Post-Deployment Stress and ReintegrationMary Beth Heller, Ph.D.

Equal Justice Works Leadership Development TrainingOctober 23, 2014

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?

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

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.”

Now, After (December 2010)

SSG Kyle Hausmann-StokesUS Army, Infantry, OIF 07-08

http://www.youtube.com/watch?v=NkWwZ9ZtPEIfrom 3:05-5:10

Reintegration Tasks(Bowling & Sherman, 2008)2

1) Redefining roles2) Managing strong emotions3) 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

Measuring Post-Deployment Stress

• Post-Deployment Health Reassessment Program (PDHRA)4

• Required by DoD since March 2005, 3-6 months post-deployment

• 2004 study5

• 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

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

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

Post-Deployment Stress PTSD

Pathway 1 – mild reintegration stress resolves

Pathway 2 – Acute Stress Disorder resolves

Pathway 3 – Acute Stress Disorder PTSD

References and Resources1 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.