Secondary traumatization of wives of war veterans with posttraumatic stress disorder

Aim

To determine the symptoms of secondary traumatic stress and possible influences of demographic and socioeconomic factors on the occurrence of secondary traumatic stress in wives of war veterans with posttraumatic stress disorder (PTSD).

Method

The study included 56 wives of war veterans diagnosed with PTSD and treated at the Center for Psychotrauma in Rijeka, Croatia. A short structured interview was conducted with each woman to collect demographic and socioeconomic data. The women independently completed an adapted 16-item version of Indirect Traumatization Questionnaire to determine the presence of secondary traumatic stress symptoms, which corresponded with PTSD symptoms as defined by the fourth edition of the Diagnostic and Statistical Manual for Mental Disorders.

Results

Out of 56 veterans’ wives included in the study, 32 had six or more symptoms of secondary traumatic stress, whereas only 3 had none of the symptoms. Twenty-two women met the diagnostic criteria for secondary traumatic stress. Women with secondary traumatic stress were married longer than those without it (mean ± standard deviation, 19.1 ± 9.1 vs 13.2 ± 7.8 years, respectively; P = 0.016). Eleven of 22 women with secondary traumatic stress and 8 of 34 women without secondary traumatic stress were unemployed (P = 0.05).

Conclusion

As more than a third of war veterans wives met the criteria for secondary traumatic stress, any treatment offered to veterans with PTSD must address the traumatization of their family.The Croatian 1991-1995 war caused a wide range of psychological and psychosocial difficulties in war veterans (1). Many of them were diagnosed with posttraumatic stress disorder (PTSD), which has considerably disrupted their social and emotional functioning (2,3). The veteran’s difficulties in everyday life mostly affect his family, while the family is expected to provide all the support that he needs (2). The wife and children witness his sleepless nights, restless dreams, and absentmindedness that sometimes lasts for hours or even days, and avoid upsetting him as much as possible (2,4-6). His low frustration threshold, lack of patience with children, inability to carry on with his family role, great expectations, and verbal and physical aggressiveness heavily influence the relationship with his spouse, children, parents, and the rest of the family (4,7-10).Previous research showed that close and long-term contact with an emotionally disturbed person may cause chronic stress, which in time in persons providing help leads to various emotional problems, such as higher levels of depressive symptoms and anxiety, problems in concentration, emotional exhaustion, pain syndromes, and sleeping problems (2,3,6). One third of wives of Croatian veterans treated for PTSD met the criteria for secondary traumatization (2). In case of posttraumatic disorders, Figley (10,11) believes that empathy toward the traumatized person may induce significant emotional agitation in other family members and calls this phenomenon the secondary stress reaction to catastrophe. Other authors used different terms for this phenomenon, such as compassion fatigue, secondary traumatic stress, and vicarious trauma (11-13). However, the mechanism of transmission of posttraumatic stress onto persons who witnessed or learned about the trauma exposure of the close ones is still rather unknown (11).Secondary traumatic stress is defined as natural emotional reaction to the traumatic experience of a significant other (10,14). Secondary traumatization is the stress caused by providing help, or wishing to help, and offering emotional support to a traumatized person. Secondary stress disorder as a syndrome is almost identical to PTSD except that indirect exposure to the traumatic event through close contact with the primary victim of trauma becomes the criterion A (10). The symptoms of secondary traumatization are similar to those present in directly traumatized persons: nightmares about the person who was directly traumatized, insomnia, loss of interest, irritability, chronic fatigue, and changes in self-perception, perception of one''s own life, and of other people (10). Physical symptoms may also be present, including headaches, indigestion, susceptibility to infections, and increased use of alcohol, drugs, or tobacco (2,12).A few studies investigated the effects that PTSD in war veterans had on their spouses (5,15,16). Dekel et al (5) in their qualitative study on the marital perceptions of 9 wives of veterans with PTSD found that being employed and having known their husbands before the war was very important to the wives of PTSD-diagnosed veterans. Various demographic variables, such as age, ethnicity, education level, or social support, were not found to influence the perceived burden and psychological distress in partners of veterans with PTSD (16). Apart from qualitative study by Dekel et al (5), our literature search of the PILOTS and EPNET bibliographical databases with the key words secondary traumatization, wives, PTSD, war trauma, sociodemographics, socio economics, education level, employment, income, and several others did not find any studies that specifically investigated the relationship between the socioeconomic status and the level of secondary traumatization symptoms or the association between the duration of marriage and the occurrence of secondary traumatization in veterans’ wives.Due to the exposure to stress, caused by the husband’s PTSD symptoms or other psychiatric and health conditions, often combined with his insufficient social and emotional support and increased demands, the veterans’ wives are at an increased risk of specific mental problems related to the life with mentally disturbed husband (3,17-19). Given the recent war in Croatia and relatively high percentage of war veterans with combat-related PTSD, we expected secondary traumatic stress in their wives and female partners to be relatively frequent and that the duration of their life together, number of children, economic situation, and (un)employment would influence the occurrence of secondary traumatic stress.The aim of this study was to determine whether the wives of war veterans with PTSD had symptoms of secondary traumatic stress and to evaluate the possible influence of demographic and socioeconomic factors on the occurrence of secondary trauma stress in these women.