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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. External Links for this ProjectDimensions for VA![]() If you have VA-Intranet access, click here for more information vaww.hsrd.research.va.gov/dimensions/ VA staff not currently on the VA network can access Dimensions by registering for an account using their VA email address. Search Dimensions for this project PUBLICATIONS:Journal Articles
DRA:
Military and Environmental Exposures, Mental, Cognitive and Behavioral Disorders
DRE: Epidemiology, Prevention, Prognosis Keywords: none MeSH Terms: none |