The role of problem solving appraisal and support in the relationship between stress exposure and posttraumatic stress symptoms of military spouses and service member partners.

Using a stress process lens, this paper considers the interrelationship between individual and family-level stress exposures and military spouse resources, including problem-solving appraisals and problem-solving support (PSS), and their associations with posttraumatic stress symptoms (PTSS) among both partners in military marital dyads. The study employs data from the Millennium Cohort Family Study, a longitudinal survey of married military dyads, with an initial panel of 9,872 spouses enroled from 2011 to 2013. A structural equation model explored the associations between service member and spouse childhood maltreatment exposure, nonmilitary and military stressors, as well as interactions with spouse resources on self-reported PTSS among both service member (SM) and spouse (SP). Among our findings, spouse childhood maltreatment muted later self-reported problem-solving appraisal and support. Spouse resources, in turn, had both protective (problem-solving appraisal) and promotive (problem-solving support) effects on PTSS for both service members and spouses. These findings emphasise the central role of spouses in military families, as more psychological resources among spouses appeared to buffer against the deleterious effects of stress exposure on both their own and their partners mental health.

Early and recent military and nonmilitary stressors associated with posttraumatic stress symptoms among military service members and their spouses.

Disparities in posttraumatic stress symptoms (PTSS) have been observed among military service members (SMs) and spouses (SPs) compared to their civilian peers, but exposure to military stressors does not adequately explain observed differences. Using a stress process framework, this study considered the associations between early and recent military and nonmilitary stressors and PTSS among SMs and SPs. We analyzed data from 3,314 SM-SP dyads in the Millennium Cohort and Millennium Cohort Family Studies. Accounting for covariates, multiple linear regression and dominance analyses were employed to consider the effects of SM and SP childhood maltreatment, recent nonmilitary stressors (e.g., financial difficulties), and recent military stressors (e.g., deployment) on their own and their partner's self-reported PTSS. For both SMs and SPs, childhood maltreatment was the strongest predictor of their own PTSS, followed by nonmilitary stressors. Couple crossover dynamics were evident as SP maltreatment and nonmilitary stressors significantly predicted SM PTSS, and SM maltreatment predicted SP PTSS. Maltreatment also multiplied the effects of SM, product term B = 0.92, p = .031, and SP, product term B = 0.75, p = .004, nonmilitary stressors. The findings emphasize the essential role of exposure to early adversity in understanding PTSS among SMs and SPs, as childhood maltreatment strongly predicted PTSS and exacerbated the effects of other stressors on PTSS. Providers should assess for early adversity among both SMs and SPs and consider the provision of services at the couple level given the potential for the transmission of stress within couples.

Feasibility and Preliminary Impact of a Community-Based Intervention for Maternal PTSD and Parenting: Parenting-STAIR Pilot.

Trauma exposure and post-traumatic stress disorder (PTSD) impact emotional and physical well-being, social functioning, and parent-child relationship quality. The effect of parental trauma on parenting and child maltreatment is often overlooked by current child welfare (CW) services. The novel intervention, Parenting-STAIR, was created to address maternal mental health, parenting skills, and child well-being outcomes. Parenting-STAIR is a combination of Skills Training in Affective and Interpersonal Regulation (STAIR) Narrative Therapy and Parent-Child Care (PC-CARE). This open pilot study aimed to examine the feasibility and preliminary impact of Parenting-STAIR in reducing maternal PTSD and increasing positive parenting skills for mothers and families involved in the child welfare system. Parenting-STAIR was delivered to 111 mothers receiving family preservation services in New York City. Of these, 70 completed treatment; statistical and clinically significant changes were observed for maternal PTSD and depression as well as in parenting stress, parenting skills, and child behaviors. These findings provide encouraging initial evidence for the feasibility and impact of this novel PTSD intervention. An evaluation of maltreatment recidivism is needed, as well as implementation of a randomized controlled trial to establish efficacy of the intervention.

The association of parentification indicators with substance use patterns among military-connected adolescents.

Military-connected youths are a vulnerable population exposed to a unique set of stressors, which may put them at increased risk for adverse mental and behavioral health outcomes, compared to their civilian counterparts. Among military-connected adolescents, emotional and instrumental parentification are mechanisms hypothesized to account for negative outcomes, including substance use. However, parentification may be protective in some cultures and has not been examined in the military population. Data were drawn from 1,441 7th-, 9th-, and 11th-graders who had a parent in the military and completed the 2013 California Healthy Kids Survey. Latent class analysis was used to examine patterns of instrumental parentification indicators among military-connected youths and associated patterns of substance use. Military-connected students in the high parentification class were significantly less likely to be in the frequent polysubstance using class (odds ratio = 0.376, 95% confidence interval [0.180, 0.782]). Findings suggest that experiences of instrumental parentification, including having more responsibilities at home, being more independent, and being able to solve problems better than peers, may be protective. For military-connected youths, these skills, developed in the context of their families, may translate to better coping with other stressful situations. Professionals may be able to build on these strengths and develop adaptive coping strategies to support military-connected youths in managing the stressors of wartime military life. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Pre- and Perinatal Risk Factors for Child Maltreatment in Military Families Across the First Two Years of Life.

