper, Rosen, &
Yanagida, 2014).
Often, the military spouses struggle alone in silence. It
is little surprise that many of the participants expressed
loneliness amid the mental health resources that are
available to them. Moreover, these findings are consistent with findings from research with U.S. Vietnam
veteran spouses (Lyons, 2001) and Canadian peacekeepers’ spouses (McLean, 2006). Researchers found
that spouses readjust their lives around the veteran’s
symptoms without regard to their own personal physical
and emotional well-being, and little is known about the
cost of such resiliency.
This study is one of the few qualitative studies conducted to explore the essence of the experience of U.S.
military spouses living with a veteran with PTSD symptoms from OCOs. In this investigation, the themes and
significant statements described were comparable to the
themes of previous research: feelings of anger, confusion,
fear, and loneliness; thoughts of confusion to understanding PTSD symptoms; and descriptions of the complexity of their relationship with their husband (Woods,
2010). Furthermore, they were consistent with themes
identified by Dekel and associates (2005) in wives of
Israeli veterans: the illness as navigating living, between
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Yambo et al.
merging and individuation, partners as present-absent,
separation and divorce, and partners as empowers. The
themes revealed that spouses perceived that navigating
their husband’s illness made it difficult to maintain their
individuality, which created emotional dissonance in
their relationship that led to thoughts of separation and
divorce. However, despite the emotional dissonance,
partners remained in their relationship. Remaining in the
relationship meant assuming the responsibility of making
household decisions on their husbands’ behalf. Hence,
the partners felt empowered when they made decisions
that impacted the well-being of their family, while their
husbands dealt with PTSD symptoms. This study, which
focused on these women’s lived experiences, detailed
the myriad adjustments they make on many fronts to
keep themselves and their children safe, to regulate
their husband’s emotions and affect and to preserve the
threads of their relationships.
This research also provided insight to the spouses’
perception of PTSD as ever-changing, unpredictable,
and stressful to their family dynamics and relationships.
According to the Substance Abuse and Mental Health
Services Administration (2014), enhanced behavioral
health clinical policy is necessary for families to receive
tailored care to help them cope with the complexities
of PTSD. Although, each spouse felt that living with
a veteran with PTSD was an individual experience,
their lives were interwoven in commonalities that cut
across all the spouses, regardless of the veteran’s PTSD
symptom severity. The findings indicate that living with
a veteran with PTSD is stressful for the spouses due to
the complexity of the condition. On a positive note,
five spouses reported gaining insight on how other
spouses coped with a difficult situation and working to
“normalize” their experience through the experiences
of others. In other words, when the spouses connected
with other individuals, they were able to make sense
of their situation. When spouses made sense of their
situation, they were able to identify common stressors
and utilized their awareness of others’ ways of coping to
cultivate their own coping strategies. Unfortunately, two
spouses, who were unable to connect with others, were
feeling exceedingly stressed and lonely in their efforts
to cope.
Although programs such as Families Overcoming
under Stress (FOCUS project) are underway to address
family resilience enhancement, most of the emphasis
has been on deployment and has not targeted PTSD
and spouse resilience (Saltzman, Bartoletti, Lester, &
Beardslee, 2014). However, even when there are collaborative efforts like the FOCUS project, military spouses
lack the tools to effectively cope with the stress of PTSD
symptoms. Thus, it is paramount for community and
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private organizations to link the spouses with resilience
services early in the military separation process.
Limitations of the study include the absence of a male
spouse in the sample. Although community organizations supported male and female spouses, we were
unsuccessful with the recruitment of a male spouse.
One male spouse intended to participate; however, his
veteran wife had a co-occurring, incurable illness that
prevented his participation. Therefore, findings cannot
be generalizable beyond female spouses. In addition, it
is not possible to control for the interaction of PTSD and
the impact of multiple deployments.
Conclusions
The experiences of these military spouses draw attention to the tremendous stress of spouses of veterans who
suffer with PTSD and traumatic injuries. Community
organizations are crucial to offering resources and connecting spouses to appropriate referral services. Yet, there
remains a need to nudge collaboration among civilian,
military, and federal components to support the health
and well-being of military spouses. Respect and understanding of the spouses’ unique position in the treatment
of PTSD warrants the unveiling of obscure systematic processes to provide continual support for military families.
Reintegrating is a challenge for military families.
Future studies are needed to understand the impact
of traumatic stress on the spouse and military family.
Clearly, we are on the cusp of transforming health care to
acknowledge and care for the unsung heroes of military
families—military spouses. It is our hope to keep military
families together through educational efforts to increase
awareness of their plight.
Acknowledgments
We appreciate the Jonas Center for Nursing and
Veterans Healthcare, Bob Woodruff Foundation, and
the National Military Family Association, which partially
funded this research.
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