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SDR 10-398 – HSR&D Study

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SDR 10-398
Prospective Predictors of Veteran and Family Post-Deployment Mental Health
Melissa A. Polusny PhD
Minneapolis VA Health Care System, Minneapolis, MN
Minneapolis, MN
Funding Period: November 2010 - October 2014

BACKGROUND/RATIONALE:
Families are a primary source of support critical to helping Veterans successfully face the challenges of reintegration. However, families face significant stressors themselves during and after deployments. These deployment-related family stressors may erode the support families offer Soldiers/Veterans. In addition, highly distressed families may further add to the challenges Soldiers/Veterans face as they reintegrate into civilian life following deployment. Understanding how families are affected by deployments, and how family well-being, in turn, affects the mental health of returning Veterans can facilitate the development of outreach, support, and intervention efforts for family members to the benefit of Veterans and their families.

OBJECTIVE(S):
The overall objective of this study was to examine the impact of family well-being across the deployment cycle on mental health outcomes among National Guard Veterans. Specific aims were to: 1) identify Soldier/Veteran and family predictors of pre-deployment family well-being, 2) characterize heterogeneity in family well-being over the course of a deployment cycle and identify predictors of distinct trajectories of family well-being, and 3) determine the impact of family well-being on Veterans' post-deployment mental health.

METHODS:
In this prospective, longitudinal cohort study, 2,089 National Guard Soldiers and 1,071 spouse/partners completed a battery of measures assessing individual/family risk and protective factors and mental health (in two areas: substance use and distress as expressed by depression & anxiety) prior to Soldiers' deployment to Iraq/Kuwait or Afghanistan. A multi-step mail survey procedure was used to collect follow-up measures from spouse/partners at month 3 (n=758, 71% response rate) and month 9 (n=710, 66% response rate) of the Soldiers' deployment. Soldiers were surveyed at month 9 (n=428; 20%) during the deployment via a secure web-based application. Three months post-deployment, both Soldiers/Veterans (n=846, 40%) and spouse/partners (n=611, 57%) completed a final wave of data collection.

FINDINGS/RESULTS:
Results of structural equation modeling revealed that pre-deployment family well-being was associated with Soldiers' reports of individual and family stressors/concerns and relationship functioning as well as spouse/partner personality factors (neuroticism/negative emotionality) and spouse/partner reports of individual and family stressors/concerns, social support, and relationship functioning.

Heterogeneity in family functioning (spouse/partner distress and alcohol use) over the course of the deployment was examined using latent class growth analysis. For spouse/partner distress, four latent trajectory classes were identified. The majority of spouse/partners (n=834, 83.7%) followed a 'resilient' trajectory, showing a pattern of low distress at pre-deployment that remained stable over deployment and post-deployment waves. Spouse/partners following a 'vulnerable-risk' distress trajectory (n=68, 6.8%) showed a pattern of low distress at pre-deployment that increased significantly to clinical levels during deployment and remained elevated post-deployment. The third latent distress trajectory (n=49; 4.9%), described as 'anticipatory distress,' showed high levels of distress at pre-deployment that sharply declined at month 3 of deployment and remained low across and following deployment. Finally, those following a 'chronic distress' trajectory (n=45, 4.5%) showed high levels of distress at pre-deployment that remained stable over the entire cycle of deployment.

For spouse/partner alcohol use, three latent trajectory classes were identified. The majority of spouse/partners (n=943, 94.7%) followed a 'resilient' alcohol use trajectory, characterized by low, stable levels of alcohol use across time. Spouse/partners demonstrating a 'vulnerable-risk' alcohol use trajectory (n=42, 4.2%) showed a pattern of low alcohol use prior to deployment, which increased during deployment and declined following deployment without returning to baseline levels. Finally, a 'deployment desistance' alcohol use trajectory (n=33, 3.3%) was characterized by high levels of alcohol use prior to deployment which markedly decreased while the Soldiers were deployed, and returned to baseline levels following Soldier/Veterans' returned from deployment.

