Mental Health Outcomes Associated with Profiles of Risk and Resilience Among Army Spouses

Background and Purpose: Although many military families appear to cope successfully with stressors, evidence has suggested that military spouses may be at increased risk for a wide array of poor outcomes including distress, substance use, and diagnosed mental health conditions. Prior studies on this topic have tended to focus on the impact of one stressor at a time, most frequently deployments, and have often overlooked the considerable presence of protective factors in this population. Using a latent profile analysis approach, the current study addresses these gaps in the literature by examining patterns of cumulative risk and concurrent protective factors among military families and the association of these patterns with mental health diagnoses among U.S. Army spouses.

Methods: Army Spouses (N = 3,036) completed a voluntary, online survey of family psychosocial fitness, the Comprehensive Soldier and Family Fitness Global Assessment Tool, which informed protective factors including coping, dyadic functioning, family cohesion, social connections, and social support. Survey results were linked with U.S. Department of Defense archival data, which informed military-specific risks, including recent family relocations, deployments and reunifications following deployments, as well as health care utilization and diagnoses. The three-step method of latent profile analysis was used to explore patterns of risk and protective factors and associations with covariates and distal outcomes.

Results: Analyses identified six distinct profiles, suggesting significant heterogeneity among military families with respect to their access to resources and exposure to risk. The largest profile of families (43.74% of the sample) had limited risk exposure and considerable strengths. Overall, 15.5% of Army spouses received a mental health diagnosis in the year following survey completion. Variability in risk and protection across profiles was associated with statistically significant differences in the prevalence of mental health diagnoses among military spouses (χ² = 126.600, df = 5, p < .001). The highest rates of diagnoses (45.4%) were observed in the profile with the lowest levels of protective factors.

Conclusions and Implications: Findings suggest that military families are not a homogenous group and highlight the importance of employing person-focused methods in order to avoid overpathologizing this population. Further, these results emphasize the need to evaluate both cumulative risk and protective factors when assessing the likelihood of adverse outcomes among military families. Several smaller subgroups within this sample had significant risk-exposure, including over 600 cumulative days of deployment on average since 2009. These profiles likely exemplified the high operational tempo that has characterized recent conflicts and were associated with increased rates of mental health diagnoses among spouses. However, these groups were comparatively small.  The majority of families in this sample appeared to be faring well. Some exposure to risk is likely inevitable for service members and their loved ones; increasing access to resources may be a fruitful avenue for prevention and intervention among families who are struggling.