Longitudinal association of health behaviors and health-related quality of life with military spouse readiness.

BACKGROUND: Unhealthy behaviors impose costs on health-related quality of life (HRQOL) reducing productivity and readiness among military members (Hoge et al., JAMA 295:1023-32, 2006; Mansfield et al. 362:101-9, 2010). Among married personnel in particular, patterns of spouse health behaviors may play an interdependent role. As a result, the identification of military spouse health factors related to readiness may inform strategies to screen for and identify those in need of greater support and enhance readiness. This study explored behavioral and HRQOL predictors and potential mediators of military spouse readiness utilizing data from the Millennium Cohort Family Study. METHODS: The analytic sample comprised of 3257 spouses of active-duty, non-separated service members who responded to both waves 1 and 2 of the survey. Sample characteristics are described with respect to demographics (e.g., age, sex, race/ethnicity, etc.), readiness measures (i.e., military satisfaction, lost workdays, health care utilization, military-related stress, and satisfaction), health behaviors (i.e., exercise, sleep, smoking, and alcohol use) and HRQOL (Veterans RAND 12-Item Short Form Survey). We conducted multivariate mediation analyses to evaluate the role of mental and physical HRQOL as mediators between the baseline health behaviors and the health readiness outcomes at follow-up, while adjusting for spouse and service member demographics. RESULTS: HRQOL had direct effects for all five readiness outcomes examined. Multiple health behaviors (insomnia, smoking, binge drinking, and exercise) were further significantly associated with spouse readiness outcomes, although most effects were mediated through HRQOL, suggesting this may be a useful index of military spouse readiness. Insomnia was the specific health behavior most consistently associated with poorer readiness across outcomes, and effects were only partially mediated by physical and mental HRQOL. CONCLUSIONS: The results show spouse health behaviors are directly and indirectly (through HRQOL) associated with readiness indicators. This suggests that assessments of modifiable health behaviors (e.g., insomnia symptoms) and mental and physical HRQOL are important indicators of readiness among military spouses and should be used to inform future programs designed to improve population health.

Individual and Military Factors That Modify the Association Between Recent Sexual Trauma and Health Outcomes Among U.S. Service Members and Veterans.

Sexual trauma (ST), which includes both sexual harassment and sexual assault, is associated with a variety of adverse mental and physical health outcomes in military and civilian populations. However, little is known about whether certain individual or military attributes or prior experiences may modify the relationship between recent ST and mental or physical health outcomes. Data from a longitudinal cohort study of current and former military members were used to examine whether individual and military factors modify the association between recent ST and health outcomes (posttraumatic stress disorder, depression, multiple somatic symptoms, and insomnia). Results indicated that demographic (sex, sexual orientation, race/ethnicity) and military factors (service branch, service component, military separation) generally did not modify the main effect of ST on the outcomes examined. On the other hand, factors known to be protective (spirituality, social support) and risk factors (childhood trauma, combat deployment, and mental health status) did modify the effect of ST on multiple outcomes examined; notably, protective effects were diminished among those who experienced recent ST. Protective factors were associated with the lowest risk of adverse outcomes among those with no ST, while risk reduction was less among survivors of ST. Diminished impacts also were found for cumulative risk factors, with the influence of multiple individual risk factors associated with increased risk but in a subadditive manner. We conclude that the effect of recent ST on the outcomes examined was persistent in the presence of potential protective factors, but that it may be impacted by ceiling effects in combination with other risk factors.

Partner Effects: Analyzing Service Member and Spouse Drinking Over Time.

INTRODUCTION: Excessive alcohol use is a significant problem in the military. Although there is a growing emphasis on family-centered alcohol prevention approaches, little is known about the interplay between partners' drinking behaviors. This study examines how service members and their spouses influence each other's drinking behavior over time and explores the complex individual, interpersonal, and organizational factors that may contribute to alcohol use. METHODS: A sample of 3,200 couples from the Millennium Cohort Family Study was surveyed at baseline (2011-2013) and follow-up (2014-2016). The research team estimated how much partners' drinking behaviors influenced one another from baseline to follow-up using a longitudinal structural equation modeling approach. Data analyses were conducted in 2021 and 2022. RESULTS: Drinking patterns converged between spouses from baseline to follow-up. Participants' own baseline drinking had a small but significant effect on changes in their partners' drinking from baseline to follow-up. Results from a Monte Carlo simulation showed that the longitudinal model could reliably estimate this partner effect in the presence of several potential sources of bias, including partner selection. The model also identified several common risk and protective factors for drinking shared by both service members and their spouses. CONCLUSIONS: Findings suggest that changing the drinking habits of one spouse could lead to a change in the drinking habits of the other, which supports family-centered alcohol prevention approaches in the military. Dual-military couples especially may benefit from targeted interventions because they face a higher risk of unhealthy alcohol consumption.

