BY JENNIFER WOODWORTH, PSY.D
Many times, symptoms of depression that continue or worsen are under reported due to the possibility of impact on career advancement or minimizing the impact on daily functioning.
MORE THAN DEPLOYMENTS
Military lifestyle involves more than just deployments. Stress on the family and children can include many moves, changing schools, leaving friends and community connections, the unique language of the military and constant training and separation of the active duty service member. Daily challenges and days of low mood are normal throughout people’s lives. When these and symptoms listed below occur daily for at least two weeks, consult with your primary care physician for an assessment of depression and treatment options.
DEPRESSION IN ACTIVE DUTY SERVICE MEMBERS
According to the Millenium Cohort Study (2014), the rates of depression among male service members prior to any deployment is 3.9%, however rises to 5.7% when returning from combat deployment. For women, the percentage doubles from 7.7% prior to any deployment to 15.7% after a combat deployment. Deployments are not the only stressful part of being a military family; however deployments can lead to significant physical or psychological traumas experienced by the service member resulting in changes in daily functioning.
Naturally, as the deployment ends and transition to family occurs, there will be a period of time where moods, feelings, and behaviors shift to meet the demands of the environment. However, many times, symptoms of depression that continue or worsen are underreported due to the possibility of impact on career advancement or minimizing the impact on daily functioning. Stigma related to any mental health issue can make service members hesitate in asking for help, with the long held belief that asking for help will impact their ability to maintain strength and lessen their role as a leader in the community. This can lead to many years passing before receiving treatment that can improve the service member’s ability to work through the depression and have a successful career and family life.
RISK FACTORS RELATED TO ACTIVE DUTY SERVICE MEMBER:
• Number of combat deployments
• Loss of combat support personnel
• Time in combat or separated from support
• Past history of depressive episodes
• Substance abuse
• High demand from unit or command
• Lack of promotion
DEPRESSION IN SPOUSES
Much attention is given to active duty and retired military members, as it should; however the signs and symptoms of depression in spouses often get overlooked. The majority of spouses are women; some of whom may be having difficulty with parts of the military lifestyle, including being separated from their family, spending much time on their own, being the primary caregiver for young children, managing the household duties, and the inconsistent schedule of daily demands of the service member’s work. Symptoms might be more subtle including increase in irritability, lack of motivation to complete daily tasks or only taking care of the minimal daily chores (taking care of the children).
RISK FACTORS FOR SPOUSES
• Post-partum “baby blues”
• Past history of depressive episodes
• Caregiving for a family member with health issues
• Spouse experiencing mental health issues related to a deployment
• Feeling lonely
• Not being able to “recharge” or take a break
• Lack of support from community
DEPRESSION IN CHILDREN AND ADOLESCENTS
According to the National Institute of Mental Health, about 11 percent of adolescents have a depressive disorder by age 18. Being part of a military family can increase some of the risks of depression which can be a chronic illness or a short term reaction to a life stressor. Sometimes, with the stresses of everyday life, a child or adolescent’s mood or behavior in a military family can be seen as typical teenage behavior without taking into account the experience of additional risk factors. Identifying a change in mood or behavior can assist in establishing treatment quickly and limit the disruption to the child’s self-esteem, peer relationships, and academic performance.
RISK FACTORS RELATED TO CHILDREN AND ADOLESCENTS
• Friends moving, being “left behind”
• Changing schools (either due to moving or transition to middle or high school)
• Being a victim of bullying at school or in the neighborhood
• Struggling in academics
• Feeling lonely
• Lack of support from parents or community
• Unsupervised time
ADDITIONAL RISK FACTORS THAT MAY CONTRIBUTE TO SYMPTOMS OF DEPRESSION
• Upcoming deployment or homecoming
• Frequent separations of active duty service member including field training or detachments lasting days, weeks, or months
• Location of duty station
• Health issues (physical, emotional, or mental)
• Changes in role at home
• Moving
• Hormones
• Changes in the family structure (divorce, re-marriage, new baby)
• Death of a family member or friend
• Trauma (car accident, witness to violence)
• Abuse (physical, emotional, sexual)
PROTECTIVE FACTORS THAT INCREASE RESILIENCE FROM EXPERIENCING DEPRESSION
• Family involvement, which includes providing limits, rules, structure, and monitoring
• Healthy modeling of coping with stress, asking for help, open communication
• Sufficient amount of sleep
• Ability to identify and describe emotions
• Effective clinical care for mental, physical, and substance use disorders
• Easy access to a variety of clinical interventions
• Support for seeking help
• Strong connections to family
• Community support
• Financial stability of family
• Support through ongoing medical and mental health care relationships
• Skills in problem solving, conflict resolution and nonviolent handling of disputes
• Participation in extra-curricular activities in two or more of the following contexts: school, with peers, in athletics, employment, religion, culture
THESE ARE SYMPTOMS TO BE AWARE OF THAT MAY INDICATE DEPRESSION
• Changes in appetite, either eating more or less than usual. Significant weight loss or weight gain. This can be seen as binge eating, eating unhealthy food or loss of appetite with limited food intake.
