The Millennium Cohort Family Study: a prospective evaluation of the health and well-being of military service members and their families

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.

Partner Effects: Analyzing Service Member and Spouse Drinking Over Time

INTRODUCTION

Excessive alcohol use is a significant problem in the military. Although there is a growing emphasis on family-centered alcohol prevention approaches, little is known about the interplay between partners' drinking behaviors. This study examines how service members and their spouses influence each other's drinking behavior over time and explores the complex individual, interpersonal, and organizational factors that may contribute to alcohol use.

METHODS

A sample of 3,200 couples from the Millennium Cohort Family Study was surveyed at baseline (2011-2013) and follow-up (2014-2016). The research team estimated how much partners' drinking behaviors influenced one another from baseline to follow-up using a longitudinal structural equation modeling approach. Data analyses were conducted in 2021 and 2022.

RESULTS

Drinking patterns converged between spouses from baseline to follow-up. Participants' own baseline drinking had a small but significant effect on changes in their partners' drinking from baseline to follow-up. Results from a Monte Carlo simulation showed that the longitudinal model could reliably estimate this partner effect in the presence of several potential sources of bias, including partner selection. The model also identified several common risk and protective factors for drinking shared by both service members and their spouses.

CONCLUSIONS

Findings suggest that changing the drinking habits of one spouse could lead to a change in the drinking habits of the other, which supports family-centered alcohol prevention approaches in the military. Dual-military couples especially may benefit from targeted interventions because they face a higher risk of unhealthy alcohol consumption.

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.

Families serve too: military spouse well-being after separation from active-duty service

BACKGROUND AND OBJECTIVES

Transitioning from military to civilian life can be challenging for families, but most research focuses only on the service member. We applied a life course model to assess spouse well-being following this important transition.

DESIGN

Prospective, longitudinal survey of service members and their spouses.

METHODS

We captured three spouse well-being domains: psychological health, physical health, and family relationships. We identified differences between families who separated from service and those still affiliated (N = 4,087) and assessed baseline factors associated with spouse well-being after the family separated from service (N = 1,199).

RESULTS

Spouses of service members who had separated from the military (versus those who had not) reported poorer mental health and family relationship quality at baseline and follow-up. After controlling for baseline differences, spouses whose families transitioned experienced a greater increase in PTSD symptoms and a steeper decline in quality of marriage. Spouses of active-duty service members reported greater increases in work-family conflict. Among families who had transitioned, the most consistent predictor of positive outcomes was baseline well-being. Protective factors included having more psychological and social resources and less financial stress.

CONCLUSIONS

Several protective and risk factors identified in the study may inform programming for families transitioning from active duty.

Longitudinal Patterns of Military Spousal Alcohol Consumption: Findings From the Millennium Cohort Family Study

OBJECTIVE

Alcohol use in the military is prevalent and has short- and long-term health, safety, and career consequences. Although several studies have examined service members' alcohol consumption, few have focused on alcohol use among military spouses. This study assessed factors at individual, interpersonal, and organizational levels to determine associations with risky alcohol use among military spouses.

METHOD

Data from baseline and first follow-up of the Millennium Cohort Family Study were used (N = 5,475; 4,923 female) to model spousal self-reported risky drinking (heavy and/or binge drinking) at follow-up. Predictors included demographic characteristics, spousal adverse childhood experiences and mental health, smoking status, marital status, family satisfaction, social support, military stress, and service member military characteristics. Logistic regression models assessed the adjusted associations between spouse and service member characteristics and spousal risky drinking at follow-up.

RESULTS

Among spouses in this sample, 19% were risky drinkers at follow-up. Baseline alcohol use status was associated with risky drinking at follow-up. Most spouses (64.2%) did not change their drinking behavior between baseline and follow-up; those who did change were nearly evenly split between an increasing (17.0%) versus decreasing (18.7%) pattern. Risk factors included male gender, cigarette smoking, elevated symptoms of post-traumatic stress, marital separation, and service member deployment with combat.

CONCLUSIONS

Although most military spouses were not engaging in risky drinking, one in five were, with about half of these having moved into the risky drinking category over time. Risky alcohol use among spouses has ramifications for themselves, the service member, and the family unit.

