Running Head: EFFECTS OF REDEPLOYMENT AS SEEN IN UNITED STATES MARINES

Effects of Redeployment on Posttraumatic Stress Disorder Symptomatology, Satisfaction with

Life, and Death Anxiety As Seen in United States Marines

Breesha Comish, Justine Gibney, John D. Pierce, Jr., & Dale S. Michaels

Philadelphia University

Authors Mailing Address: John D. Pierce, Jr., Ph. D. School of Science and Health Philadelphia University School House Lane & Henry Avenue Philadelphia, PA 19144-2556 Office: (215) 951-2556 Fax: (215) 951-6812 PierceJ@philau.edu

Abstract

Previous work has shown that PTSD is a consistent problem especially in terms of combat soldiers. In the current study, we looked at the prevalence of PTSD symtomatology, as well as the level of Satisfaction with Life and Death Anxiety experienced by redeploying United States Marines. Seventy-seven United States Marines completed PTSD Questionnaires, Satisfaction with Life and Death Anxiety surveys. The highest level of PTSD symtomatology was more prevalent in Marines that had deployed one or more times. Satisfaction with Life showed significance in terms of number of deployments as well. However, Death Anxiety proved to be not significant. These results have important implications as it brings attention to the matter of redeployment and its affects on combat troops.

Effects of Redeployment on PTSD Symptomatology, Satisfaction with Life, and Death Anxiety

