Alla Skomorovsky, Jennifer Lee and Lisa Williams

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While research has shown that Canadian Veterans who transition to civilian life due to illness and/or injury often experience difficulties adjusting to their new context, a growing body of academic literature has found that the “strength behind the uniform” – the military and Veteran families providing care to these people – can also be affected by the well-being and transition experiences of the Canadian Armed Forces (CAF) member.1, 2

Depending on the severity of the illness and/or injury sustained, military members may require assistance with daily life activities (e.g., grounds maintenance, meal preparation, cleaning services) and family members are often the first to provide, arrange and/or pay for this care, which can range in intensity, duration and frequency. As the ill/injured military or Veteran family member adjusts and adapts to the limitations of the illness and/or injury itself, and to their new civilian lifestyle, they can experience strain and tension in their family relationships.

In military families, spouses of military members are often the primary caregivers, and providing this care can have a negative impact on their own health, well-being and careers. Moreover, research shows that caring for military personnel with psychological illnesses can be particularly taxing for caregivers and increase the risk or extent of their own psychological distress due to the military member’s increased reliance on them for cognitive and/or emotional tasks and support.

Limited research has examined the unique experiences, perceptions and impacts of transition to civilian life on the families of CAF personnel or Veterans, particularly those who have been medically released due to illness and/or injuries. However, a past pilot study conducted in 2014–2015 among CAF families transitioning to civilian life suggested that the cumulative effects of illness or injury of a military member combined with their transition to civilian life can have a significant impact on various domains of family functioning.3

Following the lines of the literature reviewed above, Director General Military Personnel Research and Analysis (DGMPRA) conducted a study in 2017–2018 in order to explore and enhance our understanding of the experiences of families of ill and/or injured CAF members or Veterans at various stages of the medical release process regarding their transition from military to civilian life through a series of semi-structured interviews.4

Illness and injury affects family well-being and relationships

Consistent with the literature, interviews indicated that the CAF members/Veterans’ health directly impacts their family members’ well-being, particularly when family members play a caregiving role for the member/Veteran.

[As reported by the parents of a member/Veteran]: Because we struggled really, back then it was a real struggle. When he first came home from the very first tour was a huge struggle. I mean, he’s lost two relationships. He’s had two family breakdowns because of his PTSD.

The members/Veterans could also see the impact on their family members, including the children.

My daughter, [who] is 21, has been probably impacted the most by me, like from what she’s seen me go through. And it’s been really hard on her… because of my anxiety and my depression and everything, she now has anxiety and depression.

Most spouses related the strain on their familial, social and personal well-being primarily to the members/Veterans’ illness/injury, rather than the transition itself.

I think it’s all relative to the whole process… you have a member that’s dealing with their own mental health issues, but not seeking active treatment for himself, and they think that… you know, like, their depression, or their anxiety, their PTSD. And the other partner picks up the slack in the household. It’s difficult to carry that all the time.

Family members reported experiencing strain in their relationship with the CAF member/Veteran. In particular, many family members, who were also spouses, reported a lack of satisfaction and intimacy in their relationship with the CAF member/Veteran, as well as experiencing an emotional disconnect and/or resentment.

He’s got absolutely no interest in sex, that’s a huge impact in our relationship. Yeah, so… as a couple, that’s a difficult one to work through… to lose that intimacy with your partner.

So kind of emotionally distant, on an intimate level, absolutely more distant. It’s kind of like on the outside looking in.

I’m doing more than my share. And actually, if I go back and think about that, there is sometimes that…. Then at times, because I would like him to be more engaged in his care than I am. So yeah, there’s a bit of resentment there if I’m totally honest with myself. 

Caregiving intersects and interacts with other family responsibilities

Family members providing care to the ill or injured military members/Veterans – predominantly spouses – indicated that caregiver burden was a major contributing factor toward their reduced physical health and/or psychological well-being. Examples include the additional cognitive and physical demands placed on the caregivers, such as ongoing monitoring of the CAF member/Veteran, physically assisting CAF members/Veterans to complete their daily activities and taking over previously shared tasks (e.g., gardening, cooking, cleaning).

He is not able to physically do what he has done in the past before he was hurt, and so I took on the task of, well, everything – physical mainly – around the house. And I ended up hurting my back because of it. Somebody needs to do it, and uh… so I ended up hurting my back and now I can’t even work because of this.

Some spousal caregivers also noted that they felt emotionally and mentally drained due to the increased responsibilities and the lack of time they had for self-care. Other consequences they experienced as a result of caregiving include negative health outcomes and work repercussions.

I think it’s really isolating for a caregiver. Like, I wanted to be there for my husband and my spouse. I want to take care of him, do whatever he needs, but then… not that it’s anybody else’s fault, but where’s my break?

I feel like I’m not supported, so I just deal with that on my own, you know. I feel like I bear the brunt of the… of the housework… I feel like I have to get things done on my own. So I feel like I’m sacrificing my own health.

In comparison with spouses providing care, parents providing care typically reported that the members/Veterans’ illnesses and/or injuries did not affect their own personal lives or health. However, this might have been due to the lesser proximity and frequency with which they provided assistance.