Longitudinal Patterns of Military Spousal Alcohol Consumption: Findings From the Millennium Cohort Family Study

OBJECTIVE

Alcohol use in the military is prevalent and has short- and long-term health, safety, and career consequences. Although several studies have examined service members' alcohol consumption, few have focused on alcohol use among military spouses. This study assessed factors at individual, interpersonal, and organizational levels to determine associations with risky alcohol use among military spouses.

METHOD

Data from baseline and first follow-up of the Millennium Cohort Family Study were used (N = 5,475; 4,923 female) to model spousal self-reported risky drinking (heavy and/or binge drinking) at follow-up. Predictors included demographic characteristics, spousal adverse childhood experiences and mental health, smoking status, marital status, family satisfaction, social support, military stress, and service member military characteristics. Logistic regression models assessed the adjusted associations between spouse and service member characteristics and spousal risky drinking at follow-up.

RESULTS

Among spouses in this sample, 19% were risky drinkers at follow-up. Baseline alcohol use status was associated with risky drinking at follow-up. Most spouses (64.2%) did not change their drinking behavior between baseline and follow-up; those who did change were nearly evenly split between an increasing (17.0%) versus decreasing (18.7%) pattern. Risk factors included male gender, cigarette smoking, elevated symptoms of post-traumatic stress, marital separation, and service member deployment with combat.

CONCLUSIONS

Although most military spouses were not engaging in risky drinking, one in five were, with about half of these having moved into the risky drinking category over time. Risky alcohol use among spouses has ramifications for themselves, the service member, and the family unit.

The Millennium Cohort Study: The First 20 Years of Research Dedicated to Understanding the Long-Term Health of US Service Members and Veterans

The Millennium Cohort Study, the US Department of Defense's largest and longest running study, was conceived in 1999 to investigate the effects of military service on service member health and well-being by prospectively following active duty, Reserve, and National Guard personnel from all branches during and following military service. In commemoration of the Study's 20th anniversary, this paper provides a summary of its methods, key findings, and future directions. Recruitment and enrollment of the first 5 panels occurred between 2001 and 2021. After completing a baseline survey, participants are requested to complete follow-up surveys every 3 to 5 years. Study research projects are categorized into 3 core portfolio areas (psychological health, physical health, and health-related behaviors) and several cross-cutting areas and have culminated in more than 120 publications to date. For example, some key Study findings include that specific military service-related factors (e.g., experiencing combat, serving in certain occupational subgroups) were associated with adverse health-related outcomes and that unhealthy behaviors and mental health issues may increase following the transition from military service to veteran status. The Study will continue to foster stakeholder relationships such that research findings inform and guide policy initiatives and health promotion efforts.

Associations between spouse and service member prescriptions for high-risk and long-term opioids: A dyadic study

•

Military spouses were more likely to have risky opioid Rx if their spouse did.

•

High-risk opioid therapy was linked to pain, disability, smoking, and ACES

•

Reducing risky opioid Rx for service members may reduce similar risky Rx for spouses.

Background

Estimates suggest approximately 2.4% of service members, and 15% of service members who have engaged in recent combat, report misusing pain relievers in the past year. This study explores the extent to which military spouses’ obtainment of opioids is associated with their service member partners’ obtainment of opioid prescriptions, in addition to other factors such as service member health, state prescribing patterns, and sociodemographic characteristics.

Methods

Data were drawn from the Millennium Cohort Family Study, a large, longitudinal survey of married spouses of service members from all service branches, and archival data analyzed from 2018 to 2020. The dependent variables were spouse long-term opioid therapy and spouse opioid prescriptions that pose a high risk of adverse outcomes.

Results

Seven percent of spouse and service member dyads met the criteria for high-risk opioid use, generally because they had purchased a prescription for a ≥90 Morphine Milligram Equivalents daily dose (76.7% for spouses, 72.8% for service members). Strong associations were found between spouse and service member opioid therapies (OR = 5.53 for long-term; OR = 2.20 for high-risk).

Conclusions

Findings suggest that reducing the number of long-term and high-risk opioid prescriptions to service members may subsequently reduce the number of similar prescriptions obtained by their spouses. Reducing the number of service members and spouses at risk for adverse events may prove to be effective in stemming the opioid epidemic and improve the overall health and safety of military spouses and thus, the readiness of the U.S. Armed Forces.

Demographic Variation in Military Life Stress and Perceived Support Among Military Spouses

INTRODUCTION

Military spouses play a critical role in supporting military service members, and thus, their experiences may have a significant impact on the well-being, readiness, and resilience of the U.S. Armed Forces. Research suggests that military spouses experience unique stressors as a result of military life, but few studies have assessed demographic factors associated with their experiences of military life and perceived support.

