1. Post-Deployment Stress and Reintegration Mary Beth Heller, Ph.D. Equal Justice Works Leadership Development Training October 23, 2014

2. Learning Objectives What is post-deployment stress? Can we measure post-deployment stress? What is the relationship between post-deployment stress and PTSD? How can we support veterans during post-deployment adjustment?

4. Returning Home “So in seven days, I went from getting shot at to sitting in my recliner. And pardon my language, but that’s called the Afghanistan mindf***. Because you come from, ‘I’m here,” to “What the hell to I do now?” 1

5. Altered Perspectives “…you lose a sense of what normalcy is like…You forget what it’s like to watch TV and sit on the couch and you just…you lose all that.” “When I came back from Iraq, the biggest story in the news was Janet Jackson’s wardrobe malfunction at the Super Bowl. And it kind of rattled me, because I looked around and said, “Is this what America is paying attention to?” And I think that’s a common experience for veterans coming home, because such a small percentage of the American population is immediately affected... So there’s a real disconnect, a profound disconnect, from the personal side of this war.” “None of the guys have any work ethic. All they care about is getting drunk or high after their shift. In the Army you did what you were told. I just can’t relate to any of them anymore.”

6. Now, After (December 2010) SSG Kyle Hausmann-Stokes US Army, Infantry, OIF 07-08 http://www.youtube.com/watch?v=NkWwZ9ZtPEI from 3:05-5:10

7. Reintegration Tasks (Bowling & Sherman, 2008) 2 1)Redefining roles 2)Managing strong emotions 3)Abandoning emotional constriction and creating intimacy “In many instances, a traumatized soldier is greeting a traumatized family, and neither is ‘recognizing’ the other” 3 4) Creating shared meaning

8. Measuring Post-Deployment Stress Post-Deployment Health Reassessment Program (PDHRA) 4 Required by DoD since March 2005, 3-6 months post-deployment 2004 study 5 PTSD symptoms Depression General distress Anger Relationship problems With exception of relationship problems (due to small sample size), all mental health problems increased by 200% - 500% at 120 days

9. PDHRA DD 2900 Developed to standardize screening across services Includes screening questions for Depression Traumatic stress Suicidal/homicidal ideation Relationship problems Alcohol problems Structured Clinical Interview Depression PTSD Suicidality Harm to Others Relationship Problems Alcohol Use Disorders Sleep Problems

10. Take-home lesson Recognize that PDHA screenings may underestimate post-deployment stress Relief overshadows symptoms Certain symptom clusters are less relevant immediately after return Initial protective avoidance may mask symptoms Insure that adequate follow-up assessment was completed

11. Post-Deployment Stress  PTSD Pathway 1 – mild reintegration stress resolves Pathway 2 – Acute Stress Disorder resolves Pathway 3 – Acute Stress Disorder  PTSD

12. References and Resources 1 Finley, E.P. (2011). Fields of Combat: Understanding PTSD Among Veterans of Iraq and Afghanistan. Ithaca, NY: Cornell University Press. 2 Bowling, U.B. & Sherman, M.D. (2008). Welcoming them home: Supporting service members and their families in navigating the tasks of reintegration. Professional Psychology: Research and Practice, 39(4), 451-458. 3 Hutchinson, J. & Banks-Williams. L. (2006). Clinical issues and treatment considerations for new veterans: Soldiers of the wars in Iraq and Afghanistan. Primary Psychiatry, 13(3), 66-71. 4 Bliese, P., Wright, K, Adler, A., Hoge, C. & Prayner, R. (2005). Post- Deployment Psychological Screening: Interpreting and Scoring DD Form 2900. US Army Medical Research Unit – Europe. 5 Bliese, P.D., Wright, K.M., Adler, A.B., Thomas, J.L., & Hoge, C.W. (2007). Timing of postcombat mental health assessments. Psychological Services, 4(3), 141-148.