A qualitative study of the capabilities of family members of veterans living with operational stress injuries

• Published date: 01 December 2023
• Author: Deborah Norris,Kelly Dean Schwartz,Maya Eichler,Linna Tam‐Seto,Alyson Mahar,Kimberley Smith‐Evans,Heidi Cramm
• Date: 01 December 2023
• DOI: http://doi.org/10.1111/fare.12801

RESEARCH

A qualitative study of the capabilities of family

members of veterans living with operational

stress injuries

Deborah Norris

1

|Kelly Dean Schwartz

2

|Maya Eichler

3

|

Linna Tam-Seto

4

|Alyson Mahar

5

|Kimberley Smith-Evans

6

|

Heidi Cramm

7

1

Department of Family Studies and

Gerontology, Mount Saint Vincent University,

Halifax, Canada

2

Werklund School of Education, University of

Calgary, Calgary, Canada

3

Departments of Political and Canadian

Studies & Women’s Studies, Mount

Saint Vincent University, Halifax, Canada

4

Department of Psychiatry & Behavioural

Neurosciences, McMaster University,

Hamilton, Canada

5

School of Nursing, Queen’s University,

Kingston, Canada

6

Centre for Social Innovation and Community

Engagement in Military Affairs, Mount

Saint Vincent University, Halifax, Canada

7

School of Rehabilitation Therapy, Queen’s

University, Kingston, Canada

Correspondence

Deborah Norris, Department of Family

Studies and Gerontology, Mount Saint Vincent

University, 166 Bedford Highway, Halifax,

Nova Scotia, B3M 2J6, Canada.

Email: deborah.norris@msvu.ca

Funding information

The authors gratefully acknowledge the

funders of this study—Veterans Affairs

Canada.

Abstract

Objective: This qualitative study explores the experiences

of 26 family members supporting Canadian Armed Forces

veterans living with mental health problems including

operational stress injuries (OSIs).

Background: The research focusing on military-connected

families emphasizes the impacts of service on the families.

Little is known about how families impact military vet-

erans, particularly those diagnosed with OSIs. This

research addresses that gap by revealing the capabilities

and demands characterizing their everyday lives.

Method: Semistructured interviews with 26 individuals

identifying as family members of Canadian Armed Forces

(CAF) veterans and three focus groups (three participants

in each group for a total of nine) with family members of

CAF veterans releasedwithin the preceding10 years were

conducted. The veterans were living with broadly defined

diagnosed and undiagnosed mental health problems

including OSIs. Using the family adjustment and adapta-

tion (FAAR) model as an organizational framework,

demands and capabilities embodied within the everyday

lives of the family members were revealed.

Results: Monitoring the well-being of the veteran, manag-

ing daily life, accessing and mobilizing resources, and care-

giving were discussed as capabilities by participants in this

study. These capabilities buffer the demands associated

with the veteran’s mental health problems.

Conclusions: Results of this study endorse recommenda-

tions for family-centered program and service develop-

ment, modeled on approaches that recognize the systemic

Received: 16 December 2021Revised: 29 April 2022Accepted: 23 October 2022

DOI: 10.1111/fare.12801

© 2022 National Council on Family Relations.

Family Relations. 2023;72:2869–2885. wileyonlinelibrary.com/journal/fare 2869

and relational contexts instrumental in supporting positive

outcomes for veterans with OSIs.

Implications: Further research exploring the complex,

interdependent,and interactional role of families supporting

veterans with OSIs is warranted.

KEYWORDS

adaptation, capabilities, family, operational stress injury, posttraumatic

stress injury, veterans

INTRODUCTION

The capacity of military members and veterans to develop and maintain positive mental health

and well-being is challenged by operational imperatives (National Defence and Canadian

Forces Ombudsman, 2013). Since 1990, the Canadian Armed Forces (CAF) has engaged in

more than 20 major international operations, involving multiple deployments to Rwanda,

Bosnia, Afghanistan, and, more recently, Mali (Department of National Defence, 2021;

National Defence and Canadian Forces Ombudsman, 2013). The intensified operational tempo

is associated with an increase in the prevalence of operational stress injuries (OSIs; Veterans

Affairs Canada, 2015). OSIs are defined as persistent psychological difficulties, including anxi-

ety disorders, depression, and posttraumatic stress disorder (PTSD), resulting from operational

duties performed through military service and which interfere with daily functioning (Veterans

Affairs Canada, 2022). The effects of OSIs ripple through the families of those affected (Norris

et al., 2018).

PTSD and the families of veterans

The impacts of PTSD and other OSIs on the families of veterans are documented in research

conductedoverthe past25 years.Themajorityofthesestudieshavebeen conductedinthe

United States, initially focusing on families of those who served in the Vietnam War, and more

recently extending to the families of those who participated in Operation Enduring Freedom

(OEF) and Operation Iraqi Freedom (OIF). These studies trace a linear, unidirectional pathway

within the lives of the veterans and their families, beginning with the initial awareness of the

precipitating trauma, through to the veteran’s diagnosis and treatment of an OSI, and, finally,

to impacts experienced within their families. The research suggests causality, specifically

between PTSD in the veteran and adverse family effects (Norris et al., 2015). For example,

studies of veterans of the wars in Iraq and Afghanistan living with PTSD describe negative

effects on family functioning and the well-being of family members (Taft et al., 2008) and, in

studies involving OEF/OIF veterans and their families, both relationship distress (Campbell &

Renshaw, 2013) and lower family cohesion is reported (Tsai et al., 2012). Paternal PTSD is

associated with childhood hyperactivity and prosocial difficulties (Fear et al., 2018) as well as

parenting problems and family maladjustment (Kritikos et al., 2019). Evidence of secondary or

vicarious traumatization (Dirkzwager et al., 2005), ambiguous loss (Boss, 2007), caregiver bur-

den (Calhoun et al., 2002; Dekel, Solomon, & Bleich, 2005; Dekel et al., 2021), intrapersonal

challenges (Dekel, Goldblatt, et al., 2005), and moral injury (Nash & Litz, 2013) are also

described within this research.

The strong support for the negative impacts of OSIs, particularly PTSD, on the mental

health and well-being of the families of members and veterans is minimally balanced by evi-

dence of reciprocal effects, specifically, how families impact the mental health and well-being of

2870 FAMILY RELATIONS