Spouses of Canadian Armed Forces Veterans during Military to Civilian Transition - A Literature Review - September 21, 2020

Spouses of Canadian Armed Forces Veterans during Military to Civilian Transition - A Literature Review

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Executive Summary

To better understand the lived experiences of spouses of medically-released Canadian Armed Forces (CAF) Veterans and their role as a main source of support during the military to civilian transition (MCT), the Office of the Veterans Ombudsman (OVO) undertook a literature review of peer-reviewed work drawn from academic as well as government sources. A scoping review was conducted resulting in 73 potentially relevant articles. These were then refined to include only research published post-2006 that mentioned medically-released CAF Veterans’ spouses/partners and families.

The results of the literature review revealed that:

  • Spouses of Veterans inherit a significant amount of unpaid labour and suffer negative impacts to both physical and mental health immediately prior to, during, and following the Veteran’s medical release;

  • Several studies reported negative career impacts, social isolation, and a sense of loss from the spouses’ perspectives as a consequence of MCT;

  • One study recorded that Veterans living with partners report higher levels of satisfaction, adjustment, perceived social support, and lower difficulty with MCT than Veterans living alone or with family members;Footnote 1

  • Another referred to the spouse and family as the “strength behind the uniform” and stressed the importance of this support system for the Veteran during and after service;Footnote 2 and

  • Much of the research mentioned that numbers of medically-released Veterans, especially those with PTSD, are on the rise as CAF members are increasingly deployed in areas of conflict and front-line combat.

The review concludes that further research is required to determine how Canada might best assist those who provide valuable, and yet largely unrecognized and unpaid, support to our Veterans.

Introduction

The military to civilian transition (MCT) has received much attention in recent years, and a particular focus is now being placed on the specific experiences and needs of medically-releasing Veterans. There are already several programs and services in place, both from governmental and third-party sources, that are intended to make the MCT as smooth as possible, although research demonstrates that Veterans, especially those who have been medically released, continue to struggle.

Previous studies, in particular the Office of the Veterans Ombudsman’s (OVO) 2017 report “Transitioning Successfully: A Qualitative Study” have identified Veterans’ spouses/partners as a main source of support for post-release life in general, as well as specifically during the MCT process. However, there is a distinct lack of research focused directly on spouses/partners. While some survey research on Veterans include, for example, a few questions about the spouse’s experience of transition, these answers may not accurately reflect nor fully encapsulate the opinions and experiences of their spouses/partners. Due to the varied nature of physical and mental health conditions that can lead to a medical release, these Veterans undergo a life transition much like what civilians experience when they become less or differently abled, though with the added stress of the cultural shift from military to civilian life (Rose et al., 2018). As a main support to Veterans, spouses’ experiences during the MCT will inform the OVO’s understanding of the needs of this particular group and direct future OVO efforts to put forward recommendations for research or to improve programs and services for Veterans’ spouses and families.

Methods

A scoping review methodology was used in order to quickly identify the general state of research in the area of MCT and Veterans’ spouses, particularly of those studies conducted in Canada. No literature reviews have been published on this emerging and under-researched subject, which is why an initial scoping review was particularly appropriate. This type of review is ideal when the main intention is to “identify research gaps … [by] drawing conclusions from existing literature regarding the overall state of research activity” (Arksey & O’Malley, 2005, p.21). Arksey and O’Malley (2005) have established five stages in a scoping review: identify the research question, identify relevant studies, determine and apply various criteria in order to narrow the study selection, chart the data, then collate, summarize, and report the results.