Using multinomial logistic regression, preliminary examination of Soldier/Veteran and spouse/partner risk and protective factors predictive of membership in these distinct trajectory classes revealed a number of interesting results. At pre-deployment, Soldiers' social support (aOR=0.94) and spouse/partners' neuroticism (aOR=1.08), individual and family stressors/concerns (aOR=1.44), and family readiness (aOR=0.95) predicted greater likelihood of membership in the vulnerable risk distress vs. resilient trajectory class. Soldiers' pre-deployment individual and family stressors/concerns (aOR=2.12) and alcohol use (aOR=0.68) as well as spouse/partners' pre-deployment personality dimensions of neuroticism (aOR=1.11), introversion (aOR=1.11), and the personality trait disconstraint (i.e., impulsivity; aOR=1.11), perceptions of family readiness (aOR=0.93), and social support (aOR=0.92) predicted greater likelihood of membership in the chronic distress vs. resilient trajectory class. Spouse/partners' pre-deployment neuroticism (aOR=1.07) and individual and family stressors/concerns (aOR=1.45) predicted greater likelihood of membership in the anticipatory distress vs. resilient trajectory class.

Spouse/partner membership in the vulnerable-risk alcohol use trajectory class relative to the resilient trajectory class was predicted by spouse/partners' pre-deployment reports of disconstraint (aOR=1.16), family readiness (aOR=0.93), and relationship functioning (aOR=0.94), and by Soldiers' pre-deployment perceptions of family readiness (aOR=0.96) and relationship functioning (aOR=1.08). Spouse/partner membership in the deployment desistance alcohol use trajectory was predicted by Soldiers' pre-deployment alcohol use (aOR=1.97), and the spouse/partners' pre-deployment report of neuroticism (aOR=1.25), disconstraint (aOR=1.12), and individual and family stressors/concerns (aOR=1.55).

After controlling for pre-deployment levels of distress, Soldiers' neuroticism (B=0.18, p<.001) and individual and family stressors/concerns (B=0.28, p<.001) as well as spouse/partners' pre-deployment social support (B=0.10, p<.05) were predictive of Veterans' post-deployment distress. Spouse/partner membership in the resilient trajectory class, characterized by low, stable levels of distress across the deployment cycle, was a significant protective factor in the development of Veterans' post-deployment distress (B=-0.12, p<.05), while spouse/partner membership in the vulnerable-risk distress trajectory was associated with greater post-deployment distress among Veterans (B=0.13, p<.05).

Our findings suggest that at-risk spouse/partners of deploying Soldiers can be identified prior to deployment, and that interventions targeting spouse/partners' pre-deployment mental health, family readiness, social support, and relationship functioning may benefit Veterans' post-deployment adjustment.

IMPACT:
This research provides systematic information about family well-being across the deployment cycle and its impact on National Guard Veterans' post-deployment mental health which can be used to develop and test interventions aimed at enhancing Veterans' resilience and recovery.

PUBLICATIONS:

Journal Articles

  1. Balderrama-Durbin C, Erbes CR, Polusny MA, Vogt D. Psychometric evaluation of a measure of intimate partner communication during deployment. Journal of family psychology : JFP : journal of the Division of Family Psychology of the American Psychological Association (Division 43). 2018 Feb 1; 32(1):31-41.
  2. Miller KE, Koffel E, Kramer MD, Erbes CR, Arbisi PA, Polusny MA. At-home partner sleep functioning over the course of military deployment. Journal of family psychology : JFP : journal of the Division of Family Psychology of the American Psychological Association (Division 43). 2018 Feb 1; 32(1):114-122.
  3. Erbes CR, Kramer M, Arbisi PA, DeGarmo D, Polusny MA. Characterizing spouse/partner depression and alcohol problems over the course of military deployment. Journal of consulting and clinical psychology. 2017 Apr 1; 85(4):297-308.
  4. Erbes CR, Meis LA, Polusny MA, Arbisi PA. Psychiatric distress among spouses of National Guard soldiers prior to combat deployment. Mental health in family medicine. 2012 Sep 1; 9(3):161-9.
Book Chapters

  1. Polusny MA, Erbes CR, Hagel Campbell EM, Fairman HC, Kramer M, Johnson AK. Pre-deployment Well-Being Among Single and Partnered National Guard Soldiers: The Role of Their Parents, Social Support, and Stressors. In: Wadsworth SM, Riggs DS, editors. Military Deployment and its Consequences for Families. 2014 ed. New York, NY: Springer New York; 2013. Chapter 9. 151-172 p.
Conference Presentations

