Corinne Camacho of New York City is anxious and having trouble sleeping since her husband's Army National Guard unit recent deployment to Afghanistan. For the next year, she will be on her own with their three children, aged 11, 6 and 3.
"I have a lot of anxiety about being with the kids myself," said Camacho, 42. "I work full-time and he's the cook of the family. ... I will also be thinking about him -- I am definitely worried."
The oldest child, in particular, is struggling with her husband's absence, and Camacho has noticed that the sibling rivalry has escalated.
"He was always the strong one, the disciplinarian," she said. "Now, he's not there."
Camacho sought help from the Military Family Clinic at New York University's Langone Medical Center, one of the first clinics of its kind to provide mental health services for some of the 15,000 Afghanistan and Iraq war veterans and their families living in the region.
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Conditions treated include anxiety, depression, panic, trauma, stress and post-traumatic stress disorder (PTSD), grief, loss and bereavement, as well as children's behavioral problems or academic difficulties, all of which are associated with the impact of military service on families.
"Generally, they come in for anxiety disorders -- and PTSD is under that umbrella -- and a lot of readjustment issues in the family," said clinical psychologist Irina Komarovskaya.
"Sometimes, it not just psychotherapy they need but a bridge to other services like assistance in applying for benefits or insurance or housing," she said. "We can refer them to other agencies."
The clinic, funded with a $500,000 grant from the poverty-fighting Robin Hood foundation hopes to serve 300 families a year, most of whom are economically disadvantaged or underinsured.
Mental health treatment for spouses, children, parents or siblings of veterans is generally not available through the Veterans Administration (VA) health care system, and couples therapy is limited.
One 2008 VA study revealed that 41 percent of eligible veterans from the Iraq and Afghanistan wars do not enroll because they fear medical records will damage their careers, according to NYU.
As two of the nation's longest wars wind down, suicide is now the leading cause of death in the Army, more than combat or vehicle accidents, according to an August Pentagon report. An epidemic of post-traumatic stress and brain injuries has taken a toll not only on the mental health of soldiers, but their families, as well.
Studies have suggested the effects of military deployment on veterans and their families can be linked to problems including increased rates of domestic violence, child maltreatment, higher rates of depression among military mothers for two weeks following their husbands' deployment, and spikes in substance abuse among veterans.
The two most important resilience factors when soldiers go to war -- "to hell and back" -- are unit cohesion and family support, according to Dr. Charles Marmar, chair of NYU's Department of Psychiatry.
"The burden of deployment may be equal or even greater on the families," he said. "Fighters are trained to go to war and know what to do in war. Spouses and children are in a helpless situation, not knowing if their mothers or fathers are coming back.