1. Identifying the research question

Establishing the initial research question was guided in large part by the OVO’s 2017 study on the determinants of successful transitions for medically-released Canadian Armed Forces Veterans. That study indicated that spouses constituted one of the main supports listed by Veterans who self-identified as having undergone a successful MCT. Therefore, the focus of the current review is broadly on spouses of transitioning or transitioned Veterans, with a secondary focus on Canadian Veterans medically-released after 2006. The goal was to identify the landscape of research on spouses of Veterans and then to establish how much, if any, of that research had taken place in Canada. The research question guiding the review was “what does the research tell us about the spouses/partners of Canadian Veterans medically-released between 2006-2016 and their lived experience of the military to civilian transition, and what are the needs for supports and services for this group?”. One element that complicated the review was a lack of consensus on a definition of “successful transition” and some of the research suggested the possibility that Veterans and their spouses/partners may define “transition” and “success” quite differently; each article in the review was read and assessed with this caveat in mind.

2. Identifying relevant studies

In order to achieve a picture of the general scope of research on Veterans’ spouses, we began with a search for all studies on spouses published post-2006. The databases and journals used included Google Scholar, Journal of Military, Veteran, and Family Health, the Veterans Affairs Canada (VAC) Research Directorate website, and the Vanier Family Institute, with the initial search term(s) of “spous*,” “Veteran spouse” where appropriate, and “transition”. This broader starting point for the search revealed a notable recent article of American scholarship that forms a call to action for future research focusing on spouses of Veterans during the military to civilian transition.Footnote 3 For example, a hand-search was also conducted through the key journal Military Behavioral Health for “*spous” in order to identify research that may have been missed in other searches.Footnote 4 The current literature review also aims to encourage research on Veterans’ spouses during MCT with a focus on CAF Veteran spouses.

3. Study selection

Exclusion and inclusion criteria were developed concurrently in order to rank studies by relevance, and followed the intent to discover the extent of Canadian research on Veteran spouses, with an additional consideration of the transition process and medical release.Footnote 5 Of the initial 73 publications identified, 62 merited a closer reading. Frequency of mention of spouses provided the first measure of exclusion and after that entries were read for context and relevance of spousal mentions. 52 entries were eliminated and of the remaining 10 studies, only 2 were deemed to have met the full criteria in most senses, although neither exclusively focused on Veterans spouses.

Figure 1: Study Selection
 

4. Charting the data

We reviewed, sorted, and charted the data according to key issues and themes in an approach similar to the narrative review that more broadly presents and contextualizes study results to optimize reader understanding (Arksey & O’Malley, 2005). Each entry was charted with the following extracted information: author, year, title, type of literature (book chapter, article, etc.), and format (i.e. review, qualitative study, etc.).

Results

The results confirm the previously suspected dearth of material on the subject of Veterans’ spouses. The few studies that consider Canadian Veterans’ spouses do not specifically examine the stressful and demanding process of military to civilian transition on the partners of medically-released Canadian Armed Forces Veterans.

Out of the 62 studies that held promise beyond the initial collection of 73, most focus on the Veteran or the military/Veteran family unit as a whole, or on the spouses of currently serving CAF members. 19 studies focus on military families, 5 focus on Veteran families, and 10 focus on both military and Veteran families. This demonstrates an established trend of research interest in military and Veteran families as a whole, although it also indicates that studies focused exclusively on spouses, especially spouses of Veterans, continue to be few and far between.

Outside the identified top 10 studies, 10 focus specifically on militaryFootnote 6 or Veteran spouses and of those, 1 examines spouses from the US, the UK, Australia, and Iran, 1 examines only spouses from the UK, 3 examine only Canadian military spouses, and 5 examine only American spouses. This shows that the bulk of research on Military or Veteran spouses continues to take place in the United States, and a large proportion of Canadian research is on military spouses and not specifically on transitioning or Veteran spouses. 9 of the 62 studies have a primary focus on transition or medical release.