MATERIALS AND METHODS

Using data from the Millennium Cohort Family Study, a nationwide survey of 9,872 married spouses of service members with 2 to 5 years of military service, this study examined differences in experiences of military life and perceived support across multiple understudied subgroups of military spouses. Key outcomes included military-related stressors (e.g., deployment-related experiences), perceived social support, and perceived military efforts to provide support.

RESULTS

Military life stress and perceived support differed across military spouse, service member, and family characteristics. Results indicated that spouses who are older than age 35 or are married to enlisted service members in the Army, Navy, or Marines are more likely to experience heightened military stress or less perceived social support. Dual-military couples reported experiencing less stress associated with military life and perceiving more social support and support from the military, compared with spouses who have never served in the military.

CONCLUSION

These findings may help guide effective channeling of resources and outreach to potentially vulnerable military families.

High-risk and Long-term Opioid Prescribing to Military Spouses in the Millennium Cohort Family Study

INTRODUCTION

The use and misuse of opioids by active service members has been examined in several studies, but little is known about their spouses' opioid use. This study estimates the number of military spouses who received high-risk or long-term opioid prescriptions between 2010 and 2014, and addresses how the Military Health System can help prevent risky prescribing in order to improve military force readiness.

MATERIALS AND METHODS

This study used data from the Millennium Cohort Family Study, a nationwide survey of 9,872 spouses of service members with 2 to 5 years of military service, augmented with information from the military's Pharmacy Data Transaction Service about prescriptions for controlled drugs dispensed to these service members' spouses. Our objectives were to estimate the prevalence of opioid prescribing indicative of long-term use (≥60 day supply or at least one extended-release opioid prescription in any 3-month period) and, separately, high-risk use (daily dosage of ≥90 morphine mg equivalent or total dosage of ≥8,190 morphine mg equivalent, or prescriptions from more than three pharmacies, or concurrent prescriptions). For each of these dependent variables, we conducted bivariate analyses and multiple logistic regression models using information about spouses' physical health, sociodemographic characteristics, substance use behaviors, perceived social support, and stresses associated with military stress, among others. Informed consent, including consent to link survey responses to medical and personnel records, was obtained from all participants. The Naval Health Research Center's Institutional Review Board and the Office of Management and Budget approved the study.

RESULTS

Spouses were predominantly female (86%), had not served in the military themselves (79%), and were spouses of enlisted (91%) active duty (86%) service members. Almost half (47.6%) of spouses obtained at least one opioid prescription during the 2-year observation window, and 8.5% had received opioid prescriptions that posed risk to their health. About 7% met the criteria for receipt of high-risk opioid prescriptions, 3% obtained opioids from three or more pharmacies during a 3-month period, and 4% of spouses who received any opioids received both long-term and high-risk prescriptions. Adverse childhood experiences, physical pain, and lack of social support were associated with increased odds of obtaining high-risk opioid prescriptions.

CONCLUSIONS

Approximately 48% of military spouses had used Military Health System insurance to fill at least one opioid prescription during the 2-year observation period. The Department of Defense has taken measures to minimize high-risk opioid prescribing, including passing prescribing guidelines in 2017, establishing the controlled drug management analysis reporting tool, establishing a pain management education and training program, and more. These efforts should continue to expand as reducing the numbers of service members and spouses at risk for adverse events may be effective in reducing opioid misuse and improve the overall health and safety of military spouses and thus, the readiness of the U.S. Armed Forces.

Posttraumatic Stress Disorder Symptom Clusters in Service Members Predict New-Onset Depression Among Military Spouses

Military operations in Iraq and Afghanistan have brought increased attention to posttraumatic stress disorder (PTSD) among service members and, more recently, its impact on spouses. Existing research has demonstrated that PTSD among service members is associated with depression among military spouses. In the current study, we extended these findings by using data from service member-spouse dyads enrolled in the Millennium Cohort Family Study for which the service member had evidence of PTSD (n = 563). Prospective analyses identified the association between PTSD symptom clusters reported by the service member and new-onset depression among military spouses. Over the 3-year study period, 14.4% of these military spouses met the criteria for new-onset depression. In adjusted models, service member ratings of symptoms in the effortful avoidance cluster, odds ratio (OR) = 1.61, 95% CI [1.03, 2.50], predicted an increased risk of new-onset depression among military spouses, whereas reexperiencing symptoms, adjusted OR = 0.57; 95% CI [0.32, 1.01], were marginally protective. These findings suggest that PTSD symptom clusters in service members differentially predict new-onset depression in military spouses, which has implications for treatment provision.