Communication between partners can mitigate the impact of caregiving

Despite the reported negative impacts that caregiving, the transition experience and the illness/injury had on their spousal relationship, many spousal caregivers also reported growth in their relationship. According to study participants, the quality and clarity of communication in their relationship was an important factor that appeared to influence the severity of negative impacts. As a result of their shared transition experience and communication, many spousal caregivers reported feeling closer to the CAF member/Veteran as well as becoming a better team. Thus, it is possible that having effective communication bolsters spouses’ tolerance for the additional caregiving responsibilities and burden.

We’ve grown more into a team than a… than a couple almost. Like, what do we have to get done? Okay, how are we going to do it? So yeah, our lives focus mostly on that.

Communication is the key there, especially in a relationship.

Lessons learned and the way forward

This study helped to shed light on the experiences of CAF families during military to civilian transition. Results demonstrate that the transition experience does not solely affect the member/Veteran – it affects their family members and caregivers as well. The majority of family members and, especially, caregivers reported feelings of distress and unease during the transition process, but most reports of the decline in physical, psychological and social well-being were attributed to consequences of the illness and/or injury.

Some important methodological limitations of the present study should be considered when interpreting the results. First of all, the study was designed with an assumption that all ill and injured CAF members/Veterans who participated in the study would have caregiving needs and access to a caregiver (e.g., spouse, sibling, parent) because they had been medically released, and this influenced the development of questions used during the interview process. However, it became clear throughout the interviews that some releasing CAF members/Veterans did not have a caregiver, nor did they necessarily perceive themselves as requiring care, despite suffering from various limitations as a result of their illness and/or injury. Second, although a sizable number of CAF members/Veterans participated in the study, they were in varying stages of transition. Due to the length of the interview, it was not possible to include detailed questions regarding each stage of the transition process. Finally, given the qualitative methodology used in the study, the results are not representative of the population as a whole.

To address these limitations and build on this research, DGMPRA has developed a comprehensive research program related to military families, collaborating extensively with other government agencies – Veterans Affairs Canada and Statistics Canada. This body of research seeks to enhance the lives of military personnel, Veterans and their families across the country.

Through its exploration of the challenges experienced by families of ill and injured CAF members/Veterans, this study provides directions for enhancing the transition experience of military families and maintaining their overall well-being. With the trend for medical releases on the rise since 2013,5 this is an issue of growing importance for Veterans, their families and Canadian society as a whole. It is important to continue developing the expert knowledge necessary to support these families and to find ways to ensure their individual and family well-being.

 

Alla Skomorovsky, PhD, is a research psychologist at Director General Military Personnel Research and Analysis (DGMPRA), where she is a member of the Social Policy and Family Support Programs team. She conducts quantitative and qualitative research in the areas of resilience, stress, coping, personality and well-being of military families.

Jennifer Lee, PhD, is Chair of The Technical Cooperation Program (TTCP) Human Resources and Performance Group (HUM) Technical Panel 21 on Resilience and Acting Director of Research on Personnel and Family Support at DGMPRA, where she has been overseeing her team’s work on a range of topics, including sexual misconduct; diversity and inclusion; military, Veteran and family health; and, more recently, the implications of the legalization of cannabis on Canadian Armed Forces personnel.

Lisa Williams, MA, is a researcher at DGMPRA, where she is a member of the Social Policy and Family Support Programs team. She conducts quantitative and qualitative research in the areas of military, Veteran and family well-being.


Notes

  1. Jim Thompson, MD, et al., “Survey on Transition to Civilian Life: Report on Regular Force Veterans,” Veterans Affairs Canada (2011). Link: https://bit.ly/2J8gYex.
  2. Learn more in A Snapshot of Military and Veteran Families in Canada (November 2018 update). Link: https://bit.ly/2VNiicT.
  3. Alla Skomorovsky et al., Pilot Study on the Well-Being of Ill or Injured Canadian Armed Forces (CAF) Members and Their Families: Well-Being Model Development (2019). Scientific Report. DRDC-RDDC-2017-R203.
  4. A total of 72 semi-structured interviews were conducted, 16 of which were omitted from further analysis due to ineligibility (e.g., non-medical release, over 5 years since release). Of the remaining 56 interviews, there were 31 individual interviews with CAF members or Veterans, 11 individual interviews with primary caregivers and 14 combined interviews. Participants consisted of CAF Veterans who were medically released within the past 5 years or members who were expecting to be medically released within the near future (i.e., within 24 months of the study) due to a psychological or physical illness and/or injury. Their primary caregivers, operationally defined as the individual who provides the majority of care and/or support (physical or psychological) to the CAF member/Veteran, were also included in the interview process. Primary caregivers were typically a family member (e.g., sibling, parent) and, in the vast majority of cases, the spouse. Eligible participants were interviewed either in person or by phone at a time of their choice.
  5. Linda Van Til et al., “Well-Being of Canadian Regular Force Veterans, Findings from LASS 2016 Survey,” Veterans Affairs Canada – Research Directorate Technical Report (June 23, 2017). Link: https://bit.ly/2hWHt7y.