Evaluation of Bristol, TN and VA Business Owners’ Knowledge of PTSD
Leslie Culbertson
Research in Allied Health
April 20, 2010
Abstract
In the coming months, the United States will be flooded with a workforce. With the combat missions in Iraq and Afghanistan coming to a close, American businesses will have a brand new pool of potential applicants, most of whom have experienced at least one traumatic event in their time overseas. Post traumatic stress syndrome affects many soldiers coming home from war, further hindering their reintegration back into society. Many soldiers suffer from PTSD and go untreated due to an unwillingness to seek medical attention. Families of militaries are taught to prepare and remain vigilant for signs of PTSD, but how prepared are the new employers of returning soldiers in the identification of PTSD symptoms and its treatment?
List of Tables
Appendix A PTSD KNOWLEDGE SURVEY Page 19
Chapter 1:
Introduction
Background
Post traumatic stress disorder is an anxiety disorder, which manifests following a traumatic event and produces negative feelings or feelings of “fear, helplessness or horror,” (Mayo Clinic Staff 2011). “The third edition of Diagnostic and Statistical Manual…includes Post-Traumatic Stress Disorder (PTSD) as a sub-class within the Anxiety Disorders diagnostic category. Symptoms associated with this disorder occur after a traumatic and stressful event…” (August and Gianola 1987). PSTD can be caused by a wide range of experiences, from witnesses or experiencing childhood or adult physical, emotional, or sexual abuse (Mayo Clinic Staff 2011), to the witnessing of the atrocities of war. “Nearly half of U.S. adults experience at least one traumatic event in their lifetimes, yet only 10% of women and 5% of men develop posttraumatic stress disorder (PTSD),” (Ozer and Weiss). There are many factors that contribute to the development of PTSD, and individual factors play heavily in the development of the disorder.
PTSD affects a wide range of Americans, but two of the most affected groups are female victims of abuse and soldiers. People inflicted with PTSD have a hard time operating in their daily lives’ until treatment has been obtained. Many sufferers of the disease speak of how it becomes the main focus of their lives (Dekel). People suffering from PTSD often do not realize they are inflicted and do not seek treatment. Research of people living with or working with those suffering from PTSD has mainly focused on families and spouses of people with PTSD, but the focus of this examination will be the future employers and associates of soldiers potentially inflicted with PTSD.
Purpose
The purpose of this study is to examine the level of knowledge regarding PTSD by employers and employees of the Bristol TN and VA area, identify weaknesses in this knowledge base, and remedy those weaknesses and prepare the business population for the coming injection of potential applicants formerly employed in the United States military.
Significance
Soldiers returning to the workforce are returning from serving the country. Many soldiers returning to the country currently suffer from onsets of PTSD, and even more suffer from it without ever reporting it to authorities. Business leaders of the community and their employees owe it to these returning soldiers to have at least a basic knowledge of the potential danger of PTSD, how to recognize symptoms, and how to provide a supportive environment that eases the reintegration of our military back into civil society. A glaring example of the necessity of this is Vietnam. As soldiers returned from this unpopular war, they were met largely with disdain instead of support. What resulted is unacceptable; soldiers were ostersized from society, the business world, and their families. The unpopularity of the Afghanistan and Iraq conflicts have been regularly compared to Vietnam, but it is absolutely necessary to ensure that the return trip of soldiers this time around is different from our shameful past.
Research Question
The main focus is testing the general knowledge of PTSD among local business owners and identifying possible weaknesses in their understanding of PTSD. Through this research, other questions are expected to be answered as well:
1. What symptoms should employers and employees watch for in incoming soldiers?<?xml:namespace prefix = o />
2. How should employers and employees react and respond to possible cases of PTSD?
Assumptions
1. Some soldiers who have served in the United States military may be inflicted by PTSD and have not reported it.
Limitations
1. The research does not take into account the background or histories of the respondents of the surveys.
2. The surveys rely on some medical jargon, in addition to dealing with mentally stimulating material; as such, some responders may misunderstand the survey
Chapter 2:
Literature Review
Erika Beras (2012), in her insightful investigative piece on the reintegration of soldiers into civil society, points to the difficulty of coming home for many veterans. She expounds the history of post traumatic stress syndrome, a history that parallels the history of warfare. From ancient Roman and Greek records, to 1600s Swiss “nostalgia,” to “soldier’s heart” in the Civil War, to “shell shock” in WWI, and “battle fatigue” of WWII, the realities of post war shock have been clear to onlookers. Another important service Beras’ investigation provides is a microscopic look into the sufferers of PTSD, from more than one generation. One example she uses, Dennis Hughes, served in Vietnam after being drafted; “Once you’re in a combat zone you’re never the same,” he said, “They do various things – a lot of them mask what they have seen, whether it’s alcohol or drugs, because at that time, people didn’t want to hear nothing about…so when you went to Vietnam, that was the attitude people got. They were calling us ‘baby killers’ and all that kind of stuff, and here we are thinking we did the right thing and we’ve got to come home and be confronted with these situations.” As Beras demonstrates, veterans who already may be shocked by the horrors of war are very aware of the perceptions of bystanders, and their mental state is further deteriorated or facilitated by their outward support. Even the military is beginning to recognize the severity of the problem; as Lt. Col. Tom Strokes, military behavioral health specialist and social worker, “Combat stress units have been around for years, but more recently have taken on a more significant role and have been more accepted in the military community. It’s not what it was 20 or 30 years ago.” Lt. Col. Stokes claims that the greatest danger for solider mental health is posed when the soldier comes home, “When you come back home you don’t have a combat stress unit, you don’t have a Lt. Col. Stokes coming out to you, it’s up to you to seek treatment, to seek what you need to do to readjust, in a healthy way. And that’s where the problems occur, because you come back here, and I can speak from experience, you can feel rather anonymous and lonely and isolated.”
Another news report, written by Larkin Page-Jacobs (2012), points to specific hurdles facing returning veterans in their social integration. Adjusting to civilian life from a military tour requires significant effort. One Iraq war veteran, Rob (he requested his last name to remain anonymous), described his feelings while visiting a mall, feelings that are sharply contrasted to the typical response; “I was always having nightmares at night, and certain things trigger it: just, loud noises, or, I don’t like people behind me a lot of the time, or stuff like that. I don’t like malls with a lot of people in it. I hate it. I can’t stand a lot of people around me, because I was, able to carry a gun and get people the heck out of my way.” Dr. Wendy Troxel describes the effects of PTSD, “Recalling the event, having nightmares, avoiding difficult feelings, hyper-vigilance, being kind of alert, all of these things are actually normal stress reactions in the acute phase. PTSD is when these symptom clusters persist over time and they interfere with one’s functioning.” One of the most powerful healing tools in the battle against PTSD is a relationship. “Having a stable relationship is one of the most protective factors for veterans in terms of diminishing so many negative impacts of the adjustment difficulties, including PTSD,” Dr. Troxxel said. A major issue in the battle against PTSD is the refusal of many to seek treatment. “Ben Keen said when he began experiencing the signs that accompany PTSD, he tried to keep it to himself, both because he didn’t understand what was happening to him, “and the other half of it was that I tucked it away because I didn’t want people to find out, and I didn’t want to be tagged as a crazy soldier, or people think that all of my accolades mean nothing now because I can’t hack it.”
Constance L. Shehan (1987) demonstrates in her insightful article just how powerful spousal support is in the recovery of PTSD. Vietnam veterans inflicted with symptoms related to PTSD have been shown to have poor social integration. “Vietnam veterans have a greater propensity for marital breakup and living alone. They also have lower educational attainment, higher unemployment and absenteeism at work, relatively heavy drug use, and relatively more frequent hospitalization for psychological problems,” (Shehan 1987). Recollections stemming from PTSD directly affect sufferers lives. “Most PTSD sufferers re experience the trauma of their combat experiences through recurrent dreams or nightmares and/or intrusive recollections.” She recognizes the importance of spousal support in the process of recovery in PTSD; but one of the main components of this support is knowledge of the disease. “Vietnam veterans’ wives need to be educated about PTSD.”
Gimbel and Booth (1994) demonstrate the specific reasons why military experiences negatively affect marital relations. They present three reasons: “(a) Factors that propel men into combat also make them poor marriage material; (b) combat causes problems such as post-traumatic stress symptoms or antisocial behavior that increase marital adversity; and (c) combat intensifies pre-military stress and antisocial behavior that then negatively affect marriages.” They demonstrate in their article that PTSD both directly and indirectly affects relationships. “…war related PTSD in particular has been shown to be related negatively to marital quality.”
Emily J. Ozer and Daniel S. Weiss (2004) examine the common qualities of those affected with PTSD. “Nearly half of U.S. adults experience at least one traumatic event in their lifetimes, yet only 10% of women and 5% of men develop posttraumatic stress disorder.” The authors point to the investigation of social and political factors in the support of PTSD victims. “Virtually all interventions for PTSD focus on the individual with symptoms and utilize medication for psychotherapy. Although these interventions may help alleviate individual symptoms, they are obviously inadequate for addressing the harm to social institutions or promoting long-term healing and mental health if the sources of persistent trauma are not addressed.”