Pre-service factors associated with sexual misconduct among male U.S. Marines.

PURPOSE: Sexual assault is a prevalent and persistent problem in the military, yet few studies have examined predictors of sexual offenses. The study aim was to determine pre-service factors associated with sexual offense conviction among U.S. Marines. METHODS: This retrospective cohort study analyzed data from male active duty U.S. Marines (2003-2018). Pre-service factors were assessed using survey data from the Recruit Assessment Program, obtained prior to recruit training at the Marine Corps Recruit Depot, San Diego, California. These survey data were linked with sexual offense conviction data obtained from the Naval Criminal Investigative Service Consolidated Law Enforcement Operations Center. RESULTS: Of the 146,307 participants, the majority were 18-19 years old (66.7%) and non-Hispanic, White (62.1%) with a high school education or less (76.8%); 107 received convictions for a sexual offense. In unadjusted analyses, race and ethnicity, parental education, type of primary caregiver, parental death, family economic status, childhood emotional trauma, childhood physical abuse, childhood sexual abuse, and unprotected sex were associated with a sexual offense conviction. In the final multivariable model, race and ethnicity (American Indian/Alaskan Native, odds ratio [OR]: 5.28, 95% confidence interval [CI]: 1.86-14.98; Hispanic, OR: 1.83, 95% CI: 1.06-3.18; multiracial/other, OR: 3.28, 95% CI: 1.56-6.89), education (≤ high school, OR: 2.65; 95% CI: 1.21-5.80), parental death (OR: 2.27; 95% CI: 1.16-4.45), unprotected sex (OR: 1.78; 95% CI: 1.03-3.05), and school suspension/expulsion (OR: 1.64; 95% CI: 1.02-2.65) were significant predictors of a subsequent sexual offense conviction. CONCLUSIONS: Results underscore the importance of understanding factors associated with sexual offense and highlight the large discrepancy between self-reported estimates of sexual assault and sexual offense convictions. Findings may inform the development of effective strategies to reduce sexual misconduct, such as technology-facilitated programs that provide private, targeted education; supportive assistance; and prevention materials to individuals who may have elevated sexual misconduct risk.

Longitudinal Patterns of Military Spousal Alcohol Consumption: Findings From the Millennium Cohort Family Study.

OBJECTIVE: Alcohol use in the military is prevalent and has short- and long-term health, safety, and career consequences. Although several studies have examined service members' alcohol consumption, few have focused on alcohol use among military spouses. This study assessed factors at individual, interpersonal, and organizational levels to determine associations with risky alcohol use among military spouses. METHOD: Data from baseline and first follow-up of the Millennium Cohort Family Study were used (N = 5,475; 4,923 female) to model spousal self-reported risky drinking (heavy and/or binge drinking) at follow-up. Predictors included demographic characteristics, spousal adverse childhood experiences and mental health, smoking status, marital status, family satisfaction, social support, military stress, and service member military characteristics. Logistic regression models assessed the adjusted associations between spouse and service member characteristics and spousal risky drinking at follow-up. RESULTS: Among spouses in this sample, 19% were risky drinkers at follow-up. Baseline alcohol use status was associated with risky drinking at follow-up. Most spouses (64.2%) did not change their drinking behavior between baseline and follow-up; those who did change were nearly evenly split between an increasing (17.0%) versus decreasing (18.7%) pattern. Risk factors included male gender, cigarette smoking, elevated symptoms of post-traumatic stress, marital separation, and service member deployment with combat. CONCLUSIONS: Although most military spouses were not engaging in risky drinking, one in five were, with about half of these having moved into the risky drinking category over time. Risky alcohol use among spouses has ramifications for themselves, the service member, and the family unit.

Health Disparities Among Lesbian, Gay, and Bisexual Service Members and Veterans.

