The Association of Military Veterans' Social/Emotional and Physical Functioning with Child and Family Outcomes

Background and Purpose: The conflicts in Iraq and Afghanistan have been associated with high rates of mental and physical health issues among military service members. As service members transition to civilian life, functioning deficits associated with these injuries may continue to impact both veterans and their families. The children of veterans are an understudied population who may experience a host of stressors including exposure to disabling parental injury.  Using structural equation modeling, this study examines associations among veteran physical and social/emotional functioning deficits, the functioning of veteran families, and adverse outcomes for veteran-connected children, with particular attention to the mediating role of family functioning. 

Methods: Data were drawn from the Chicago Veterans Survey, completed between August 2015 and March 2016. Participants included 594 male veterans who reported financial responsibility for at least one child (45.9% of the total sample of 1294 veterans). Data were collected using a multi-pronged, nonprobability sampling approach. Veteran social/emotional and physical functioning was measured using the World Health Organization disability assessment schedule 2.0.  Family functioning was measured using the general functioning subscale of the McMaster family assessment device. Adverse child functioning was measured using a screening tool including common problems experienced by military/veteran-connected youth.

Results:  Multicollinearity was noted in preliminary models so final models were run separately to evaluate the clinically distinct effects of veterans’ social/emotional and physical functioning.  Confirmatory factor analysis indicated that both measurement models provided a good fit for the data.  Fit indices for the social/emotional functioning model included: x²(N=594, 50) = 192.628, p=0.0007, CFI=0.978 and RMSEA=0.027 (90% CI: 0.018, 0.035). Fit indices for the physical functioning model included: x²(N=594, 44) = 155.767, p=0.0006, CFI=0.979 and RMSEA=0.029 (90% CI: 0.019, 0.038). Structural equation models also provided a good fit for the data.  Direct pathways between veteran functioning deficits, family functioning deficits, and adverse child outcomes were all positive and highly significant.  Family functioning mediated the relationship between veteran functioning and child outcomes in both models (β = 0.065, p = 0.017; β = 0.055, p = 0.006, respectively).

Conclusions and Implications: Though most families in this sample appear resilient, findings suggest that both veteran social/emotional and physical functioning may be associated with adverse outcomes for a subset of veteran-connected youth and families.  Given the comorbidity between physical and mental health deficits and the similar pattern of relationships noted in models, findings imply that distinctions between physical and mental health may be less critical. Rather, veterans’ overall health, comprising both physical and social/emotional elements, appears to be important to the wellbeing of veteran families.  Further, the mediating role of family functioning underscores the interdependent nature of resilience processes across the family system.  Positive outcomes may be best served by focusing resources on promoting resilience processes at the family level. Findings highlight the need to better identify veteran-connected families who could benefit from family-level prevention and intervention services. While evidence-based family treatments are available, current policy limitations to VHA-provided services make it difficult for families to access needed services.