Military and Family Stressors for Female Military Members

CHAPTER 1: STATEMENT OF THE PROBLEM

Retaining qualified men and women in military service is the backbone of total force readiness. Given the amount of money required to recruit and train personnel, it is vital that military leadership understand the factors that influence the career commitments of service members, and particularly female service members, for whom much less is known.  Fifteen years of combat operations in Iraq and Afghanistan had a tremendous impact on the mental and physical health of military families.  Since 2001, more than 2.6 million troops have been deployed to Iraq and Afghanistan (Padden & Posey, 2013).  Many warriors are now facing high rates of suicide, depression, homelessness, and unemployment that have sounded the alarm for immediate action (National Alliance on Mental Illness (NAMI) 2012; Van Dahlen, 2011).

Female service members may experience unique family-related stressors.  Understanding factors that influence the readiness of female service members is important for several reasons. First, the number of females in the service is increasing. Between 2000 and 2015, the percentage of female military personnel increased from 15.4 percent to 16.8 percent (DOD, 2015).  This trend comes at a time when, for the first time in U.S. history, women are serving in roles more similar to those of men (National Center for Veterans Analysis and Statistics, 2011).  Second, the majority of the research on active duty families to date has focused on male service members because  active duty service members are majority male (85%),  and male service members are more likely to be married (56%) compared to female service members (45%; DOD, 2015).  Third, female service member marriages are distinct in that they are more likely than male service members to be in dual-military marriages where both spouses are active duty (45% of females compared to 7% of males) (DOD, 2015).

Studies have found that family factors, such as the quality of military marriages, have potential implications for service member’s retention and deployment readiness (Burrell et al. 2006; Diana, 1998; Herspring, 2013).  Specifically, service members whose spouses are happy in the relationship are significantly more likely to remain in the military (Booth, Segal, & Bell, 2007; Rosen & Durand, 1995; Land, 2010; Pittman & Orthner, 1988).  Competing with family obligations and the civilian labor market increases the challenges faced by the military to retain active-duty service members.  Given that over 54% of active-duty members are married (DoD, 2015), the enrichment of military family well-being has been deemed a national security priority (DoD, 2011).  However, little to no research has been conducted to date examining the effects of relationship quality and military satisfaction specifically among female service members and their male spouses.

Military Life Stressors

Military families deal with issues common in civilian families, including child care, parenting concerns, and education requirements.  However, military families also face issues unique to their circumstances such as relocation, frequent separations and reunifications from deployments, and spouse unemployment/underemployment (Drummet, Coleman, & Cable, 2003; Burrell, Adams, Durand, & Castro, 2006). Families of female service members may have additional concerns. For example, since women continue to provide the majority of childcare in military families, maternal deployment raises concerns about potential disruptions in the quality of care for children when mothers are deployed (Coltrane, 2000). Furthermore, when faced with work-family conflicts, female service members may experience more distress than male service members.  Orthner (1990) found that service women with more traditional husbands are less likely to feel that their spouses support their careers.  In non-traditional military families, including those with female service members, the dynamics associated with balancing scheduled and unscheduled military work requirements, including deployment, and supporting family needs, are often made more challenging (Burnam et al., 1992; Drummet et al., 2003).

Other stressors unique to military families come from the experiences of deployment and combat. Facing multiple long deployments in combat areas, service members regularly experience traumatic situations (Carlson, Stromwall, & Lietz, 2013).  Compared to previous wars, studies have found increases in the rates of Post-Traumatic Stress Disorder (PTSD), Traumatic Brain Injury (TBI), depression, and alcohol/substance abuse among male service members (Cohen et al., 2010; Duma, 2010; Okie, 2005; Seal et al., 2010).  Service members who screen positive for a mental health concern were significantly more likely to leave the service during the year after deployment (Hoge, Auchterlonie, & Milliken, 2006). Some military studies have suggested that, compared to their male counterparts, service women experience worse health-related quality of life and a greater likelihood of depressive and anxiety disorders following stress exposure (Lehavot et al., 2012; Grubaugh et al., 2006). However, the influence of mental health on retention among female service members has not yet been studied.