The impact of family stressors and resources on military spouse's perception of post-deployment reunion stress

Much of the prior research on variables impacting spouses' perceptions of reunion stress have focused on individual variables and have not examined these variables within their shared context, despite the indication from some research and theory that this is a key component of understanding couple's responses to stressors. The present study examined the impact of various family stressors and resources, both independently and in conjunction with each other, on spouses' perceptions of reunion stress. To examine these variables, the present study utilized cross-sectional data from a representative sample of 1,558 military service members and their spouses participating in the Millennium Cohort Family Study. Results indicated that poorer mental health among spouses and service members was associated with increased reunion stress as reported by spouses across all models tested. In addition, stressful communication during deployment was significantly associated with spouses' perceptions of reunion stress. These results can help guide more targeted prevention and intervention efforts to decrease spouses' sense of reunion stress.

Magnitude of problematic anger and its predictors in the Millennium Cohort

Background

Problematic anger is intense anger associated with elevated generalized distress and that interferes with functioning. It also confers a heightened risk for the development of mental health problems. In military personnel and veterans, previous studies examining problematic anger have been constrained by sample size, cross-sectional data, and measurement limitations.

Methods

The current study used Millennium Cohort survey data (N = 90,266) from two time points (2013 and 2016 surveys) to assess the association of baseline demographics, military factors, mental health, positive perspective, and self-mastery, with subsequent problematic anger.

Results

Overall, 17.3% of respondents reported problematic anger. In the fully adjusted logistic regression model, greater risk of problematic anger was predicted by certain demographic characteristics as well as childhood trauma and financial problems. Service members who were in the Army or Marines, active duty (vs. reserves/national guard), and previously deployed with high levels of combat had increased risk for problematic anger. Veterans were also more likely to report problematic anger than currently serving personnel. Mental health predictors included posttraumatic stress disorder (PTSD), major depressive disorder (MDD), and comorbid PTSD/MDD. Higher levels of positive perspective and self-mastery were associated with decreased risk of problematic anger.

Conclusion

Not only did 1 in 6 respondents report problematic anger, but risk factors were significant even after adjusting for PTSD and MDD, suggesting that problematic anger is more than an expression of these mental health problems. Results identify potential targets of early intervention and clinical treatment for addressing problematic anger in the military and veteran context.

Military Life Stressors, Family Communication and Satisfaction: Associations with Children's Psychosocial Outcomes

Families experience multiple stressors as a result of military service. The purpose of this study was to examine facets of military life and family factors that may impact child psychosocial and mental health functioning. Using baseline data from the Millennium Cohort Family Study, this study examined family demographics and composition (age, number of children), military life stressors (injury, family, and deployment stressors), family communication and satisfaction as assessed by the Family Adaptability and Cohesion Evaluation Scale-IV, parental social functioning assessed via the Short Form Health Survey-36, and child mental health and behavioral functioning (parental reports of clinician-diagnosed mental health conditions such as depression) and an adapted version of the Strengths and Difficulties Questionnaire. Injury- and family-related military stressors were significant indicators of heightened risk for child mental health conditions, whereas greater levels of parental social functioning and family satisfaction were associated with lower risk of child mental health conditions. Differential associations were found in child functioning when military-related variables (e.g., service component), sociodemographic, and family composition factors (number and age of the children in the home) were examined. These findings underscore the importance of examining the "whole child" within the broader ecological and military family context to understand factors associated with children's mental and behavioral health. The results from the present study highlight the complex relationships that may be at play, which, in turn, have considerable implications for the development of policies to support children and families encountering multiple stressors related to a parent's military service.

Association of military life experiences and health indicators among military spouses

Background

The health and well-being of military spouses directly contribute to a robust military force by enabling the spouse to better support the active duty member’s career. In order to understand the overall health and well-being of military spouses, we assessed health indicators among military spouses using the Healthy People 2020 framework and examined associations of these health indicators with military experiences and psychosocial factors.