Military families are exposed to a unique constellation of risk factors, which may impact maltreatment outcomes. The present study examined prospective relationships between demographic, health, birth-related, and military-specific risk factors identified prior to a child's birth on their risk for maltreatment in the first two years of life. Data from the Millennium Cohort Study, Department of Defense (DoD) operational records and Family Advocacy Program data on met-criteria maltreatment, and Birth and Infant Health Research program data on suspected maltreatment were linked for 9076 service member parents. Discrete time survival analysis showed that preterm birth increased risk of maltreatment while parents' older age, physical health, and service in the Navy or Air Force decreased risk. Building on DoD's New Parent Support Program, findings suggest the need for universal and targeted prevention efforts, beginning during pregnancy, which limit or eliminate risk factors for maltreatment in military families.

Maladaptive coping among military-connected adolescents: Examining combined risk using QCA.

Introduction: Military-connected students in public schools face a unique set of stressors that may impact their wellbeing and academic functioning. Methods: Twenty-four youth in the 7th to 12th grades who had an active-duty parent (mother or father) serving in the U.S. Armed Forces were interviewed. Participants completed a qualitative interview while actively completing a Life History Calendar (LHC) to mark deployment and family military service milestones and discuss how they impacted the youth respondent. This study used Qualitative Comparative Analysis (QCA) to explore the interplay and combination of specific stressors related to relocation and deployment experiences among adolescents, and to determine key factors associated with maladaptive outcomes. Results: The results of the QCA analysis identified bullying experiences and negative experiences with other military-connected youth as conditions that are associated with maladaptive coping. Discussion: Chronic and acute stressors in adolescence are established risk factors for mental, emotional, and behavioral problems in the short and long-term including suicidality, substance use and abuse, and substance use disorders. Through qualitative inquiry we were able to identify specific contextual details related to maladaptive coping that can be used to further refine areas of focus for research, prevention, and interventions for military-connected adolescents.

Association between cumulative risk and protective factors with mental distress among female military spouses.

OBJECTIVE: Guided by a resilience framework, this study examines the accumulation of risk and protective factors, as well as the potential buffering effects of protective factors on mental distress among female military spouses. BACKGROUND: Most research with this population has focused on individual risk factors affecting military spouses. Less frequently have the effects of cumulative risk, risk factors not specifically associated with military service, or protective factors been examined, though there is evidence for their importance. METHOD: This study used secondary survey data from 334 female Army spouses collected in 2012 as part of the Land Combat Study 2. Cumulative risk and protective factor scores as well as scores within risk (intrapersonal, family, and military-specific) and protective (individual and environmental) factor domains were calculated. Four structural equation models were run to examine main and interaction effects on mental distress, a latent variable representing depression, anxiety, and trauma symptoms. RESULTS: In cumulative risk and protective factor models, cumulative risk was directly, positively associated with mental distress. This relationship was moderated by cumulative protection. In domain-specific models, only family risk was directly associated with mental distress. This relationship was moderated by environmental protective factors. CONCLUSION: Findings indicate mental distress among military spouses is associated with exposure to cumulative risk and attenuated by the presence of certain domains of protective factors. Family risk factors including marital distress and work-family conflict may be particularly pernicious stressors, but informal and structural supports may be important targets for prevention and intervention efforts. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Mental health outcomes associated with profiles of risk and resilience among U.S. Army spouses.

The current study examined patterns of risk and protective factors among military families and associations with mental health diagnoses among U.S. Army spouses. Spouses (N = 3,036) completed a survey of family psychosocial fitness, which informed protective factors including coping, family cohesion, and social support. Survey results were linked with Department of Defense archival data, which provided information on military-specific risks, including relocation, deployments, and reunification, as well as mental health care diagnoses. The three-step method of latent profile analysis identified six profiles, suggesting significant heterogeneity in military families with respect to their access to resources and exposure to risk. The largest profile of families (40.48% of the sample) had limited risk exposure and considerable strengths. Variability in risk and protection across profiles was associated with statistically significant differences in the prevalence of mental health diagnoses among spouses (χ² = 108.968, df = 5, p < .001). The highest prevalence of mental health diagnoses among Army spouses (41.2%) was observed in the profile with the lowest levels of protective factors. Findings point to the importance of evaluating both concurrent risk and protective factors. Increasing access to resources may be a fruitful avenue for prevention among military families that are struggling. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Mental Health Outcomes Associated with Risk and Resilience among Military-Connected Youth.