  1. Erbes CR, Polusny MA, Vogt D. Psychometric evaluation of the Deployment Communication Inventory. Paper presented at: Association for Behavioral and Cognitive Therapies Annual Convention; 2015 Nov 12; Chicago, IL.
  2. Polusny MA, Erbes CR, Arbisi PA, DeGarmo D, Kramer M, Hagel Campbell EM, Bangerter AK, Vogt DS. Understanding Distinct Trajectories of Intimate Partner Adjustment across the Deployment Cycle. Presented at: International Society for Traumatic Stress Studies Annual Symposium; 2015 Nov 5; New Orleans, LA.
  3. Polusny MA, Erbes CR, Arbisi P, DeGarmo D, Kramer M, Hagel Campbell EM, Bangerter AK, Vogt D, Cutting AH. Predictors and Influence of Spouse/Partner Distress Trajectories Across Deployment on Veterans’ Post-deployment Mental Health. Poster session presented at: VA HSR&D / QUERI National Meeting; 2015 Jul 9; Philadelphia, PA.
  4. Hagel Campbell EM, Bangerter AK, Erbes CR, Polusny MA. A Randomized Controlled Trial of Special Mailing Procedures on Survey Response Rates: UPS vs USPS Priority Mail. Poster session presented at: VA HSR&D / QUERI National Meeting; 2015 Jul 8; Philadelphia, PA.
  5. Polusny MA. MN Global Assessment Tool-Resilience training effectiveness. Presented at: Military Medicine Summit; 2015 May 16; St. Louis Park, MN.
  6. Sayers S, Barg F, Mavandadi S, Hess T, Stanely S, Erbes CR, Polusny MA, Arbisi P, Curry J, Kiser L, Ventimiglia A, Dowling L, Carter P, Renshaw K. Pre- and post-deployment prediction of complicated family reintegration: findings from two samples of National Guard Veteran/partner dyads. Paper presented at: Association for Behavioral and Cognitive Therapies Annual Convention; 2014 Nov 21; Philadelphia, PA.
  7. Polusny MA, Erbes CR, Arbisi P, DeGarmo D, Kramer M. Predictors and impacts of trajectories of family functioning across deployment on post-deployment PTSD symptoms among National Guard soldiers. Paper presented at: International Society for Traumatic Stress Studies Annual Symposium; 2014 Nov 6; Miami, FL.
  8. Arbisi P, Kramer M, Erbes CR, Polusny MA. Temperamental compatibility as assessed by the MMPI-2 RF in National Guard solider couples: Impact on perceived quality of relationship. Paper presented at: MMPI-2-RF/MMPI-2/MMPI-A Annual Symposium on Recent Research; 2014 Apr 25; Scottsdale, AZ.
  9. Erbes CR, Polusny MA. Framing the Unique Experience of the Reserve Component. Paper presented at: University of Michigan Health System Depression Center National Research Summit on Reserve Component Military Families; 2013 Apr 25; Ann Arbor, MI.
  10. Polusny MA, Erbes CR. Pre-deployment sleep disturbances as predictors of PTSD and depression in National Guard troops. Paper presented at: International Society for Traumatic Stress Studies Annual Symposium; 2012 Nov 3; Los Angeles, CA.
  11. Polusny MA, Quigley K, Baker D, Vermetten E. Conducting successful prospective longitudinal studies. Presented at: International Society for Traumatic Stress Studies Annual Symposium; 2012 Nov 3; Los Angeles, CA.
  12. Erbes CR, Meis LA, Polusny MA. PTSD, past combat experiences, and intimate partner violence among National Guard Soldiers and their partners prior to a subsequent deployment. Paper presented at: International Society for Traumatic Stress Studies Annual Symposium; 2012 Nov 2; Los Angeles, CA.


DRA: Military and Environmental Exposures, Mental, Cognitive and Behavioral Disorders
DRE: Epidemiology, Prevention, Prognosis
Keywords: Family, Reintegration Post-Deployment, Risk Factors
MeSH Terms: none

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