INTRODUCTION: This study investigated whether health disparities exist among lesbian, gay, and bisexual individuals serving in the U.S. military by examining the associations of sexual orientation with mental, physical, and behavioral health among a population-based sample of service members and veterans. METHODS: Sexual orientation and health outcomes were self-reported on the 2016 Millennium Cohort Study follow-up questionnaire (N=96,930). Health outcomes were assessed across 3 domains: mental health (post-traumatic stress disorder, depression, anxiety, binge eating, problematic anger), physical health (multiple somatic symptoms, physical functioning, BMI), and behavioral health (smoking, problem and risky drinking, insomnia). Adjusted logistic regression models conducted between 2019 and 2022 estimated the associations between sexual orientation and each health outcome. RESULTS: Lesbian, gay, and bisexual individuals (3.6% of the sample) were more likely to screen positive for post-traumatic stress disorder, depression, anxiety, binge eating, problematic anger, multiple somatic symptoms, and insomnia than heterosexual individuals. Gay/lesbian and bisexual women reported more adverse health outcomes (overweight and obesity, smoking, problem/risky drinking) than heterosexual women. Gay and bisexual men reported some adverse health outcomes (e.g., smoking and problem drinking) but better physical health (e.g., less overweight/obesity) than heterosexual men. CONCLUSIONS: Lesbian, gay, and bisexual service members reported poorer mental, physical, and behavioral health than heterosexual peers, most notably among gay/lesbian women and bisexual individuals. Findings suggest that lesbian, gay, and bisexual service members experience health disparities, despite many having equal eligibility for health care, highlighting the need for improved equity initiatives that promote cultural responsiveness, acceptance, and approaches to support the healthcare needs of lesbian, gay, and bisexual military members.

Families serve too: military spouse well-being after separation from active-duty service.

BACKGROUND AND OBJECTIVES: Transitioning from military to civilian life can be challenging for families, but most research focuses only on the service member. We applied a life course model to assess spouse well-being following this important transition. DESIGN: Prospective, longitudinal survey of service members and their spouses. METHODS: We captured three spouse well-being domains: psychological health, physical health, and family relationships. We identified differences between families who separated from service and those still affiliated (N = 4,087) and assessed baseline factors associated with spouse well-being after the family separated from service (N = 1,199). RESULTS: Spouses of service members who had separated from the military (versus those who had not) reported poorer mental health and family relationship quality at baseline and follow-up. After controlling for baseline differences, spouses whose families transitioned experienced a greater increase in PTSD symptoms and a steeper decline in quality of marriage. Spouses of active-duty service members reported greater increases in work-family conflict. Among families who had transitioned, the most consistent predictor of positive outcomes was baseline well-being. Protective factors included having more psychological and social resources and less financial stress. CONCLUSIONS: Several protective and risk factors identified in the study may inform programming for families transitioning from active duty.

Military service experiences and reasons for service separation among lesbian, gay, and bisexual individuals in a large military cohort.

BACKGROUND: The well-being of lesbian, gay, and bisexual (LGB) individuals is a topic of increasing concern within the military where significant institutional barriers, targeted aggression, and differential organizational policies such as "Don't Ask Don't Tell" have historically contributed to experiences of exclusion and discrimination. However, limited research has examined specific military and post-separation experiences among LGB service members and veterans. The goal of this study was to examine differences in military and service separation experiences by sexual orientation among a large representative sample of United States service members and veterans. METHODS: Survey data from the 2016 Millennium Cohort Study follow-up questionnaire were used to assess sexual orientation and multiple outcomes of interest: military experiences (morale, feelings about the military, missed workdays) and service separation experiences (reasons for separation, post-separation employment). The associations between sexual orientation (LGB versus heterosexual) and each of these outcomes were evaluated in a series of adjusted logistic regression models, stratified by sex when interactions were observed. RESULTS: Of the 99,599 participants, 3.4% identified as LGB. In adjusted models, LGB service members had significantly higher odds than heterosexual service members of feeling: unimpressed by the quality of unit leadership, unsupported by the military, and negative about the military overall. Bisexual women were more likely than heterosexual women to feel less unit camaraderie; both gay and bisexual men felt less camaraderie than heterosexual men. LGB veterans were more likely than heterosexual peers of the same sex to separate from service due to unplanned administrative reasons. Compared to heterosexual women, lesbian and bisexual women were more likely to separate from service due to dissatisfaction with promotions/pay and disability/medical reasons, while bisexual women specifically separated due to dissatisfaction with leadership and incompatibility with the military. Gay and bisexual men also reported separating due to incompatibility with the military, but only bisexual men were more likely to report separating due to disability/medical reasons compared to heterosexual men. CONCLUSIONS: Less positive military- and separation-specific experiences disproportionately affected LGB service members in this study. Promoting inclusion and increasing support for LGB service members may improve satisfaction with military service and retention.