Of the top 10 studies, 52,5,6,7,8 address the MCT and/or medical release in a significant manner although 26,7 of those take the form of reviews and analysis of existing research. Of the top 10 studies, a few (30%, n 3) are quantitative,3,5,7 the majority (50%, n 5) are qualitative studies dominantly based on interviews,1,2,8,9,10 and 2 are literature reviews.4,6 21,9 of the top 10 draw results directly from samples of Veteran spouses, 22,10 draw results from samples made up mostly of Veteran or military spouses, 13 draws results from a sample of CAF spouses, and 18 from both Veterans and from CAF members expected to medically release within 24 months of the study, and their primary caregivers, the majority of whom were spouses. The remaining 4 studies from the top 10 —those that did not directly draw results from spouses— either take the form of a scoping or literature review4,6 or they are quantitative studies based on previously conducted research.5,7

The table below (Fig. 2) details the sample sizes of participants and the form in which information was collected from the 61,2,3,8,9,10 studies out of the top 10 that drew results directly from various spouses. By momentarily excluding the studies that did not draw directly from spouses, we can clearly see that previous Canadian research on military/Veteran spouses has largely been limited to small sample sizes. The studies are also dominantly focused on the effects of PTSD or caregiving on spouses and families.

Figure 2: Studies from the top 10 that draw results directly from spouses

Study Reference Number  /  Number and composition of participants*

1)  7 spouses/partners of CAF Veterans interviewed

2)  Phase 1) 26 family members of CAF Veterans interviewed, 22 of which were spouses
      Phase 2) 7 female spouses, 1 male spouse, and 1 mother in three focus groups

3)  1661 CAF member spouses surveyed

8)  56 participants interviewed: 31 CAF members / Veterans; 11 caregivers;**

9)  8 CAF Veteran spouses interviewed

10)  17 interviewed: 1 family member, 1 CAF Veteran, and 15 CAF military spouses

*Unless otherwise noted, spouses are female.
**study did not specify further than to state that the majority of the caregivers were spouses.

The studies and reviews of the top 10 selections were all published between 2009 and 2019, although the majority (70%, n 7) were published in 2018-2019. Most of the studies are quite recent and take the form of primary qualitative research, which indicates a lack of large scale quantitative data on this subject.

It should be noted that most of the studies that address difficulty in the MCT and the impacts on spouses largely speak to situations in which the Veteran suffers from one or more mental health problems that may or may not be in addition to a physical injury. All of the top studies mention several common elements when discussing the effect of MCT on Veteran spouses. For example, one such element that received much attention is the burden of caregiving on untrained and unprepared individuals and how it has far-reaching repercussions for both the spouse and the family, which can contribute to mental health issues. When the Veteran medically-releases with a mental illness such as posttraumatic stress disorder (PTSD), there are costs to maintaining a close relationship with the Veteran, even when the spouse does not identify strongly with the identity of ‘caregiver’. For example, one study stated that “partners of military Veterans can themselves develop symptoms of trauma, elevated stress levels, caregiver burden, and secondary traumatization” (Turgoose & Murphy, 2019, 195). Referring dominantly to spouses, one study described those providing care to Veterans as the “strength behind the uniform” and observed that caring for military members and Veterans with psychological illnesses “can be particularly taxing … and increase[s] the risk or extent of their own psychological distress due to the [injured partner’s] increased reliance on them for cognitive and/or emotional tasks and support” (Skomorosvky et al., 2019, 3).

Recent research has demonstrated that Veteran spouses provide tremendous assistance and are key supporters and facilitators of their Veteran partner’s MCT. In the OVO’s 2017 study on successful transition, Veteran participants indicated that their spouses were among their top transition supports (OVO, 2017, 8). In a 2018 study commissioned by Veterans Affairs Canada, Kelly Schwartz’ analysis of the 2016 Life After Service Survey (LASS)Footnote 7 noted that 86 percent of those living in ‘Veteran and Partner Only’ households reported satisfaction with their current lives as a whole as compared to 76 percent of those living in ‘Veteran Alone’ households (Schwartz, 2018, 21). The same study also highlighted various significant differences in happiness, perception of success and social support, and connection to community between Veterans living with spouses/partners and those living on their own. Those Veterans living alone are much more likely to struggle during and after MCT, and even one in six (17%) of those not currently in a relationship listed their former or estranged spouse/partner in response to the question about an individual on whom the Veteran could count in an emergency (Schwartz, 2018, 23); this underlines the role that partners both past and present play in supporting Veterans.