Methods

Using data from the Millennium Cohort Family Study, a U.S. Department of Defense-sponsored survey of 9872 spouses of service members with 2–5 years of military service, we examined attainment of Healthy People 2020 goals for spouses and service members, including healthy weight, exercise, sleep, and alcohol and tobacco use. Multivariable logistic regression models assessed associations of spouse health indicators with stressful military life experiences and social support, adjusting for demographics and military descriptors. The spousal survey was administered nationwide in 2011.

Results

The majority of military spouses met each health goal assessed. However, less than half met the healthy weight and the strength training goals. Reporting greater perceived family support from the military was associated with better behavioral health outcomes, while having no one to turn to for support was associated with poorer outcomes. Using the Healthy People 2020 objectives as a framework for identifying key health behaviors and benchmarks, this study identified factors, including military-specific experiences, that may contribute to physical health behaviors and outcomes among military spouses. With respect to demographic characteristics, the findings are consistent with other literature that women are more likely to refrain from risky substance use and that greater education is associated with better overall health outcomes.

Conclusions

Findings suggest that enhanced social and military support and tailored programming for military spouses may improve health outcomes and contribute to the well-being of military couples. Such programming could also bolster force readiness and retention.

Mental Health of Children of Deployed and Nondeployed US Military Service Members: The Millennium Cohort Family Study

OBJECTIVE

Families experience multiple stressors as a result of military service. The purpose of this study was to investigate the associations among service member deployment experiences, family and military factors, and children's mental health using baseline data from the Millennium Cohort Family Study, a study designed to evaluate the health and mental health effects of military service on families, including children.

METHOD

This study examined administrative data on deployment status (combat, noncombat, and no deployments), as well as service member- and spouse-reported data on deployment experiences and family functioning in relation to the mental health of children in the family who were aged 9 to 17 years.

RESULTS

Most children were not reported to have mental health, emotional, or behavioral difficulties regardless of parental deployment status. For an important minority of children, however, parental deployments with combat, compared with those with no deployment, were associated with a parental report of attention-deficit disorder/attention-deficit hyperactivity disorder and depression as diagnosed by a clinical provider, after accounting for demographics, psychosocial context, and military factors. Children's odds of a parental report of depression were significantly higher in both the combat and the noncombat deployment groups than in the no deployment group.

CONCLUSION

These findings extend our understanding of the association between parental deployments and children's mental health, with implications for services and training mental health providers serving military families.

Depression among military spouses: Demographic, military, and service member psychological health risk factors

BACKGROUND

More than a decade of war has strained service members and their families and the psychological health of military spouses is a concern. This study uses data from the largest study of military families in the United States to examine the demographic, military-specific, and service member mental health correlates of probable diagnosis of major depressive disorder (MDD) among military spouses.

METHODS

Data were from service member-spouse dyads from all branches of the U.S. military. Demographic and military-specific factors were assessed using administrative personnel records and survey data.

RESULTS

Of the 9,038 spouses, 4.9% had a probable diagnosis of MDD. In unadjusted models, spouses of service members who deployed and experiencecd combat-related events, were enlisted, had a probable posttraumatic stress disorder (PTSD) diagnosis, or screened positive for alcohol misuse were more likely to screen positive for MDD. In adjusted models, only spouses married to enlisted service members or those with PTSD had increased risk for MDD. Other demographic and military-related factors associated with MDD in spouses included less educational attainment, unemployment, having four or more children, and having prior military service (although not currently serving in the military) in the adjusted models.

CONCLUSIONS

Findings characterize demographic, military, and service member psychological health factors that are associated with depression among military spouses. These findings imply that deployment alone may not negatively affect military spouses, but rather it may be the mental health impact on the service member, especially PTSD that increases the odds for MDD among military spouses.

The Impact of Military and Nonmilitary Experiences on Marriage: Examining the Military Spouse's Perspective