Charles C. Hendrix and Lisa M. Anelli continue investigations into the relationship between PTSD and family life. They claim that there is a distinct need for the long term study of PTSD effects. “…veteran’s preoccupations with Vietnam experiences permeate and continue to impair family life. This impairment can be demonstrated by lower levels of cohesion, flexibility, and communication.” Although PTSD is a serious detriment to marital life, the support of one’s loved ones is again shown to be a significant feature of recovery, as well as an indicator for treatment. “Additionally, with help from family life educators and therapists, the family can serve to detect the symptoms, confront the problems stemming from PTSD, recapitulate the traumatic events, and resolve the trauma-inducing conflicts associated with the events.”
In the article “Being a Wife of a Veteran with Posttraumatic Stress Disorder,” the tensions and problems of PTSD are demonstrated to permeate beyond the afflicted individual. “Clinical observations and empirical studies have indicated that the consequences of traumatic events are not limited to the victim, often affecting significant others in the victim’s environment…described as secondary traumatization.” The authors display that the support of families is a key component of PTSD recovery. “The entire family system was affected by the posttraumatic injury, and the wives bore the burden of supporting and caring for their husbands and families…Therefore, any assistance offered to men with PTSD must take into account supporting and empowering the wives and children.
As the authors of the article “Correlates of female veterans’ perpetration of relationship aggression,” (2012) demonstrate, the affects of PTSD are far reaching and can affect a wide variety of victims. There has been little research into the perpetration of intimate partner aggression among female veterans, despite greater participation by females in military systems. “Findings demonstrated that although women veterans were significantly more likely to perpetrate physical intimate partner aggression than were their male partners, there were no gender differences with respect to psychological aggression perpetration.”
Chapter 3:
Research Method
Research Design
The study is aimed at testing the level of knowledge regarding the causes, symptoms, and treatments of PTSD. Respondents will be given a multiple choice test of thirty (30) questions that will include a comments section at the end. The tests will contain ten questions regarding the various causes of PTSD, ten will cover the symptoms of PTSD, and ten will cover the treatments of PTSD. Of each grouping of questions five questions will be of a factual or statistical nature, and five will be presented as hypothetical situations. The respondents will be expected to answer each question truthfully and completely as possible, and the test will be anonymous. The comments section of the test will provide respondents to provide subjective or personal information regarding their personal experiences with PTSD.
Research Questions
The questions will be presented in two forms: factual and hypothetical. The factual questions will be based on general statistics and facts of PTSD, whereas the hypothetical questions will test the possible reactions and misconceptions of respondents.
Participants
A wide sampling of Bristol business leaders will be asked to participate in the survey. A maximum of five participants from a single location may take the test, so as to not dilute the responses based in a single geographic or business location. Businesses that typically employ former soldiers will have preference, but all types of businesses will be welcomed.
Data Collection Methods
The tests will be disseminated to employers along with instructions for taking the test, and they will be collected one week after they are issued. Questions will be presented to participants with four possible answers.
Data Analysis
After the tests have been conducted and collected, the information will be analyzed and categorized. Information analyzed from the tests will be separated based on four categories:
· Total percentage of factually correct answers
· Total percentage of correct answers for hypothetical answers
· Percentage of answers of hypothetical questions that reflect misconceptions
· Identification of any common misconceptions among respondents
References
Anelli, C. C. (1993). Impact of Vietnam War Service on Veterans' Perceptions of Family Life . Family Relations .
Beras, E. (2012, April 16). ForVeterns Coming Home Isn't Always Easy. Essential Public Radio .
Booth, C. G. (1994). Why Does Mlilitary Combat Experience Adversely Affect marital Relations . Journal of Marriage and Family .
Gianola, L. R. (1984). Symptoms of War Trauma Induced Psychiatic Disorder: Southeast Asian Refugees and Vietnam Veterans. International Migration Review , 820-832.
Lissa Duntra, G. D. (2012). Correlates of female veterans' perpetration of relationship aggression. Psychological Trauma: Theory, Research, Practice, and Policy, 2012 .
Page-Jacobs, L. (2012, April 16). For Veterans With PTSD, Building Relationships is No Easy Task. Essential Public Radio .
Rachel Dekel, H. G. (2005). Being a Wife of a Veteran with Posttraumatic Stress Disorder. Family Relations .
Shehan, C. L. (1987). Spouse Support and Vietnam Veterans' Adjustment to Post-Traumatic Stess Disorder. Family Relations .
Staff, M. C. (2011, April 12). Post-traumatic stress disorder (PTSD). Retrieved March 3, 2012, from www.mayoclinic.com: http://www.mayoclinic.com/health/post-traumatic-stress-disorder/DS00246/DSECTION=causes
Weiss, E. J. (2004). Who Develops Posttraumatic Stress Disorder. Current Directions in Psychological Science .