As Seen in United States Marines

Posttraumatic stress disorder, or PTSD, is a disorder that affects the lives of many different people in a variety of age groups. PTSD is a reaction to an extreme traumatic event (Leahy & Holland, 2000). To be considered traumatic and extreme, an event must fit specific conditions. The event must involve death, threat of death, serious physical injury, or threat to physical integrity of self or others (Leahy & Holland, 2000). There are a number of symptoms that PTSD presents. Specifically, there are three cardinal sets: reexperiencing the trauma, avoidance of internal and external cues that are connected to the trauma, and increased arousal (which include insomnia and irritability, among others) (Leahy & Holland, 2000). PTSD is an extremely common disorder. In a community sample, lifetime prevalence ranged from 1% to 14% (Leahy & Holland, 2000). According to one survey, 76% of American adults reported exposure to extreme stress (van der Kolk, McFarlane, & Weisaeth, 1996). Another survey revealed that 15.2% of U. S. Vietnam veterans continued to suffer from PTSD 20 years after the end of the Vietnam War (van der Kolk, McFarlane, & Weisaeth, 1996). Many of the effects of PTSD impact a persons every day life. Parallel schemas exist: high levels of competence and interpersonal sensitivity tend to go hand-in-hand with self-hatred, lack of self-care, and interpersonal cruelty (van der Kolk, McFarlane, & Weisaeth, 1996). Traumatic events influence people in a number of ways. One area PTSD affects is a persons ability to trust. After a traumatic event, experiences affect a persons perception of their relationships (van der Kolk, McFarlane, & Weisaeth, 1996). Another area PTSD affects is the lack of a sense of responsibility. Many people with PTSD suffer from self-blame, guilt and shame, and feel a loss of internal locus of control (van der Kolk, McFarlane, & Weisaeth, 1996). PTSD can also cause negative effects on a persons sense identity. Those with PTSD fail to maintain a sense of significance, competence, and inner worth, while also thinking of themselves as unlovable, despicable, and weak (van der Kolk, McFarlane, & Weisaeth, 1996).Soldiers in particular face many extreme traumatic events that cause them to develop PTSD. The immediate reaction for many soldiers is combat stress reaction, or CSR. This often leads to the development of PTSD. There are six main factors that soldiers suffering from CSR encounter. Soldiers experience distancing, including reports of psychic numbing, fantasies about running, and thoughts about civilian life, with 20% of the total variance reporting these feelings (van der Kolk, McFarlane, & Weisaeth, 1996). Anxiety was another factor. Soldiers reported paralyzing anxiety, fear of death, and thoughts of death. Insomnia was also a problem. Soldiers also felt fatigue and guilt about poor performance in combat (van der Kolk, McFarlane, & Weisaeth, 1996). Soldiers also experienced loneliness and vulnerability, with 8% of the total variance (van der Kolk, McFarlane, & Weisaeth, 1996). Many also felt a loss of self-control, including weeping, screaming, and impulsive behaviors, totaling 7% of the variance. Lastly, soldiers experienced disorientation, difficulty concentrating, focusing thoughts, and making mental associations (van der Kolk, McFarlane, & Weisaeth, 1996). Those soldiers who are dealing with these symptoms, along with the stress of combat, are obviously not in the proper condition to be in combat or to be redeployed.The effects of war on troops have faded in and out of interest in the mental health community over the last hundred years. The Vietnam War sparked the interest again in the 1970s (Herman, 1997). Today, PTSD is a diagnosable disorder and is becoming better understood every year. However, though there is more attention being given to the troops fighting the War on Terror in respect to PTSD, many troops still do not seek or receive treatment. In a survey on combat experiences, 65 to 95 percent of marines reported, after deployment, that they were exposed to different stressors such as being attacked and ambushed, seeing dead bodies, and being responsible for the death of an enemy combatant (Hoge et al, 2004). In addition, 86% of the marines who met criteria for depression, anxiety, or PTSD reported that they acknowledge they have a problem (Hoge et al, 2004). However, of that 86%, only 21% reported that they received treatment from a mental health professional (Hoge et al, 2004). Likewise, a study completed on service utilization in a sample of service members from Iraq and Afghanistan showed that 12% suffered from PTSD and it was then associated with feeling of lower quality of life (Erbes et al, 2007). However, all of these service members went through the process of deactivation and or discharge (Erbes et al, 2007). Many if not all marines are deployed numerous times. The present study examined the significance of redeployment and how this assumed re-exposure to traumatic stress would cause different levels of PTSD symtomatology, satisfaction with life, and death anxiety. The mental health of combat soldiers is of great concern as it affects their ability to perform their job and function at home. A study done by Matthew Friedman (2006) looked at a significant minority of returning military personal and the trouble they faced with readjustment into life in the United States. He reported that this minority suffered from PTSD or some other psychiatric disorder. Friedman examined the debilitating effects of PTSD and how it affects the everyday life of an individual. However, this did not bring any attention to the redeploying military personal and how it affects his or her readjustment into and back out of life as result to redeployment in the United States. The current study seeks to bring attention the number of redeploying marines who exhibiting symtomatologies of PTSD or possible mental health concern. In addition, studies have been conducted on the lack of proper evaluations for returning combat soldiers. Milliken, Auchterlonie, and Hoge, measured the health needs among soldiers returning from Iraq and association of screening with mental health care utilization (2007). They concluded many soldiers returning from Iraq who suffer from some type of mental health issue are not picked up from initial health evaluations (Milliken et al, 2007). Likewise, the lack of confidentiality within the military might cause some soldiers suffering from alcohol problems to not seek treatment (Milliken et al, 2007). This study is very important as it addresses the ineffectiveness of the actual health evaluations. However, it does not address the need for more attention to those being redeployed with possible mental health issues. The current problem is that there is not enough research on the affects of redeployment on combat soldiers. Previous research looks at the effects of deployment and the need for better evaluations for returning soldiers. In addition, the knowledge known about PTSD can be used to better delve the issue of redeployment and its affects on the individual. However, there is no real research done focusing on the men that show signs of PTSD while being redeployed. The purpose of this study was to examine the differences between the number of deployments and its effects on the prevalence of PSTD symptomantologies, and the level of satisfaction with life and death anxiety. Whereas previous studies have focused solely on the prevalence of PTSD symptomantology and the combat experiences after deployment, we chose to focus on the number of marines that are redeploying while reporting symptoms that meet criteria for PTSD, show low satisfaction with life, and low death anxiety. In addition, we sought to find correlations between PTSD symptomantology, satisfaction with life, and death anxiety. We hypothesized that there are many troops redeploying that are experiencing PTSD symtomanologies, have low satisfaction with life, and have low death anxiety. In addition, we hypothesized that there were higher levels of PTSD symtomatology in troops that have been deployed more than once. Method

Participants

Participants were 77 United States Marines (4 women, 73 men; mean age = 20.16 years, SD = 2.3) stationed at Camp Lejuene in Jacksonville, North Carolina. Participants rank in the Marines ranged from private (14.3), private first class (40.3), lance corporal (28.6), corporal (14.3), and sergeant (2.6). The number of deployments completed ranged from 0 -3 with a mean for each group being zero (53.2), one (26.0), and two or more (20.8). Those participants that were deploying again totaled 83.1% and those not deploying again totaled 16.9%.