There has been conflicting research regarding direct association between deployments and marital quality, particularly from the military spouse's perspective. In the current study, we sought to extend past research by examining the direct association between both military and nonmilitary experiences and military spouse marital quality using 2011-2013 baseline data from the Millennium Cohort Family Study, a large sample of military couples representing all U.S. service branches and components. Military experiences were assessed using electronic deployment records to capture the number and length of deployments since 2001, and service members reported combat experience and symptoms indicative of posttraumatic stress disorder (PTSD). Military spouses reported on service members' recent time away from home, nonmilitary family stressors, and marital quality. Results of the logistic regression model adjusted for demographic, relationship, and military covariates indicated that most military experiences did not have a direct statistical association with low marital quality except service member PTSD, odds ratio (OR) = 1.54, 95% CI [1.17, 2.04]. Rather, nonmilitary experiences of the military spouse, including lack of social support, OR = 2.68, 95% CI [2.07, 3.47]; caregiver burden, OR = 1.56, 95% CI [1.22, 1.99]; work-family conflict, OR = 1.42, 95% CI [1.18, 1.69]; and financial strain, OR = 1.27, 95% CI [1.03, 1.55], increased odds of low marital quality. Implications of these findings include providing additional supports to address nonmilitary family stressors that are particularly salient to military spouses with an aim to promote marital quality.

Prevalence of psychiatric morbidity in United States military spouses: The Millennium Cohort Family Study

BACKGROUND

Approximately half of US service members are married, equating to 1.1 million military spouses, yet the prevalence of psychiatric morbidity among military spouses remains understudied. We assessed the prevalence and correlates of eight mental health conditions in spouses of service members with 2-5 years of service.

METHOD

We employed baseline data from the Millennium Cohort Family Study, a 21-year longitudinal survey following 9,872 military-affiliated married couples representing all US service branches and active duty, Reserve, and National Guard components. Couples were surveyed between 2011 and 2013, a period of high military operational activity associated with Operation Iraqi Freedom and Operation Enduring Freedom. Primary outcomes included depression, anxiety, posttraumatic stress disorder (PTSD), panic, alcohol misuse, insomnia, somatization, and binge eating, all assessed with validated self-report questionnaires.

RESULTS

A total of 35.90% of military spouses met criteria for at least one psychiatric condition. The most commonly endorsed conditions were moderate-to-severe somatization symptoms (17.63%) and moderate-to-severe insomnia (15.65%). PTSD, anxiety, depression, panic, alcohol misuse, and binge eating were endorsed by 9.20%, 6.65%, 6.05%, 7.07%, 8.16%, and 5.23% of spouses, respectively. Having a partner who deployed with combat resulted in higher prevalence of anxiety, insomnia, and somatization. Spouses had lower prevalence of PTSD, alcohol misuse, and insomnia but higher rates of panic and binge eating than service members. Both members of a couple rarely endorsed having the same psychiatric problem.

CONCLUSIONS

One third of junior military spouses screened positive for one or more psychiatric conditions, underscoring the need for high-quality prevention and treatment services.

A Call for Theoretically Informed and Empirically Validated Military Family Interventions

Although multiple evidence-based family interventions exist, less than a handful have been developed or rigorously tested specifically for military families. Indeed, few interventions available to military families are theory based or empirically validated; most have good face validity but little data on efficacy or effectiveness. This article argues for an emphasis on the rigorous evaluation, via pragmatic randomized controlled trials, of theory-based family interventions to strengthen and support military families. Data are provided from a theory-based, empirically validated parenting program for families (After Deployment, Adaptive Parenting Tools, or ADAPT) to demonstrate the potential for randomized controlled trials to yield rich data about family functioning beyond program outcomes. Opportunities to generate theoretically informed, evidence-based family interventions for military families will contribute not only to testing theories about military families but also to advancing well-being for the next generation of service members and their families.

Smoking and drinking behaviors of military spouses: Findings from the Millennium Cohort Family Study

INTRODUCTION

The associations between stressful military experiences and tobacco use and alcohol misuse among Service members are well documented. However, little is known about whether stressful military experiences are associated with tobacco use and alcohol misuse among military spouses.

METHODS

Using 9872 Service member-spouse dyads enrolled in the Millennium Cohort Family Study, we employed logistic regression to estimate the odds of self-reported cigarette smoking, risky drinking, and problem drinking among spouses by Service member deployment status, communication regarding deployment, and stress associated with military-related experiences, while adjusting for demographic, mental health, military experiences, and Service member military characteristics.

RESULTS

Current cigarette smoking, risky drinking, and problem drinking were reported by 17.2%, 36.3%, and 7.3% of military spouses, respectively. Current deployment was not found to be associated with spousal smoking or drinking behaviors. Communication about deployment experiences with spouses was associated with lower odds of smoking, but not with risky or problem drinking. Spouses bothered by communicated deployment experiences and those who reported feeling very stressed by a combat-related deployment or duty assignment had consistently higher odds of both risky and problem drinking.