Personal Resources

There are numerous services available to military members.  The use of formal civilian and military resources has often been the focus of research on mitigating the effects of stressors for service members and their families (DOD, 2004; Meredith et al. 2011).  The ability to use available resources is meant to improve a family’s response to stress and improve the deployment experience.  Resources come in a variety of formats.  The RAND Corporation reviewed several DOD programs available for service members and their families that were designed to improve family resiliency.  The study found that military families faced obstacles accessing many of these programs (Meredith et al., 2011).  Civilian organizations have also made large investments in resources for service members and their families as they cope with deployments (DOD, 2004).  Unfortunately, the lack of collaboration and harmonization of services provided by federal, state, and local agencies hinders delivery of supportive services to military families in need of them (Jackonis, Deyton, & Hess, 2008).

Female service members and their families may require resources that differ from those utilized by families of male service members.  Personal resources and informal social support (e.g., significant other, extended family, neighbors, and friends) have been shown to have a positive effect on stress, mental health, separation adjustment, and career intentions for military families (Bolger et al., 2000; Fontana, Rosenheck, & Desai, 2010; Hobfoll, Dunahoo, & Monnier, 1991; Wood, Scarville, & Gravino, 1995). However, in nontraditional female-headed military families, male spouses may perceive a lack of beneficial formal resources designed to meet their needs.  From reports of services geared to female spouses to stigma related to seeking support (Southwell & MacDermid Wadsworth, 2016), the ability for male spouses to depend on extended family and friends may be even more important in minimizing the strain associated with the military lifestyle (Paley, Lester, Mogil, 2013; Westman & Etzion, 2005).  The quality of marital relationships has also been studied as a resource to buffer service members from the effects of military stressors (Coombs, 1991).  Poor marital quality has been linked to poor mental health and attrition in service members (Riviere et al., 2012; Vuga & Juvan, 2013). Bowen (1986) found that spouse support had a direct and positive effect in enlisted Air Force service women retention intentions, but there is little other research about the influence of resources on the well-being of female service members.

Family Stress Theory: The ABC-X Model

Resilience is a concept increasingly used in military research regarding military and family stressors and total force readiness of service members (Land, 2010).  As with any system, families strive to maintain stability when their steady state is disrupted by change.  Families often respond to stress based on individual members’ characteristics as well as the larger family dynamics.  The current study will be guided by Family Stress Theory (ABC-X), which includes the following components: stressor events (A) the buffering influence of family resources (B) and family perceptions of the events (C), which lead the family either to crisis or successful adaptation (X) (Hill, 1949; Boss, 2002).  The ABC-X framework posits that families who experience stressful events will be vulnerable to negative outcomes, and family relationships can be altered by accessing resources and making meaning of the event.  Although a part of the overall theory, the family’s perception of the stressor was not part of the current research question and was not measured.  Informed by literature on family resilience, Family Stress Theory presents an ideal theoretical framework uniquely appropriate to address how families adapt to stressful experiences (Patterson, 2002; Price, Price, & McKenny, 2010).  Successful adaptation to stressors is described by high levels of functioning and growth in response to stressors, whereas family crisis is a state of disequilibrium, diminished functioning, and presence of negative outcomes resulting from stressors (Young, 1983).  As service members and their families experience an increasingly stressful military environment (A), their perception (C) of the demands of the military may negatively impact their military satisfaction (X) and retention plans.  By examining the couples’ support resources (B), the current study aims to assess the extent to which personal resources may buffer service members and attenuate the impact of military-life stress on military satisfaction.

Purpose of the Current Study

Most of what we know about deployment stressors, mental health outcomes, and military families comes from studies conducted either exclusively or predominately in samples of male service members (Dohrenwend et al., 2006; Fikretoglu et al., 2006; Welsh et al., 2015; Foran, Wright, & Wood, 2013; Hoge et al., 2004), leaving us potentially little information about the unique needs of female service members.  This study is a secondary data analysis of the Millennium Cohort Study (MCS) and Millennium Cohort Family Study (MCFS) datasets using data de-identified by the Naval Health Research Center (NHRC). The combined datasets will be used to investigate the relationship between military and family stressors and military satisfaction in a large, longitudinal military family dataset oversampled for active duty female service members; as well as exploring moderating factors that may buffer female service members from the effects of these stressors.  The primary aim of this study is to investigate the relationship between military and family stressors and military satisfaction for a large cohort of active duty female service members, and how this relationship may differ from male service members.  The secondary aim of this study is to explore moderating factors that may buffer female service members from the effects of these stressors on their satisfaction with the service, and offer potential points of intervention.

