Distress tolerance, family cohesion and adaptability, and posttraumatic stress symptoms among combat veterans and their parents

• Published date: 01 December 2023
• Author: Gadi Zerach,Tamar Gordon‐Shalev
• Date: 01 December 2023
• DOI: http://doi.org/10.1111/fare.12861

RESEARCH

Distress tolerance, family cohesion and adaptability,

and posttraumatic stress symptoms among combat

veterans and their parents

Gadi Zerach|Tamar Gordon-Shalev

Department of Psychology, Ariel University,

Ariel, Israel

Correspondence

Gadi Zerach, Ariel University, Ariel 40700,

Israel.

Email: gadize@ariel.ac.il

Abstract

Objective: Theaversiveimpactofcombat-relatedpost-

traumatic stress disorder (PTSD) on family members has

been examined mainly among veterans’partners as well as

veterans’offspring.

Background: Only a few studies have examined secondary

PTSD symptoms (PTSS) in veterans’parents, and the con-

ditions in which distress tolerance (DT) contributes to vet-

erans’PTSS and parents’secondary PTSS (SPTSS) remain

unexplored. In the present study, we aimed to use a dyadic

approach to explore the association between veterans’and

parents’DT and their PTSS and that of their parents, as

well as to examine the moderating role of family cohesion

and adaptability in these associations.

Method: A volunteer sample of 102 dyads of Israeli combat

veterans and their parents responded to online validated

self-report questionnaires in a cross-sectional study. Analysis

included actor–partner interdependence modeling (APIM)

andmoderationanalyses.

Results: Veterans’PTSS was positively correlated with

parents’SPTSS. Moreover, two actor effects were revealed

wherein veterans’DT contributed to their own PTSS, and

parents’DT negatively predicted their own SPTSS. More-

over, veterans’DT negatively predicted their parents’

SPTSS (partner effect). Importantly, analysis of modera-

tion revealed that under average and high levels of paren-

tal perception of family cohesion, higher levels of DT were

tied to lower PTSS among veterans.

Conclusion: Exposure to a traumatized veteran offspring

might entail SPTSS among parents. Veterans’high DT is

Received: 20 December 2021Revised: 6 June 2022Accepted: 30 December 2022

DOI: 10.1111/fare.12861

This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits

use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or

adaptations are made.

© 2023 The Authors. Family Relations published by Wiley Periodicals LLC on behalf of National Council on Family Relations.

2886 Family Relations. 2023;72:2886–2907.

wileyonlinelibrary.com/journal/fare

associated with lower PTSS, and their parents’perception

of the family as cohesive might augment this association.

Implications: The findings highlight the importance of

acknowledging distress of indirectly exposed parents of com-

bat veterans. Strengthening military families’cohesion might

be important for veterans coping with posttraumatic stress.

KEYWORDS

APIM, distress tolerance, parents, PTSD, veterans

INTRODUCTION

One of the most detrimental effects of exposure to combat-related trauma is posttraumatic stress

disorder (PTSD; Bryant, 2019). Veterans’PTSD symptoms (PTSS) are known to have a ripple

effect affecting the psychological state of their significant others who might experience secondary

PTSS (SPTSS; Diehle et al., 2017). Nevertheless, most studies to date address these effects mainly

among traumatized veterans’spouses or offspring and only a few studies have focused on parents

of veterans (Bitton et al., 2017). Moreover, whereas a few studies have documented negative

correlations between distress tolerance (DT) and veterans’PTSS (e.g., R. C. Brown et al., 2018),

associations with parents’SPTSS and the familial conditions inwhich these effects take place has

remained unexplored. The present study aims to use a dyadicapproach to assess the interrelation-

ship between DT, PTSS and SPTSS, and the moderating role of perception of family cohesion

and adaptability among combat veterans and their parents.

Literature review

Effects of PTSD on the family

Exposure to potentially traumatic events during military service might put combatants at risk

for long-term mental health disorders, the most common of which is PTSD (Yehuda

et al., 2015). PTSD is characterized by four distinct symptom clusters: intrusive reexperiencing

of the traumatic event(s), avoidance of trauma reminders, alterations in arousal and reactivity,

and persistent negative alterations in cognitions and mood (American Psychiatric Association

[APA], 2013). In the aftermath of military service and participation in combat, between 6% to

25% of veterans in the armed forces are reported to suffer from PTSD (e.g., Fulton etal., 2015).

Among veterans of the Israeli Defense Forces (IDF)—the target population of this study—

recent studies reported about 21% of the participants were classified as suffering from self-

reported probable PTSD (Zerach & Levi-Belz, 2022). It should be noted that many veterans

may experience a symptom intensity range below the threshold required to establish a diagnosis,

but still experience PTSS. Estimated prevalence of subthreshold PTSD among military veterans

ranged from 2.3% to 22.3%, with a weighted mean rate of 7.6% (Bergman et al., 2017).

A growing body of research shows that the detrimental impact of war trauma may also

entail long-term consequences for the mental health of family members of trauma survivors

(e.g., Waddell et al., 2020). The term secondary traumatization refers to those who have come

in close contact with a traumatized person, experience emotional distress, and display SPTSS

similar to that of the primary trauma survivor (Figley, 1995). The Diagnostic and Statistical

Manual of Mental Disorders (5th ed.; DSM-5; APA, 2013) also noted that repeated or extreme

indirect exposure to aversive details of a traumatic event can potentially provide the criteria for

PTSD. Studies, including two meta-analyses, have found a positive association between

DISTRESS TOLERANCE AND PTSS2887