Depressed manReturning veterans of the conflicts in Iraq and Afghanistan may have unrecognized depression triggering family problems and domestic abuse.

Researchers working with veterans referred for psychiatric evaluation from a primary care service found that major or minor depression was associated with domestic abuse and other family problems.

The researchers, at the University of Pennsylvania and the Mental Illness, Research Education, and Clinical Center at the Philadelphia VA Medical Center, looked at the family problems of 168 veterans who were referred for behavioral health evaluation and who had served in Iraq or Afghanistan since 2001.

More than 40 percent were currently married or cohabiting, some 21 percent were recently separated or divorced and almost 55 percent had at least one child.

Two-thirds of the married/cohabiting veterans reported some type of family readjustment problem or conflict occurring several times a week: 42 percent felt like a guest in their household, 21.8 percent reported their children were not acting warmly or were afraid of them, and 35.7 percent were unsure about their role in regular household responsibilities.

Veterans with depression or PTSD were more likely to experience these readjustment problems. The presence of family problems may limit the effectiveness of treatments for depression or PTSD because of the importance of positive family relationships to veterans’ recovery.

According to the researchers, the results suggest an opportunity to improve treatment for returning veterans by involving family in the veteran’s recovery.

In addition, about 56 percent of the patients with current or recently separated partners reported severe conflicts involving “shouting, pushing or shoving,” and 35 percent reported that this partner was afraid of them.

The researchers, led by Steven L. Sayers, PhD, of the Philadelphia VA Medical Center, noted that while there has been very little empirical research focused on the family problems of veterans in the first year or two following their return from a major military conflict, family problems among those with partners are common.

The rates of problems found in this study were similar to those in longer-term studies of Vietnam veterans diagnosed with PTSD.

“In the current study, however, we did not find that PTSD was associated with overall rates of family problems,” the researchers wrote. “In contrast, depression was most consistently related to the presence of both readjustment and domestic abuse problems.”

Many of the veterans at the Medical Center with PTSD were already in treatment in the Behavioral Health Service and so were not part of this primary care sample referred for evaluation.

The researchers found that specific role-related readjustment problems were related both to depression and PTSD.

For example, whereas about 20 percent of the veterans reported that their children were afraid of them or did not act warmly, those with PTSD were at greater risk of this experience (36 percent).

Source: American Psychological Association