Distress tolerance, family cohesion and adaptability, and posttraumatic stress symptoms among combat veterans and their parents

Gadi Zerach, Tamar Gordon-Shalev

Research output: Contribution to journalArticlepeer-review


Objective: The aversive impact of combat-related posttraumatic stress disorder (PTSD) on family members has been examined mainly among veterans' partners as well as veterans' offspring. Background: Only a few studies have examined secondary PTSD symptoms (PTSS) in veterans' parents, and the conditions in which distress tolerance (DT) contributes to veterans' PTSS and parents' secondary PTSS (SPTSS) remain unexplored. In the present study, we aimed to use a dyadic approach to explore the association between veterans' and parents' DT and their PTSS and that of their parents, as well as to examine the moderating role of family cohesion and adaptability in these associations. Method: A volunteer sample of 102 dyads of Israeli combat veterans and their parents responded to online validated self-report questionnaires in a cross-sectional study. Analysis included actor–partner interdependence modeling (APIM) and moderation analyses. Results: Veterans' PTSS was positively correlated with parents' SPTSS. Moreover, two actor effects were revealed wherein veterans' DT contributed to their own PTSS, and parents' DT negatively predicted their own SPTSS. Moreover, veterans' DT negatively predicted their parents' SPTSS (partner effect). Importantly, analysis of moderation revealed that under average and high levels of parental perception of family cohesion, higher levels of DT were tied to lower PTSS among veterans. Conclusion: Exposure to a traumatized veteran offspring might entail SPTSS among parents. Veterans' high DT is associated with lower PTSS, and their parents' perception of the family as cohesive might augment this association. Implications: The findings highlight the importance of acknowledging distress of indirectly exposed parents of combat veterans. Strengthening military families' cohesion might be important for veterans coping with posttraumatic stress.

Original languageEnglish
Pages (from-to)2886-2907
Number of pages22
JournalFamily Relations
Issue number5
StatePublished - Dec 2023


  • APIM
  • PTSD
  • distress tolerance
  • parents
  • veterans


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