Upon examination of existing literature, the following themes emerged on the impact of MCT and/or caregiving on Veteran spouses:

Figure 3: From the top 10 studies: Impact of MCT/caregiving on Veteran spouses

Impact of MCT/caregiving on Veteran spouses

  1. Pride in Veteran’s service but also grief and loss over person Veteran had been previous to illness/injury or who spouse was before taking on caregiving role.
  2. Negative career impacts during service, transition, and after service.
  3. Negative impact on mental and physical health of spouse.
  4. Constant anticipation and accommodation of Veteran’s needs and managing symptoms, potentially including drastic changes in social participation.
  5. Challenges maintaining or creating new friendships due to isolation of circumstances or a lack of understanding of military culture.
  6. Stigma against mental illness or help-seeking persists, despite recent progress.
  7. Lack of sufficient awareness of MCT and services available to Veterans and their families.

Discussion

Recent studies reveal a small but growing trend of gleaning information on spouses directly from spouses, as opposed to indirectly through reporting by Veterans. Spouses provide a helpful point of view and likely offer a perspective that their Veteran partners do not have. The literature review findings confirm that although they act as a main support during the military to civilian transition, the spouses/partners of Canadian Veterans are an understudied and under-supported group. The number of medically-releasing Veterans has been on the rise since 2013Footnote 8, and so supporting Veterans, their spouses, and their families will be an issue of increasing importance. Canadian studies have identified a number of issues and challenges facing spouses of medically-releasing and transitioning Veterans but have largely not suggested solutions other than a general enhancement of existing programs or mental health services for spouses. Moving forward, further research should be conducted and consideration given to the programs and services currently available to these spouses/partners, with the goal of either developing new or promoting existing supports relating to mental health, financial planning, caregiving tools, and community building.

Given the current state of the field, there are not enough Canadian studies on Veteran spouses/partners, and more quantitative research is needed to accurately identify barriers to achieving success in and immediately after transition, for both the Veteran and the person who is often their main support: their spouse/partner. On an international level, there is a moderate amount of data extrapolated from larger studies that do not have an original purpose of focusing on spouses. Almost all studies are U.S. in origin, and research has yet to focus on single Veterans, the spouses/partners of female Veterans or those of visible minority Veterans. Research on the subject of MCT in general is hampered by an inconsistency in the definition(s) of successful transition, including the length of transition, and so work on Veteran spouses as participants and supports of the transition is made more complex. There are very few Canadian studies specifically on medically-released Veterans and their spouses although there are some studies on CAF members’ spouses and deployment, reintegration, and temporary conditions or injuries (i.e. pre-release), and several international studies on Veteran spouses that focus on the short and long-term effects of Operational Stress Injuries.

Conclusion

Studies on the spouses/partners of Canadian Veterans, and especially those that draw directly from the spouses/partners, as opposed to including them as part of a discussion on Veterans or their families, represent a small portion of recent research on MCT. In particular, more Canadian research needs to be done on spouses of medically-released Veterans during and after the military to civilian transition (MCT), as this group experiences greater and more complex challenges than their regularly releasing and retiring counterparts.

Among the top ten results of the literature review, most research revealed that spouses of Veterans inherit a significant amount of unpaid labour and suffer negative impacts to both physical and mental health immediately prior to, during, and following the Veteran’s medical release. Several studies reported negative career impacts, social isolation, and a sense of loss from the spouses’ perspectives as a consequence of MCT. One study recorded that Veterans living with partners report higher levels of satisfaction, adjustment, perceived social support, and lower difficulty with MCT than Veterans living alone or with family members.Footnote 9 Another referred to the spouse and family as the strength behind the uniform and stressed the importance of this support system for the Veteran during and after serviceFootnote 10 and much of the research mentioned that numbers of medically-released Veterans, especially those with PTSD, are on the rise as Canadian Armed Forces members are increasingly deployed in areas of conflict and front-line combat. Further research must be done in order to determine how Canada might best assist those who provide valuable and yet largely unrecognized and unpaid, support to our Veterans.