Sexual Health Problems among Service Men: The Influence of Posttraumatic Stress Disorder.

Military operational stressors, such as combat exposure, may increase the risk of sexual health problems. This study examined factors associated with sexual health problems, and tested the mediating effect of probable posttraumatic stress disorder (PTSD) on the association between stressors (i.e., combat deployment and sexual assault) and sexual health problems among U.S. service men. Using multivariable logistic regression (n = 16,603) and Cox proportional hazards models (n = 15,330), we estimated the risk of self-reported sexual health difficulties and sexual dysfunction medical encounters, respectively. Mediation analyses examined the effect of probable PTSD as an intermediate factor between high combat deployment and sexual assault on sexual health problems. Approximately 9% endorsed sexual health difficulties and 8% had a sexual dysfunction. Risk factors for these sexual health problems included older age, lower education level, enlisted rank, disabling injury, certain medical conditions, and higher body mass index. Probable PTSD significantly mediated the associations between high combat with sexual health problems and sexual assault with sexual dysfunction. Additionally, high combat was directly associated with sexual health difficulties. These findings indicate a relationship between these stressors and sexual health problems which suggests that treatment options should be expanded, especially to include psychogenic sexual dysfunctions.

Risk and protective factors predictive of marital instability in U.S. military couples.

The objective of this study was to predict marital instability from a range of risk and protective factors in a large, representative cohort of military couples participating in the Millennium Cohort Family Study. Online and paper surveys were administered to service members and their spouses in 2011-2013, which captured couples' demographic and background characteristics, family stressors, military experiences, and mental health risk factors as well as protective factors including family communication, and military support and satisfaction. Approximately 3 years later, change in marital status was examined among participants who completed a follow-up survey (n = 6,494 couples). Hierarchical logistic regression models indicated that couples' younger age, lower education, childhood trauma, spouse employment status, mental health, and lower levels of communication contributed significant unique risk for marital instability. Moderation analyses by service member gender and spouse military status revealed that social isolation increased odds of marital instability for couples in which the service member was male but was not evidenced for couples in which the service member was female. Further, combat experience increased odds of marital instability for couples in which the service member was married to a veteran spouse but not for service members married to a dual-military or civilian spouse. Findings from this study can be used to target specific couple risk factors for marital instability and to tailor programs to at-risk subgroups. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Sexual health difficulties among service women: the influence of posttraumatic stress disorder.

Background Sexual health among service women remains understudied, yet is related to health and quality of life. This study examined if the associations between recent combat and sexual assault with sexual health difficulties were mediated by mental disorders and identified factors associated with sexual health difficulties among service women. Methods Data from two time points (2013 and 2016) of the Millennium Cohort Study, a large military cohort, were used. The outcome was self-reported sexual health difficulties. Mediation analyses examined probable posttraumatic stress disorder (PTSD) and major depressive disorder (MDD) as intermediate variables between recent combat and sexual assault with the sexual health difficulties. Multivariable logistic regression modeling was used to examine the association of demographic, military, historical mental health, life stressors, and physical health factors with sexual health difficulties. Results Of the 6,524 service women, 13.5% endorsed experiencing sexual health difficulties. Recent combat and sexual assault were significantly associated with sexual health difficulties. Probable PTSD mediated the associations of recent combat and sexual assault with sexual health difficulties; probable MDD did not mediate these relationships. Other significant factors associated with sexual health difficulties included enlisted rank, historical mental disorders, childhood trauma, and disabling injury. Limitations Use of self-reported data, outcome not assessed using a standardized measure and future studies may benefit from examining other mediators. Conclusion Our findings that combat and sexual assault may have negative effects on service women's sexual health suggest that treatment options and insurance coverage for sexual health problems should be expanded.

Demographic Variation in Military Life Stress and Perceived Support Among Military Spouses.

