Mental health outcomes associated with profiles of risk and resilience among military-connected youth

2018-07-03Although many military families cope with stressors effectively (Wadsworth, 2013), a significant subset of military spouses and children, who number close to 3 million (U.S. Department of Defense, 2017), experience adverse consequences of wartime military service including poor health and mental health, increased risk behaviors, suicidality, and substance use (Chandra, Lara-Cinisomo, et al., 2010; de Burgh, White, Fear, & Iversen, 2011; Flake, Davis, Johnson, & Middleton, 2009; Gilreath et al., 2016; Gorman, Eide, & Hisle-Gorman, 2010; Lester et al., 2010; Mansfield et al., 2010; Sullivan et al., 2015). These outcomes are a public health concern and highlight the need to understand contributing factors to develop policy, prevention, and intervention efforts to support military families. ❧ This three-paper dissertation was guided by a risk and resilience framework (Black & Lobo, 2008; Bowen & Martin, 2011; Masten & Narayan, 2012; Palmer, 2008; Rodriguez & Margolin, 2015), which posits that outcomes are determined by a dynamic balance of (a) the stressors a family faces and (b) protective factors the family possesses or accesses from surrounding systems. Although the most recent research examining resilience in military families has used variable-focused analytic models (e.g., Cederbaum et al., 2014; Gilreath et al., 2013; Sullivan et al., 2015), this work employs a person- or family-focused approach, defining unique subgroups of military families based on profiles of risk and protective factors and evaluating outcomes (Masten, 2001; Nurius & Macy, 2008; Rosato & Baer, 2012). A family-centered approach has the potential to advance understanding due to its increased focus on the strengths of military families and the use of analytic models able to examine constellations of risk and protective factors as they naturally occur (Masten, 2001; Nurius & Macy, 2008; Rosato & Baer, 2012; Saltzman et al., 2011). Capitalizing on the U.S. Army’s extensive secondary data holdings, this dissertation research used Comprehensive Soldier and Family Fitness data along with additional U.S. Department of Defense archival datasets to understand risk and protective factors affecting military families and associated mental health outcomes for spouses and children. ❧ Chapter 1 presents the theoretical framework guiding this project, a discussion of the theoretical and empirical evidence undergirding the risk and protective factors employed in these analyses, and an overview of the methodology for each of the three studies. Chapter 2 (Study 1) examines the psychometric properties of the Family Global Assessment Tool, which will inform protective factor scales employed in subsequent models. Chapter 3 (Study 2) explores patterns of risk and protective factors affecting military families and their association with mental health outcomes for military spouses. Because spouse outcomes were hypothesized to have cascading effects on youth outcomes, Chapter 4 (Study 3) builds on the results of Study 2 by modeling spouse mental health as a risk factor along with other family-level risk and protective factors associated with mental health outcomes for military-connected youth. Finally, Chapter 5 explores conclusions that can be drawn from the three studies and outlines broader implications for future research, policy, and practice