CHAPTER 2: LITERATURE REVIEW

The Armed Forces has been an all-volunteer force since 1973.  As such, the services compete with higher education and the civilian job market to attract and retain talented individuals.  Unfortunately, the pool of men and women who are qualified and interested in joining the military is often limited by requirements such as health and substance use history, criminal background, physical fitness, and educational attainment (Carter, Kidder, Shafer, & Swick, 2017).  These requirements, along with budgetary demands to become smaller and mission demands to become more technologically advanced, have resulted in changes in the demographics of the military.  The men and women who are joining to serve their country have an average age of 28.5 years (older), over 90 percent have at least a high school diploma (more educated), and come from middle-class families (DOD, 2015; Watkins & Sherk, 2008).  Compared to previous wars, the men and women serving in the Armed Forces are also more likely to have families (Martin & McClure, 2000).  It is estimated that over half (52 percent) of today’s total military force and 42 percent of active duty members are married and 44 percent have children (ICF International, n.d.).

While the size of the military has decreased, the increased number of military operations resulting from wars in Iraq and Afghanistan has ensured that the need to recruit and retain qualified men and women an important goal of the Department of Defense.  To maintain the skills and knowledge necessary to meet national security objectives, the military will need to become more inclusive to attract and maintain qualified personnel.  Since the 2010 census report that women account for 50.8 percent of the general population (Howden & Meyer, 2011), an increased understanding of service women and their needs will be necessary in order to appeal to new female recruits.  While the number of female service members has been on the rise, they are still an underrepresented population in the military.  According to the Military Leadership Diversity Commission (MLDC; 2011), female enlisted and officers have lower retention rates than males in the military.  The differences in retention between male and female officers increase over time beginning at the fourth year of service (MLDC, 2011).  Retention among dual military couples varies by gender, with female service members experiencing more pressure to leave the military (Orthner & Bowen, 1982).  In a study of Navy personnel, Farkas and Durning (1982) found that 37% of their dual military couples would likely leave the service if forced to serve apart.  In the past, the greatest recruitment tool for many service men is the belief that serving in the military is more than an occupation; it is a culture of shared beliefs, practices, and experiences (Clervil, Grandin, & Greendlinger, 2010).  Is this true for service women?

To retain qualified military personnel, particularly female service member, a level of satisfaction with military service and the military community is required.  Previous research has used satisfaction with the military as one of the job related attitudes that factor into personal readiness and retention (Schumm, Bell, & Resnick, 2001; Teplitzky, Thomas, & Nogami, 1988); finding that greater satisfaction with military life resulted in higher retention (Bowen, 1986).  When queried, the majority of service members and their spouses indicate satisfaction with the military (BSF, 2014; Teplitsky et al., 1988).  Unfortunately, the literature is scarce on gender differences in satisfaction with the military, especially when taking exposure to military stressors into account.

Military and Family Stressors

The wars in Iraq and Afghanistan have resulted in over 2 million service men, women, and military families enduring multiple and extended deployment cycles with shorter rest periods between deployments (Padden & Posey, 2013).  Most military families do well with the complex demands of military life because they have strengths and skills (protective factors) that enable them to adjust to the changing requirements with few difficulties.  For others, the high operations tempo (OPTEMPO) and increased frequency of deployments, especially to combat areas, have added significant strain on military families, and the systems that support them (Burrell, Castro, & Durand, 2002).  The presence of a single risk factor is rarely enough to result in a service member’s decision to leave the military.  As with overall health quality (Carlson et al., 2013), service members are exposed to a number of risk factors that intersect to determine their overall satisfaction with the military.  During the course of military service, service members are required to spend extended periods away from home to carry out military missions.  These deployments (e.g., military operations, exercises, and trainings) place great stress and strain on a complex family system (Knox & Price, 1995).  Military families face challenges from 24-hour work schedules, unplanned extended work hours, weekend duty, and regular changes in duty assignments that impact routines with children and spouses, individually and as a whole.  A study by Orthner (2002) found that one third of the participants in the study reported more than 17 weeks away from home.  Approximately one-third of those who have been sent to Iraq and Afghanistan have served at least two tours in support of U. S. objectives (American Psychological Association (APA), 2007).  Although many military families navigate quite well through routine deployments, the stress of prolonged deployments and time away from family, particularly during periods of war and conflict, may begin to take their toll on military families. As a result, we see increased rates of PTSD, TBI, depression, and alcohol/substance abuse compared to previous wars (Cohen et al., 2010; Duma, 2010; Okie, 2005; Seal et al., 2010) in male samples.  Military suicides have also reached national crisis level with one active duty soldier taking his or her own life every 36 hours and one veteran every 80 minutes (National Alliance of Mental Illness (NAMI), 2012).