INTRODUCTION: Military spouses play a critical role in supporting military service members, and thus, their experiences may have a significant impact on the well-being, readiness, and resilience of the U.S. Armed Forces. Research suggests that military spouses experience unique stressors as a result of military life, but few studies have assessed demographic factors associated with their experiences of military life and perceived support. MATERIALS AND METHODS: Using data from the Millennium Cohort Family Study, a nationwide survey of 9,872 married spouses of service members with 2 to 5 years of military service, this study examined differences in experiences of military life and perceived support across multiple understudied subgroups of military spouses. Key outcomes included military-related stressors (e.g., deployment-related experiences), perceived social support, and perceived military efforts to provide support. RESULTS: Military life stress and perceived support differed across military spouse, service member, and family characteristics. Results indicated that spouses who are older than age 35 or are married to enlisted service members in the Army, Navy, or Marines are more likely to experience heightened military stress or less perceived social support. Dual-military couples reported experiencing less stress associated with military life and perceiving more social support and support from the military, compared with spouses who have never served in the military. CONCLUSION: These findings may help guide effective channeling of resources and outreach to potentially vulnerable military families.

Posttraumatic Stress Disorder Symptom Clusters in Service Members Predict New-Onset Depression Among Military Spouses.

Military operations in Iraq and Afghanistan have brought increased attention to posttraumatic stress disorder (PTSD) among service members and, more recently, its impact on spouses. Existing research has demonstrated that PTSD among service members is associated with depression among military spouses. In the current study, we extended these findings by using data from service member-spouse dyads enrolled in the Millennium Cohort Family Study for which the service member had evidence of PTSD (n = 563). Prospective analyses identified the association between PTSD symptom clusters reported by the service member and new-onset depression among military spouses. Over the 3-year study period, 14.4% of these military spouses met the criteria for new-onset depression. In adjusted models, service member ratings of symptoms in the effortful avoidance cluster, odds ratio (OR) = 1.61, 95% CI [1.03, 2.50], predicted an increased risk of new-onset depression among military spouses, whereas reexperiencing symptoms, adjusted OR = 0.57; 95% CI [0.32, 1.01], were marginally protective. These findings suggest that PTSD symptom clusters in service members differentially predict new-onset depression in military spouses, which has implications for treatment provision.

Alcohol misuse and separation from military service: A dyadic perspective.

OBJECTIVE: Alcohol misuse is a prevalent problem among military service members and their spouses. Service member alcohol misuse may contribute to poor job performance, legal infractions, and failure to meet physical standards. Spousal alcohol misuse may indicate problems with military life. However, limited information is available about how alcohol misuse in military families affects occupational outcomes, specifically military attrition. METHOD: The current study examined 7,965 opposite sex married couples from the Millennium Cohort Family Study with one military and one civilian/veteran partner. Both partners reported on three measures of alcohol misuse (binge drinking, alcohol problems, and heavy weekly drinking). The associations between each partner's measures of alcohol misuse and subsequent military separation were evaluated using logistic regression. Sex, concordance of alcohol misuse, mental health, and service branch were explored as moderators. RESULTS: In fully adjusted models, service member alcohol problems were directly related to military separation. Additionally, service member heavy weekly drinking was strongly associated with military separation among female service members but not male service members. Service member and spouse binge drinking interacted such that when only one partner reported binge drinking military separation was less likely, but both partners' binge drinking conveyed a marginally increased risk of military separation. CONCLUSIONS: Prevalence of alcohol misuse was high among military families. Service member alcohol misuse was more strongly related to military separation than spouse alcohol misuse. Additionally, heavy weekly drinking among female service members may be an indicator of a significant issue that merits interventions aimed at retaining these service members.

High-risk and Long-term Opioid Prescribing to Military Spouses in the Millennium Cohort Family Study.