Materials

Three surveys were used to assess the prevalence of post traumatic stress disorder, satisfaction with life, and death anxiety. The Posttraumatic Stress Questionnaire (Leahy and Holland, 2000) was used to measure the number of clinical criteria Marines met for post-traumatic stress disorder. The questionnaire consisted of 12 statements describing symptoms people often have after experiencing a traumatic event(s) (Sample question: Upsetting memories about what happened). Participants provided a rating for each statement according to a four point scale (from None to A Lot). Higher scores indicated meeting criteria for Posttraumatic Stress Disorder. We scored the PTSD survey using two measures. For the first measure, all the scores for PTSD criteria were totaled. For the second measure, we examined PTSD symtomatology by totaling only answers that were given for moderate and severe criteria.The second survey used was the Satisfaction with Life survey (Pavot, W. & Diener, E.). This is a five-item survey designed to measure how happy people are with the current condition of their life (Sample question: In most ways my life is close to ideal). Responses were measured along a 7-point Likert scale from Strongly disagree to Strongly agree. Scores were added up and higher scores meant greater satisfaction with life, while lower scores meant greater dissatisfaction with life. The third survey used was the Death Anxiety survey (Templer, D. I.). The survey consisted of 15 items, measuring how afraid a person is of death. The statements in the survey range from questions regarding thinking about death to various ways of dying (Sample question: I am very much afraid to die). Each statement was rated along a 7-point Likert scale from Strongly disagree to Strongly agree. Six items were reverse scored so that higher scores on the scale indicated greater death anxiety.

