HSR&D Home » Research » SDR 10-398 – HSR&D Study
Prospective Predictors of Veteran and Family Post-Deployment Mental Health
Melissa A. Polusny, PhD
Minneapolis VA Health Care System, Minneapolis, MN
Funding Period: November 2010 - October 2014
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.
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.
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.
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.
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.
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DRA: Military and Environmental Exposures, Mental, Cognitive and Behavioral Disorders
DRE: Epidemiology, Prevention, Prognosis
MeSH Terms: none