The U.S. military is a hierarchical and very masculine environment (Foynes et al., 2015). Success in the military often requires conforming to male established norms.  While women have played a role with military operations since the Revolutionary War (Goldstein, 2001), enforcement of policies may still reflect a male bias.  In a survey conducted by the Service Women’s Action Network (2017), gender bias and family policies were identified as personal and community challenges for active duty women.  Family considerations were listed at the most important factor contributing to their decision to remain in the military for 48 percent of the participants.  Gender-bias is often associated with decreased satisfaction with the military and decreased likelihood of staying in the military long-term (Foynes et al., 2015).  Service women have reported that their male counterparts have referred to them as weak, whiny, hormonal, and incapable (Blank, 2008). This added bias could pressure service women into hiding mental health issue for fear that revealing it could further the perception that they cannot handle their military.

Female service members are more likely to be in dual-military marriages (20.3%) and their marriages are twice as likely to end in divorce (DOD, 2015; Negrusa, Negrusa, & Hosek, 2014; Karney & Crown, 2007).  Much of what we know about military and family stressors on military family outcomes has been derived from research conducted on predominantly male samples.  The outcomes experienced by women in the military are distinct and can vary based on branch of service (SWAN, 2017).  Today’s service women are exposed to unique deployment-related stressors, very difficult living conditions, and the increased likelihood of being exposed to trauma, especially military sexual trauma (MST; Carlson et al., 2013).

Work-Family Conflict

One way military service can negatively impact job satisfaction and retention is through the conflict it creates between work and family.  The family and the military are both categorized as greedy institutions that make excessive demands on their members (Coser, 1974).  As an organization, the military directly impacts the lives of employees and their families (Segal, 1988).  Military families are routinely expected to cope with challenges associated with the risk of injury/death, geographic mobility, deployment, or overseas assignments (Segal, 1988).  Out of loyalty to the military, members can find themselves struggling to find balance between professional and family priorities. Failing to do so, can lead to increased stress on the individual and the family system.

Research in work-family conflict has shown a strong associated with military and family stressors, as well as disproportionately impacting female service members (Hammer, Allen, & Grigsby, 1997; Westman & Etzion, 2005).  The influence of military service can often be very strong for service members and can present itself in various ways.  In addition to long periods of time away from the family, increased time in service brings the desire to obtain outstanding evaluations and assignments that can increase the service members’ opportunity for promotion.  Obtaining premium assignments can lead to relocating family members to new geographic or overseas locations.  These career decisions often result in families making decisions on the quality of local schools to spouse employment opportunities.  The ideal assignment could also require the service member to accept an assignment that would require more time away from the family or unaccompanied assignments.  Conflict occurs when service members are unable to fulfill family obligations while away from family fulfilling work obligations.   In a study on Navy sailors, officer and enlisted members found that the work-family balance was not ideal (Snodgrass & Kohlmann, 2014) and military spouses reported that separations from the service member as their greatest source of dissatisfaction with military life (Black, 1993).   The conflict between work and family can impact recruitment and retention decisions of service members (MacDermid Wadsworth & Southwell, 2011) and can present a particular challenge for women and dual-military couples with children.  Recognizing that attrition and low morale negatively effect readiness (DUSD, 2004), the military services are exploring ways to accommodate the diverse needs of their members.

Number of Children under 18

The presence of children at home is significantly associated with increases in stress and depression for deployed service members and their spouses (Warner et al., 2009).  Balancing the roles of spouse, parent, and military employee can have gender differences.  Since motherhood can be particularly demanding, female service members may feel the pressure to make greater sacrifices of time and career goals (Milkie & Peltola, 1999).  For example, the decision to have children can often be seen as a disruption to career progression and a burden on their command.  The negative perception from leadership could potentially open the female service member up to discrimination from male peers (Harris, 2009).  Research shows that females are more often expected to sacrifice their career to care for minor children (Westwood & Turner, 1996; Harris, 2009).  Additionally, the perception of putting one’s military career ahead of parenting minor children can create emotional strain for many parents (Kelley et al., 2001).