Procedure

We traveled to Jacksonville, North Carolina where in the Jacksonville Mall we recruited our participants. We asked anyone that walked by to complete our survey. All surveys were anonymous and took approximately 10 minutes to complete. Marines were asked to be as honest as possible and were told that they could stop participation at any time if they felt uncomfortable with the questions. All participants were treated in accordance with the APA code of ethics (American Psychological Association, 2002).ResultsInitially we examined a break down for each category of PTSD symtomatology and the percentage of participants that marked a 3 or a 4, indicating moderate to severe expression of that criterion. For the hallmark symtomatologies of PTSD such as upsetting memories about the event, 31.1% marked moderate to severe expression of the criterion. About Twenty three percent reported having nightmares about the event. For the category pertaining to flashbacks 18.2% reported moderate to severe presentation of the criterion. More drastically, 58.4% reported moderate to severe levels of irritability and anger. Likewise, 41.6% reported feeling on edge or unable to relax and 40.3% had marked that they had sleeping difficultly. Percentages ranging 32-36.4% also reported moderate to severe levels of anxiety, lack of interest, inability to feel close to others, and feeling emotionally numb. For a T-Test Analysis we broke participants into two groups, the first group was made up of 36 previously deployed Marines and the second was comprised of 41 Marines that had not yet been deployed or seen combat. In addition, we used two types of measures in the analysis of PTSD symtomatology. For the first we collected the total sum of scores for all criteria for PTSD on the Symtomatology questionnaire from all the participants. For our second measure we examined PTSD symtomatology by counting the number of symptoms that each participant answered a 3 or 4, indicating moderate to severe expression of that criterion.A T-Test analysis revealed significantly greater PTSD symtomatology in previously deployed Marines (M = 31.8 [SD = 10.5]) compared to Marines who had not been deployed (M = 18.8 [SD = 5.9]; t (75) = 6.81, p < 0.001). Our second measure confirmed our first finding, showing a T-Test analysis revealing significantly greater PTSD symtomatology in previously deployed marines (M = 6.67 [SD = 4.18] compared to Marines who had not yet been deployed (M = 1.90 [SD = 2.20]; t (75) = 6.36, p < 0.001). In addition, we examined Satisfaction with Life and Death Anxiety. For the Satisfaction with Life survey, T-Test analysis yielded significant findings. It showed significantly lower Satisfaction with Life expressed by the previously deployed Marines (M = 19.03 [SD = 7.22]) when compared to Marines who have not yet been deployed (M = 22.34 [SD = 7.55]; t (75) = 1.96, p < 0.054). However, a T-Test analysis measuring Death Anxiety, as seen in these same groups, revealed that levels did not differ depending on whether the Marines were previously deployed (M = 47.81 [SD = 14.33]), or not (M = 43.10 [SD = 11.66]; t (75) = 1.60, p < 0.115). SEE TABLE 1We then focused on combat experienced Marines, facing redeployment within the next six months. Participants were broken into two groups. The first group was made up of 23 Marines that will deploy for their second time or more. The remaining 41 participants made up the second group; it was comprised of Marines who have not yet seen combat. We excluded the 13 Marines whom will not deploy again from this analysis. We again chose to examine PTSD symtomatology using two forms of measurement. Upon a T-Test analysis, results revealed significantly greater PTSD symtomatology seen in combat experienced Marines facing redeployment (M = 28.55 [SD = 10.14]) compared to Marines who had no combat experience (M = 18.76 [SD = 5.91]; t = (62) = 4.90, p < 0.001). Likewise, findings were further supported when we examined PTSD symtomatology through numbers of moderate to severe answers. T-Test analysis again revealed significantly greater PTSD symtomatology in combat experienced Marines facing redeployment (M = 5.61 [SD = 4.18]) compared to Marines who have not yet seen combat (M = 1.90 [SD = 2.20]; t = (62) = 4.66, p < 0.001).A T-Test analysis was also run to determine whether there were significant differences between these groups when examining Satisfaction with Life and Death Anxiety. Upon analysis of the Satisfaction with Life scale, we found there to be no significant difference between combat experienced Marines (M = 20.48 [SD = 7.20]) verses Marines who had not yet seen combat (M = 22.34 [SD = 7.55]; t = (62) = .96, p < 0.339). Likewise, findings for level Death Anxiety between these two groups yielded no significant difference. T-Test Analysis showed that combat experienced Marines (M = 48.70 [SD = 14.83]) verses Marines who had not yet seen combat (M = 43.07 [SD = 11.66]; t = (62) = 1.68, p < 0.099) simply did not prove to be dissimilar.In addition to T-Test analysis we examined further into the PTSD symtomatology in context of the number for previous deployments each participant has completed. Participants were broken into three groups. The first group consisted of 41 Marines whom had not yet been on deployment or will not deploy again. The second group was made up of 20 Marines that had been deployed once. The last group was made up of 16 individuals whom had completed two or more deployments. These groups were then compared using a One Way Analysis of Variance. One Way Analysis of variance revealed significant differences in PTSD Symtomatology depending upon the number of redeployments. Upon examination, Marines who had deployed two or more times (M = 38.31 [SD = 8.17]) verses Marines who had been deployed once (M = 26.55 [SD = 9.25]) verses Marines who have not yet seen combat (M = 18.76 [SD = 5.91]; F (2, 74) = 41.216, p < 0.001) showed significant differences in levels of PTSD Symtomatology. To further support these findings, we again examined PTSD Symtomatology by counting the number of symptoms that each respondent answered 3 or 4, indicating moderate to severe expression of that criterion. Significant differences were found again as PTSD Symtomatology in Marines who had deployed two or more times (M = 9.00 [SD = 3.16]) versus Marines who had been deployed once (M = 4.80 [SD = 4.01]) versus Marines who have not yet seen combat (M = 1.90 [SD = 2.20]; F (2, 74) = 33.754, p < 0.001).Furthermore, we again examined the levels of Satisfaction of life and Death Anxiety within these groups. One way analysis of variance revealed slightly significant differences in levels of Satisfactions of Life between Marines deployed two or more times (M = 17.00 [SD = 7.24]) verses Marines deployed once (M = 20.65 [SD = 7.24]) compared to Marines who have not yet seen combat (M = 22.34 [SD = 7.55]; F (2, 74) = 3.053, p < 0.053). However, there were no significant differences between these groups when we examined levels of Death Anxiety. We then further examined the issue of redeployment and its affects on PTSD Symtomatology. While focusing on only those who will deploy again, the participants were broken down into three groups, again based on the number of completed deployments. The first group had zero completed deployments and contained 41 Marines. The second groups contained 18 Marines and had completed one deployment. The third and final group was made up of 5 Marines who all had complete two or more deployments. We compared PTSD Symtomatology differences between groups using two methods, one by simply adding up criterion, and the other again, by counting the number of 3 and 4 responses each participant checked, indicating moderate to severe expression of that criterion. The first One Way Analysis of Variance showed significant differences between groups in relation to the number of deployments completed. Analysis revealed Marines whom have completed zero deployments (M = 18.76 [SD = 5.09]) versus Marines with one completed deployment (M = 26.27 [SD = 9.71]) compared to Marines with two or more completed deployments (M = 36.80 [SD = 7.53]; F (2, 61) = 17.50, p < 0.001). Upon using the second method of scoring, findings again further supported previous results. Again, significant differences were seen between the zero deployment group (M = 1.90 [SD = 2.20]), one deployment group (M = 4.78 [SD = 4.22]), and the two or more deployment group (M = 8.60 [SD = 2.41]; F (2, 61) = 15.227, p < 0.001).When we examined the differences between said groups for levels of Satisfaction of Life and Death Anxiety we found no significant differences. Of the groups formed no differences were seen between, Marines with zero deployments (M = 22.34 [SD = 7.55]) nor did Marines with one deployment (M = 20.22 [SD = 7.28]), or Marines with two or more deployments (M = 19.60 [SD = 6.64]; F (2, 61) = 0.501, p < 0.608). Likewise, there were no significant differences between groups for Death Anxiety, zero deployments (M = 43.07 [SD = 11.66], one deployment (M = 48.39 [SD = 15.10]), and two or more deployments (M = 49.80 [SD = 15.43]; F (2, 61) = 1.41, p < 0.253).Upon answering the surveys the Marines were also asked to fill out demographic information. Part of that section included questions about treatments. Participants were asked whether they sought treatment for any of the above PTSD symtomatology. If they answered yes, they were then asked whether they received treatment. Of the population 13 of the participants answered yes and 64 participants answered no, they have not sought treatment. We then looked into those Marines that marked they has received treatment. DiscussionThe results of the present study support the hypothesis that there are troops redeploying that have presenting PTSD symtomanologies. Many also have low satisfaction with life, however we could not produce any significant data to show and support our hypothesis dealing with the existence of low death anxiety. Likewise, the more completed deployments each Marine had experienced, the higher the level of PTSD symtomatology. These results demonstrate the need for better evaluations of returning military personnel. Equally, it demonstrates the need for subsequent evaluations for soldiers while home and before redeployment. Our work confirms early work showing that many troops do not seek treatment (Hoge et al, 2004). This poses a large problem as these undiagnosed individuals not only suffer but, put themselves and others at risk upon redeployment.This research study is both relevant and important. Throughout the United States, young men and women join the military and many will see combat. The War on Terror is a war like every war, full of traumatic situations and traumatic stress. Many men are returning with PTSD symtomatology and are getting treatment, however, there are those who are not as our results demonstrates. It is these men that are of concern, as they are not only likely to see more traumatic situations, but they are likely going to compound issues they already have. In addition, it is important to look at the well being of not only the troops that possibly suffer from PTSD but also the soldiers that they might affect in process. By returning to combat while possibly suffering from PTSD they put themselves in danger as they may become paralyzed with fear. The in ability to act could not only cost them their own life but the lives of their fellow soldiers. However, there are some limitations to the study. Because of the short amount of time we had to conduct the study and the small window of time we had to acquire a decent population, the population size suffered. Though still substantial enough to draw reliable results, the study to could be expanded. Spending more time collecting data in different locations around Camp Lejeune could have created a more lucrative population. Likewise, this study could be expanded to encompass all Marine bases in the United States. Also, other branches of the military could be examined. In addition, there could be comparative studies done for active enlisted men versus reserves. In addition, the PTSD survey we used is only used to determine symtomatology. This does not necessarily mean individuals have diagnosable cases of PTSD. An expansion of the study could be conducted to use clinical evaluations that actually diagnose PTSD as well as to help determine those that are on the verge of developing PTSD. Much more could be done to expand upon the prevalence of PTSD in redeploying marines.Another idea that could be done further with this study could be to expand it into a longitudinal study. By using a population that is about to be deployed and running an evaluation before deployment and running subsequent evaluations throughout each participants four year enlistment, one could truly determine the possible course of PTSD for each individual. Likewise, one can find better determinants for the types of people that are more prone to develop PTSD.Although our results are limited in relation to population, we would expect that they would prove to be consistent if tested on a larger population. We expect that if the population could have been larger wee would have even more significant results for PTSD symtomatology and Satisfaction with Life, as well as significant results for Death Anxiety. The reason for the lack of significant results for Death Anxiety could be simply due to the small population or could be due to a proposed numbing. Redeployment of troops is a controversial topic for many families and this study was conducted to help gain further knowledge on the subject and to bring more attention to the affects of redeployment on United States Marines.

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