INTRODUCTION: The use and misuse of opioids by active service members has been examined in several studies, but little is known about their spouses' opioid use. This study estimates the number of military spouses who received high-risk or long-term opioid prescriptions between 2010 and 2014, and addresses how the Military Health System can help prevent risky prescribing in order to improve military force readiness. MATERIALS AND METHODS: This study used data from the Millennium Cohort Family Study, a nationwide survey of 9,872 spouses of service members with 2 to 5 years of military service, augmented with information from the military's Pharmacy Data Transaction Service about prescriptions for controlled drugs dispensed to these service members' spouses. Our objectives were to estimate the prevalence of opioid prescribing indicative of long-term use (≥60 day supply or at least one extended-release opioid prescription in any 3-month period) and, separately, high-risk use (daily dosage of ≥90 morphine mg equivalent or total dosage of ≥8,190 morphine mg equivalent, or prescriptions from more than three pharmacies, or concurrent prescriptions). For each of these dependent variables, we conducted bivariate analyses and multiple logistic regression models using information about spouses' physical health, sociodemographic characteristics, substance use behaviors, perceived social support, and stresses associated with military stress, among others. Informed consent, including consent to link survey responses to medical and personnel records, was obtained from all participants. The Naval Health Research Center's Institutional Review Board and the Office of Management and Budget approved the study. RESULTS: Spouses were predominantly female (86%), had not served in the military themselves (79%), and were spouses of enlisted (91%) active duty (86%) service members. Almost half (47.6%) of spouses obtained at least one opioid prescription during the 2-year observation window, and 8.5% had received opioid prescriptions that posed risk to their health. About 7% met the criteria for receipt of high-risk opioid prescriptions, 3% obtained opioids from three or more pharmacies during a 3-month period, and 4% of spouses who received any opioids received both long-term and high-risk prescriptions. Adverse childhood experiences, physical pain, and lack of social support were associated with increased odds of obtaining high-risk opioid prescriptions. CONCLUSIONS: Approximately 48% of military spouses had used Military Health System insurance to fill at least one opioid prescription during the 2-year observation period. The Department of Defense has taken measures to minimize high-risk opioid prescribing, including passing prescribing guidelines in 2017, establishing the controlled drug management analysis reporting tool, establishing a pain management education and training program, and more. These efforts should continue to expand as reducing the numbers of service members and spouses at risk for adverse events may be effective in reducing opioid misuse and improve the overall health and safety of military spouses and thus, the readiness of the U.S. Armed Forces.

Military Life Stressors, Family Communication and Satisfaction: Associations with Children's Psychosocial Outcomes.

Families experience multiple stressors as a result of military service. The purpose of this study was to examine facets of military life and family factors that may impact child psychosocial and mental health functioning. Using baseline data from the Millennium Cohort Family Study, this study examined family demographics and composition (age, number of children), military life stressors (injury, family, and deployment stressors), family communication and satisfaction as assessed by the Family Adaptability and Cohesion Evaluation Scale-IV, parental social functioning assessed via the Short Form Health Survey-36, and child mental health and behavioral functioning (parental reports of clinician-diagnosed mental health conditions such as depression) and an adapted version of the Strengths and Difficulties Questionnaire. Injury- and family-related military stressors were significant indicators of heightened risk for child mental health conditions, whereas greater levels of parental social functioning and family satisfaction were associated with lower risk of child mental health conditions. Differential associations were found in child functioning when military-related variables (e.g., service component), sociodemographic, and family composition factors (number and age of the children in the home) were examined. These findings underscore the importance of examining the "whole child" within the broader ecological and military family context to understand factors associated with children's mental and behavioral health. The results from the present study highlight the complex relationships that may be at play, which, in turn, have considerable implications for the development of policies to support children and families encountering multiple stressors related to a parent's military service.

Longitudinal trajectories of comorbid PTSD and depression symptoms among U.S. service members and veterans.

BACKGROUND: Posttraumatic stress disorder (PTSD) often co-occurs with other psychiatric disorders, particularly major depressive disorder (MDD). The current study examined longitudinal trajectories of PTSD and MDD symptoms among service members and veterans with comorbid PTSD/MDD. METHODS: Eligible participants (n = 1704) for the Millennium Cohort Study included those who screened positive at baseline for both PTSD (PTSD Checklist-Civilian Version) and MDD (Patient Health Questionnaire). Between 2001 and 2016, participants completed a baseline assessment and up to 4 follow-up assessments approximately every 3 years. Mixture modeling simultaneously determined trajectories of comorbid PTSD and MDD symptoms. Multinomial regression determined factors associated with latent class membership. RESULTS: Four distinct classes (chronic, relapse, gradual recovery, and rapid recovery) described symptom trajectories of PTSD/MDD. Membership in the chronic class was associated with older age, service branch, deployment with combat, anxiety, physical assault, disabling injury/illness, bodily pain, high levels of somatic symptoms, and less social support. CONCLUSIONS: Comorbid PTSD/MDD symptoms tend to move in tandem, and, although the largest class remitted symptoms, almost 25% of participants reported chronic comorbid symptoms across all time points. Results highlight the need to assess comorbid conditions in the context of PTSD. Future research should further evaluate the chronicity of comorbid symptoms over time.

Association of military life experiences and health indicators among military spouses.

