1. 1 William Satterfield, Ph.D. LCDR, US Public Health Service Senior Policy Analyst Office 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 the United States Surgeon General United States Department of Health and Human Services June 20, 2012

2. 2 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

3. 3 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

4. 4 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

5. 5 Preparation/pre-exposure Pre-existing Mental Health concerns Development age Strength of relationships Communication Community/social support Factors Related to Impact

6. 6 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

7. 7 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

8. 8 Those with PTSD 2X as likely to divorce; 3X more likely to divorce two or more times – 4X greater likelihood of marital distress – 2 nd 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

9. 9 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

10. 10 Couples therapies – Cognitive-Behavioral Conjoint Therapy – Emotion-Focused Therapy Pre-deployment preparation Psycho-educational intervention Supportive interventions Recommendations/Intervention

11. 11 Office of Military Community Outreach (Military Community and Family Policy) – Military OneSource ( www.militaryonesource.mi l) – 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

12. 12 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

13. 13 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

14. Questions Questions?