• Changes in sleep patterns; sleeping more or less than usual. This could be expressed as sleeping during the day, staying up most of the night, or difficulty getting up in the morning for school or activities.
• Changes in motor activity. Look for slower movements including increased time getting dressed or restless energy such as increased fidgeting.
• Fatigue, lack of energy, or being bored. Look for lack of motivation including not attending previously enjoyed activities or isolating from family or peers.
• Feelings of worthlessness or guilt. Service members returning from combat might have feelings of survivor’s guilt if they have experienced the death or injury of peers. Adolescents might express thoughts of not being good enough or guilty for not appreciating what they have. They may take the blame or responsibility for negative events or outcomes.
• Persistent sad or irritable mood. Look for crying more than usual, changes in appearance or clothing choice, or increase in hostility with parents or teachers.
• Frequent vague, non-specific physical complaints. Some adolescents experience frequent stomach aches, headaches, or muscle aches related to depression.
• Reckless behavior and/or alcohol or substance abuse. Any member of the family may use substances to deal with feelings of sadness to numb or forget about their stresses. They may engage in activities that put their physical health at risk due to feelings of guilt or worthlessness.
• Decreased concentration or indecisiveness. This may be expressed as an “I don’t care” attitude in decisions that the family member usually had an opinion.
• Frequent absences from school or poor performance in school. This can indicate decrease in motivation and energy or may include behavior problems with teachers or peers.
• Recurrent thoughts or attempts of self-harm or suicide. Always take this seriously when a family member mentions death or self-harm and contact a mental health professional as soon as possible.
WHAT YOU CAN DO
If you recognize these symptoms in someone you know, sometimes knowing what to do next can be a challenge.
• Open a discussion about changes you have noticed and express your concern. Ask if your family member has noticed these changes and what may be contributing to them.
• Contact a primary care physician or insurance for a referral to mental health professionals who specialize in depression and understanding of the current military lifestyle.
• Explore multiple treatment interventions including individual or group psychotherapy and/or medication assessments.
• Continue to provide support to your family member by listening to their concerns and following up with mental health appointments.
Intervention programs available for military families include education and skill development for handling situations unique to military life.
F.O.C.U.S.
Families Overcoming Under Stress is a family centered approach that is developed from evidenced-based research to increase resiliency and decrease risk in military families. F.O.C.U.S.’ purpose is to increase the resiliency of the family during a stressful time. Identifying and regulating emotions (anger, sadness, fear, guilt), finding the deployment triggers that increase emotions, communication within the family, problem solving, and goal setting are points focused on during sessions.
FOR CHILDREN AND ADOLESCENTS
Operation Purple Camp Intervention provides connection and social support for children and adolescents in military families. It is designed as a one-week camp to promote healthy coping strategies to utilize during deployments (Chawla & McDermid Wadsworth, 2012) •
References
Schaller, E. K., Woodall, K. A., Lemus, H., Proctor, S. P., Russell, D. W., & Crum-Cianflone, N. F. (2014). A longitudinal comparison of posttraumatic stress disorder and depression among military service components. Military Psychology, 26, 77-87. http://dx.doi.org/10.1037/mil0000034
ABOUT THE AUTHOR:
Jennifer Woodworth is a licensed clinical psychologist in private practice in Vista, CA. She has worked in the mental health field for seven years. Her husband is retired from the Marine Corps and she has three children ages six, eight, and ten.