BACKGROUND: The health and well-being of military spouses directly contribute to a robust military force by enabling the spouse to better support the active duty member's career. In order to understand the overall health and well-being of military spouses, we assessed health indicators among military spouses using the Healthy People 2020 framework and examined associations of these health indicators with military experiences and psychosocial factors. METHODS: Using data from the Millennium Cohort Family Study, a U.S. Department of Defense-sponsored survey of 9872 spouses of service members with 2-5 years of military service, we examined attainment of Healthy People 2020 goals for spouses and service members, including healthy weight, exercise, sleep, and alcohol and tobacco use. Multivariable logistic regression models assessed associations of spouse health indicators with stressful military life experiences and social support, adjusting for demographics and military descriptors. The spousal survey was administered nationwide in 2011. RESULTS: The majority of military spouses met each health goal assessed. However, less than half met the healthy weight and the strength training goals. Reporting greater perceived family support from the military was associated with better behavioral health outcomes, while having no one to turn to for support was associated with poorer outcomes. Using the Healthy People 2020 objectives as a framework for identifying key health behaviors and benchmarks, this study identified factors, including military-specific experiences, that may contribute to physical health behaviors and outcomes among military spouses. With respect to demographic characteristics, the findings are consistent with other literature that women are more likely to refrain from risky substance use and that greater education is associated with better overall health outcomes. CONCLUSIONS: Findings suggest that enhanced social and military support and tailored programming for military spouses may improve health outcomes and contribute to the well-being of military couples. Such programming could also bolster force readiness and retention.

Engaging military couples in marital research: does requesting referrals from service members to recruit their spouses introduce sample bias?

BACKGROUND: While enrolling dyads in research studies is not uncommon, there is limited literature on the utility of different recruitment strategies and the resulting selection biases. This paper examined two recruitment strategies used to enroll military couples in a longitudinal study, assessing the impact of both strategies on the representativeness of the final study sample. METHOD: Descriptive and bivariate analyses were conducted to 1) identify characteristics associated with spouse referral, 2) compare response rates based on recruitment strategy and assess whether recruitment strategy modified correlates of response propensity among spouses, and 3) assess whether referred spouse characteristics differed from non-referred spouses in the final sample. The study sample consisted of married US service members with 2-5 years of military service as of October 2011 and their spouses. RESULTS: Service members who referred their spouses to participate in the Millennium Cohort Family Study were more likely to be male, have children, serve in the Army, and have combat deployment experience than those who did not refer their spouse. Nearly two-thirds (n = 5331, 64.9%) of referred spouses participated in the Family Study, compared with less than one-third (n = 3458, 29.5%) of directly contacted spouses. Spouse characteristics also differed significantly between recruitment groups. CONCLUSIONS: Overall results suggest that minimal bias was introduced by using a referral recruitment methodology. Service members appeared to be more likely to refer their spouses if they perceived the research topic as relevant to their spouse, such that male service members with combat deployment experience were more likely to refer female spouses caring for multiple children. Referred spouses were significantly more likely to respond to the Millennium Cohort Family Study survey than those who were directly contacted; however, the overall success rate of using a referral strategy was less than recruiting spouses through direct contact. Differences between referred spouses and spouses contacted directly mirrored service member referring characteristics.

Mental Health of Children of Deployed and Nondeployed US Military Service Members: The Millennium Cohort Family Study.

OBJECTIVE: Families experience multiple stressors as a result of military service. The purpose of this study was to investigate the associations among service member deployment experiences, family and military factors, and children's mental health using baseline data from the Millennium Cohort Family Study, a study designed to evaluate the health and mental health effects of military service on families, including children. METHOD: This study examined administrative data on deployment status (combat, noncombat, and no deployments), as well as service member- and spouse-reported data on deployment experiences and family functioning in relation to the mental health of children in the family who were aged 9 to 17 years. RESULTS: Most children were not reported to have mental health, emotional, or behavioral difficulties regardless of parental deployment status. For an important minority of children, however, parental deployments with combat, compared with those with no deployment, were associated with a parental report of attention-deficit disorder/attention-deficit hyperactivity disorder and depression as diagnosed by a clinical provider, after accounting for demographics, psychosocial context, and military factors. Children's odds of a parental report of depression were significantly higher in both the combat and the noncombat deployment groups than in the no deployment group. CONCLUSION: These findings extend our understanding of the association between parental deployments and children's mental health, with implications for services and training mental health providers serving military families.