Table 3.

Consequences of the war trauma of veterans for their families.

Authors	Subjects	Research Area	Results
Riggs et al. (1998) [85]	26 heterosexual couples in which the veterans had PTSD were compared to 24 couples in which the veteran did not have PTSD.	Quality of the intimate relationships of male Vietnam veterans.	Approximately 70% of veterans with PTSD and their partners experienced clinically significant levels of relationship distress, while the percentage was around 30% for non-PTSD couples. PTSD veterans and their partners reported greater relationship problems, intimacy difficulties, and a higher likelihood of considering separation and divorce compared to non-PTSD veterans and their partners. The level of relationship distress correlated with the severity of PTSD symptoms in veterans, particularly emotional numbing symptoms.
Jordan et al. (1992) [86]	Nationally representative sample of 1200 male Vietnam veterans and the spouses or co-resident partners of 376 of these veterans.	The presence of PTSD and items affecting family and marital adjustment, parenting problems, and violence.	Families of male veterans with current PTSD exhibited significantly higher levels of severe and widespread issues in marital and family adjustment, parenting skills, and violent behavior compared to families of male veterans without current PTSD.
Dekel et al. (2005) [87]	9 wives of veterans with PTSD.	Examination of the marital perceptions of veterans’ wives and how the lives of these women largely revolved around their husband’s illness.	The wives experienced a continuous tension between becoming deeply connected with their husbands and striving to maintain their independence. Furthermore, they acknowledged positive aspects of the marital relationship that provided them with strength for present and future coping.
Nice et al. (1981) [89]	Study I: 101 Navy POWs repatriated from Vietnam (RPWs) and 100 in a comparison group. Study II: 29 RPW families and 38 RPW comparison families.	Marital stability and perceptions of marital adjustment and family environment were investigated among Navy prisoners of war RPWs and a Navy comparison group.	The rate of divorce after repatriation was significantly higher among the RPW group compared to the comparison group. Predictors of divorce among RPW families included having fewer children, longer duration of captivity, and religious affiliation. When comparing perceptions of marital adjustment and family environment, no significant differences were found between a subset of RPW and comparison families who remained together.
Levin et al. (2016) [92]	66 wives of ex-POWs with PTSD, and 37 wives of ex-POWs and 55 wives of combat veterans without PTSD symptoms.	Evaluation of the implications of war captivity and ex-POWs’ PTSD, and PTSD trajectory on their wives’ marital adjustment, adjusting for their secondary traumatization.	The study’s findings indicate that wives of ex-POWs with PTSD reported lower levels of consensus, affection, and overall marital adjustment compared to the wives of controls, even after accounting for secondary traumatization. This suggests that both the experience of captivity and PTSD have a negative impact on wives’ marital adjustment, extending beyond the individual effects of secondary traumatization.
Glassman et al. (1987) [84]	A Vietnam veteran and his family.	Case report: Expression of veteran’s paranoid schizophrenia involved delusions and hallucinations relating to Vietnam, and his wife and children’s paranoia.	Wife and children shared veteran’s paranoia.
Hall and Simmons (1973) [95]	POWs’ wives and children.	Psychological issues centered on themes of desertion, ambiguity of role, repressed anger, sexuality, censure, and social isolation.	Severe and progressive psychological and psychophysiological symptoms are frequently observed, with common manifestations including separation anxiety, role distortion, and sleep disorders among children. Male children tended to experience these effects more significantly than their female counterparts.
Lieblich (1997) [97]	Israeli POWs’ wives.	The cases of Israeli POWs are presented from their wives’ points of view.	Their narratives depict the abrupt separation, the challenges faced during the prolonged and uncertain waiting period, and their emotional responses upon reunion. These voices contribute to the construction of the social role attributed to the wife of a POW. Unfortunately, society often overlooks or underestimates the courage and suffering endured by these wives, despite the fact that they undergo their own trauma and struggle to adapt to the political and personal events that shape their lives.
Haley (1984) [101]	Two case examples involving 26- and 27-year-old Marines with PTSD symptoms.	Investigation of the activity and aggression of the preschool child reawakens the painful effects of combat aggression and sadism in the Vietnam combat veteran.	Efforts to manage aggression in both the veteran and his children can potentially result in ineffective coping strategies and the emergence of symptoms within the veteran, the child, or the entire family system.
Ruscio et al. (2002) [102]	66 male Vietnam veterans and their children.	Examination of the differential pattern of associations between the symptom clusters of PTSD and the perceived father–child relationships	The cluster of emotional numbing exhibited a significant association with the perceived quality of all relationship domains, suggesting that it is the aspect of PTSD most strongly connected to interpersonal difficulties in war-zone veterans.
Dekel and Goldblatt (2008) [103]	Review.	Review of the literature on intergenerational transmission of PTSD from fathers to sons in families of war veterans.	This review highlights the current paucity of knowledge regarding family members and extrafamilial systems that may contribute to intergenerational transmission of PTSD or to its moderation.
Zerach and Aloni (2015) [107]	98 Israeli ex-POWs’ children and 90 controls’ children whose fathers fought in the 1973 Yom Kippur War.	Examination of the secondary traumatization symptoms and parental bonding among adult children of ex-POWs’ children that were compared to adult children of comparable veterans (controls’ children) and the mediating role of parental bonding and exposure to stress in the association between group and secondary traumatization symptoms.	Four decades after the war, living with ex-POWs is linked to the psychological well-being of their children. Ex-POWs’ children exhibit more symptoms of secondary traumatization and lower levels of paternal care compared to children of controls. The association between the research group and secondary traumatization is mediated by exposure to stress caused by fathers’ behaviors and the level of paternal care.