The present study aimed to describe patterns of risk and protective factors affecting U.S. Army families and their association with mental health diagnoses among military-connected children. Wartime military service is associated with increased adverse outcomes for military-connected youth, but few studies have explored the impact of concurrent risk and access to protective factors. Using big data methods to link existing datasets, protective factors (e.g., marital and family functioning) were drawn from a voluntary survey completed by 1,630 US Army spouses. Risk factors (e.g., parent mental health, family moves, deployment) were drawn from Department of Defense (DoD) archival data. Rates of mental health diagnoses among youth were derived from DoD healthcare records. Using the three-step method of latent profile analysis, five profiles emerged with variability across risk and protective factors. The largest group (40% of the sample) had considerable protective factors and limited risk exposure. Statistically significant differences in the prevalence of mental health diagnoses among military-connected youth were observed across profiles (χ2  = 30.067, df = 4, p < .001), with the highest rates (31.1% and 30.5%) observed in the two profiles with the lowest protective factors. Findings suggest most military families are faring well and highlight the importance of a thorough assessment that evaluates both the stressors military families face and the strengths they possess.

el presente estudio tuvo como finalidad describir los patrones de riesgo y los factores protectores que afectan a las familias del Ejército de los Estados Unidos y su asociación con los diagnósticos de salud mental entre niños relacionados con los militares. El servicio militar en tiempos de guerra está asociado con mayores consecuencias adversas para los jóvenes relacionados con los militares, pero pocos estudios han analizado el efecto del riesgo simultáneo y el acceso a los factores protectores. Utilizando métodos de datos masivos para conectar conjuntos de datos existentes, se extrajeron los factores protectores (p. ej.: funcionamiento familiar y conyugal) de una encuesta voluntaria contestada por 1630 cónyuges de militares del Ejército de los Estados Unidos. Los factores de riesgo (p. ej.: la salud mental de los padres, las mudanzas familiares, las comisiones) se obtuvieron de los datos de archivo del Departamento de Defensa (DoD). Los índices de los diagnósticos de salud mental entre los jóvenes se extrajeron de los expedientes de asistencia sanitaria del DoD. Utilizando el método de tres pasos del análisis de perfiles latentes, surgieron cinco perfiles con variabilidad entre los factores de riesgo y los factores protectores. El grupo más grande (el 40% de la muestra) tuvo factores protectores considerables y una exposición a riesgos limitada. Se observaron diferencias estadísticamente significativas en la prevalencia de diagnósticos de salud mental entre los jóvenes relacionados con los militares en los perfiles (χ2 = 30.067, df = 4, p < .001), y los índices más altos (31.1% and 30.5%) se observaron en los 2 perfiles con factores protectores más bajos.Los resultados sugieren que la mayoría de las familias militares se encuentran bien y destacan la importancia de una evaluación exhaustiva que evalúe tanto los factores desencadenantes de estrés que enfrentan las familias de militares como las fortalezas que poseen.

Preliminary Psychometrics and Potential Big Data Uses of the U.S. Army Family Global Assessment Tool.

The purpose of the present study is to explore the psychometric properties of the U.S. Army's Family Global Assessment Tool (GAT), which assesses the psychosocial fitness of Army families. With data from 1,692 Army spouses, we examined the structure, reliability and validity of the GAT, using confirmatory factor analysis (CFA) and two validity studies. Fifty-three items and 9 factors were retained following CFA. This model provided a good fit, and scales demonstrated strong internal consistency. Bivariate correlations and results from a theoretically driven model provide preliminary evidence of validity. Findings support the usefulness of the GAT for measuring psychosocial fitness of Army spouses.

Suicidality among military-connected adolescents in California schools.

Previous research indicates that suicidal ideation is higher among military-connected youth than non military-connected youth. This study extends prior work by examining suicidal ideation, plans, and attempts in military-connected and non military-connected adolescents. Data were gathered from 390,028 9th and 11th grade students who completed the 2012-2013 California Healthy Kids Survey. Bivariate comparisons and multivariate logistic analyses were conducted to examine differences in suicidal ideation, plans, attempts, and attempts requiring medical attention between military and not military-connected youth. In multivariate logistic analyses, military-connected youth were at increased risk for suicidal ideation (OR = 1.43, 95 % CI = 1.37-1.49), making a plan to harm themselves (OR = 1.19, CI = 1.06-1.34), attempting suicide (OR = 1.67, CI = 1.43-1.95), and an attempted suicide which required medical treatment (OR = 1.71, CI = 1.34-2.16). These results indicate that military-connected youth statewide are at a higher risk for suicidal ideation, plans, attempts, and attempts requiring medical care because of suicidal behaviors. It is suggested that policies be implemented to increase awareness and screening among primary care providers, school personnel, and military organizations that serve military-connected youth.