CONCLUSIONS

Our findings suggest that contextual characteristics about the deployment experience, as well as the perceived stress of those experiences, may be more impactful than the simple fact of Service member deployment itself. These results suggest that considering the impact of deployment experiences on military spouses reveals important dimensions of military community adaptation and risk.

Assessing and adjusting for non-response in the Millennium Cohort Family Study

BACKGROUND

In conducting population-based surveys, it is important to thoroughly examine and adjust for potential non-response bias to improve the representativeness of the sample prior to conducting analyses of the data and reporting findings. This paper examines factors contributing to second stage survey non-response during the baseline data collection for the Millennium Cohort Family Study, a large longitudinal study of US service members and their spouses from all branches of the military.

METHODS

Multivariate logistic regression analysis was used to develop a comprehensive response propensity model.

RESULTS

Results showed the majority of service member sociodemographic, military, and administrative variables were significantly associated with non-response, along with various health behaviours, mental health indices, and financial and social issues. However, effects were quite small for many factors, with a few demographic and survey administrative variables accounting for the most substantial variance.

CONCLUSIONS

The Millennium Cohort Family Study was impacted by a number of non-response factors that commonly affect survey research. In particular, recruitment of young, male, and minority populations, as well as junior ranking personnel, was challenging. Despite this, our results suggest the success of representative population sampling can be effectively augmented through targeted oversampling and recruitment, as well as a comprehensive survey weighting strategy.

Establishing a methodology to examine the effects of war-zone PTSD on the family: the family foundations study

Military deployment may adversely affect not only returning veterans, but their families, as well. As a result, researchers have increasingly focused on identifying risk and protective factors for successful family adaptation to war-zone deployment, re-integration of the returning veteran, and the longer-term psychosocial consequences of deployment experienced by some veterans and families. Post-traumatic stress disorder (PTSD) among returning veterans may pose particular challenges to military and military veteran families; however, questions remain regarding the impact of the course of veteran PTSD and other potential moderating factors on family adaptation to military deployment. The Family Foundations Study builds upon an established longitudinal cohort of Army soldiers (i.e. the Neurocognition Deployment Health Study) to help address remaining knowledge gaps. This report describes the conceptual framework and key gaps in knowledge that guided the study design, methodological challenges and special considerations in conducting military family research, and how these gaps, challenges, and special considerations are addressed by the study.

Concentrations of environmental phenols and parabens in milk, urine and serum of lactating North Carolina women

Phenols and parabens show some evidence for endocrine disruption in laboratory animals. The goal of the Methods Advancement for Milk Analysis (MAMA) Study was to develop or adapt methods to measure parabens (methyl, ethyl, butyl, propyl) and phenols (bisphenol A (BPA), 2,4- and 2,5-dichlorophenol, benzophenone-3, triclosan) in urine, milk and serum twice during lactation, to compare concentrations across matrices and with endogenous biomarkers among 34 North Carolina women. These non-persistent chemicals were detected in most urine samples (53-100%) and less frequently in milk or serum; concentrations differed by matrix. Although urinary parabens, triclosan and dichlorophenols concentrations correlated significantly at two time points, those of BPA and benzophenone-3 did not, suggesting considerable variability in those exposures. These pilot data suggest that nursing mothers are exposed to phenols and parabens; urine is the best measurement matrix; and correlations between chemical and endogenous immune-related biomarkers merit further investigation.

The Millennium Cohort Family Study: a prospective evaluation of the health and well-being of military service members and their families

The need to understand the impact of war on military families has never been greater than during the past decade, with more than three million military spouses and children affected by deployments to Operations Iraqi Freedom and Enduring Freedom. Understanding the impact of the recent conflicts on families is a national priority, however, most studies have examined spouses and children individually, rather than concurrently as families. The Department of Defense (DoD) has recently initiated the largest study of military families in US military history (the Millennium Cohort Family Study), which includes dyads of military service members and their spouses (n > 10,000). This study includes US military families across the globe with planned follow-up for 21+ years to evaluate the impact of military experiences on families, including both during and after military service time. This review provides a comprehensive description of this landmark study including details on the research objectives, methodology, survey instrument, ancillary data sets, and analytic plans. The Millennium Cohort Family Study offers a unique opportunity to define the challenges that military families experience, and to advance the understanding of protective and vulnerability factors for designing training and treatment programs that will benefit military families today and into the future.