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.

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External Links for this Project

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PUBLICATIONS:

Journal Articles

1. 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. [view]
2. 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. [view]
3. 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. [view]
4. 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. [view]

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. [view]

Conference Presentations

1. 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. [view]
2. 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. [view]
3. 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. [view]
4. Polusny MA. MN Global Assessment Tool-Resilience training effectiveness. Presented at: Military Medicine Summit; 2015 May 16; St. Louis Park, MN. [view]
5. 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. [view]
6. 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. [view]
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. [view]
8. 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. [view]
9. 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. [view]
10. 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. [view]
11. 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. [view]
12. 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. [view]

DRA: Military and Environmental Exposures, Mental, Cognitive and Behavioral Disorders
DRE: Epidemiology, Prevention, Prognosis
Keywords: none
MeSH Terms: none