References

  1. Baker, S. P, Norris D. The Experiences of Female Partners of Canadian Forces Veterans Diagnosed with Post-Traumatic Stress Disorder. Shaping the Future: Military and Veteran Health Research. In: Aiken AB, and Bélanger SAH, editors. Proceedings of the November 2010 Military and Veteran Health Research forum. Canadian Institute for Military and Veteran Health Research. Kingston (ON): McGill-Queen’s University Press; 2013, pp. 175-85.

  2. Cramm H, Norris D, Schwartz K.D, Tam-Seto L, Williams A, Mahar A. (2019). Impact of Canadian Armed Forces Veterans’ Mental Health Problems on the Family During the Military to Civilian Transition. Military Behavioral Health. 1-11.
    https://doi.org/10.1080/21635781.2019.1644260

  3. Dursun S, Sudom K. (2009). Impacts of Military Life on Families: Results from the Perstempo Survey of Canadian Forces Spouses. Defence Research & Development Canada, Director General Military Personnel Research & Analysis. Technical Report. DGMPRA TR 2009-001 November 2009.

  4. Eichler M, Norris D, Cramm H, Tam-Seto L, Smith-Evans K. Operational Stress Injuries and the Mental Health and Well-Being of Veteran Spouses: A Scoping Review. Journal of Family Theory & Review 10 (September 2018): 657-671. DOI: 10.1111/jftr.12283

  5. Fossey M, Cooper L, Raid K. (2019). The transition of military veterans from active service to civilian life: impact of transition on families and the role of the family, support, and recognition. Military Veteran Reintegration: Approach, Management, and Assessment of Military Veterans Transitioning to Civilian Life. Edited by Carl Andrew Castro and Sanela Dursun. Academic Press, pp.185-213.

  6. Manser, Lynda. (2015). The Needs of Medically Releasing Canadian Armed Forces Personnel & Their Families – A Literature Review. Ottawa, ON: Military Family Services.

  7. Schwartz, K D. (2018). Review of mental health support for Veteran families: A demographic profile using the 2016 Life After Service Survey (LASS). Veterans Affairs Canada, pp.1-54.

  8. Skomorovsky A, Lee J, Williams L. “Caregiving in Military and Veteran Families,” Research Recap (August 8 2019), The Vanier Institute of the Family.

  9. Smith-Evans K, Norris D. (2018). The Experiences of Spouses of Canadian Armed Forces Veterans Diagnosed with Post-Traumatic Stress Disorder: Pathways to Resilience. In S. Dursun, S, Urban, & W. Dean (Eds.), The Home Front: Family Well-Being and Military Readiness. Kingston: Canadian Defence Academy Press, pp. 123-135.

  10. Tam-Seto L, Krupa T, Stuart H, Aiken A.B, Lingley-Pottie P, Cramm H. (2018). Identifying military family culture competencies: experiences of military and Veteran families in Canadian health care. Journal of Military, Veteran and Family Health. 4(2) 2018. Doi: 10.3138/jmvfh.2017-0030

  11. Turgoose D, Murphy D. A systematic review of interventions for supporting partners of military Veterans with PTSD. Journal of Military, Veteran and Family Health 5(2) 2019 DOI: 10.3138/jmvfh.2018-0035

  12. Rose S, VanDenKerkhof E, Schaub M. Determinants of successful transition literature review. Journal of Military, Veteran and Family Health 4(1) 2018. Doi: 10.3138/jmvfh.4313

  13. Van Til L, Sweet J, Poirier A, McKinnon K, Pedlar. (2017). Well-Being of Canadian Regular Force Veterans, Findings from LASS 2016 Survey. Veterans Affairs Canada – Research Directorate Technical Report. https://bit.ly.2hWHt7y

  14. Office of the Veterans Ombudsman. (2017). Transitioning Successfully: A Qualitative Study. https://www.ombudsman-veterans.gc.ca/pdfs/reports/transition-e.pdf

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