Over 40% of military children are under the age of 5 (DUDS, 2009).  The cost and availability of affordable childcare is a concern for service members and their families.  For example, 38 percent of respondents to the annual Blue Star Family (BSF) survey reported childcare as the primary reason for not working.  The need for affordable and adequate childcare can be amplified for females and dual-military couples.  In the case of recent conflicts, even short, but repeated separations, can potentially encompass a significant percentage of a child’s life.  Separation from a parent during early childhood can also prove particularly stressful for the child (Paris et al. 2010).  Chartrand et al. (2008) found that school-aged children with a deployed active duty parent exhibited higher levels of both internalizing and externalizing behavior than children with a non-deployed active duty parent.  Young children were more likely to exhibit behavioral problems such as disobedience and clinginess (Barker & Berry, 2009), while older children are likely to exhibit academic performance, emotional disturbances, and anger (Sheppard, Malatras, & Israel, 2010).

The literature links the psychological health of the non-deployed parent to the positive adjustment of children (Chartrand et al., 2010).  The at-home parent, carrying the additional burden of parenting alone and concerned with the well-being and safety of their spouse, may lack the necessary coping skills needed to balance the responsibilities of family (Barker & Berry, 2009).  When a primary caretaker is the deployed parent, the support normally sought by children to deal with stressful circumstances or emotional distress may no longer be available (DOD, 2010; Gewirtz, Erbes, Polusne, Forgatch, & DeGarmo, 2011).  Under potentially challenging circumstances, even the most sensitive and responsive parent may become less available and attuned to their child’s emotional needs.  Father involvement has been linked to positive outcomes in military children (Posada et al., 2015).  Unfortunately, the study sample was pulled from female spouses leaving the need for

Mental Health

By virtue of their gender, service women may encounter mental health concerns that may impact their retention decisions. According to the DoD annual report on sexual assault, reports of sexual assault increased 53% from 2012 to 2013, and this level was sustained in 2014 (DoD, 2015).  Studies also indicate that service women experience health-related quality of life concerns and a greater likelihood of depressive and anxiety disorders (Lehavot et al., 2012; Grubaugh et al., 2006).  Despite reports that over one-third of returning veterans received mental health services in the year following deployment (Hoge et al., 2005), service women may face major barriers to receiving professional help due to mental health stigma (Hoge et al., 2004; Kelly et al., 2008) and risks due to gender and racial bias.  While we know that multiple deployments and exposure to stressors are associated with a greater risk of mental health problems (Johnson et al., 2007), we lack information on how these deployments have specifically impacted a large sample of service women or their satisfaction with the military.  .

Use of Personal Resources

Our need for relationship and relational connections to foster growth and resilience has been well documented in the literature.  Support from one’s spouse and informal support sources may assist individuals and families coping with stressful events (Cohen et al., 2000; Kelly et al., 2017).  Research aimed at understanding protective factors beneficial in mitigating the association between stressors and adverse outcomes has grown.  Research on the impact of social support and marital satisfaction among female service members is unknown.

Social Support

Building effective support networks for military families is essential for military retention and readiness. Most service women are stationed away from their family of origin, so developing a social support network becomes very important.  These naturally occurring relationships serve as a source of physical and emotional assistance to servicewomen during stressful times (Griffith, 2015).  The perception of a strong support network for daily functioning, as well as during the deployment cycle, is emerging as an important mental health tool (Boyd et al., 2013).  Married service women (with civilian spouses) are not exempt from challenges to military life.  Studies show that women who choose to marry are less likely to receive the social support from their spouses experienced by their male counterpart (Frayne et al., 2006).

The moderating hypothesis suggests that social support improves the effects of stressful events such as separations from family and friends, lack of employment, and balancing work and family obligations.  Informal social support systems, including friends, relatives, work colleagues, and church members,, have been positively linked to separation adjustment for military families (Hobfoll et al., 1991; Wood, Scarville, & Gravino, 1995), and women have specifically identified children, employment, close friends, and family as their main sources of support when separated from their military husbands (Vormbrock, 1993). Military families who lack adequate social support networks are often associated with concerns related to isolation, pregnancy or health complications, financial troubles, and poor problem-solving ability (Vormbrock, 1993; Wood et al., 1995). Therefore, adequate social support networks are crucial for these families.  To successfully support the family during military service, informal support members must negotiate a balance between assisting the family during separations and supporting the family in maintaining independence.

Marital Satisfaction

Support from one’s spouse serves as an important source of support.  From the literature, we see that marital satisfaction influences a woman’s support of her husband (Pittman & Orthner, 1988).  In studies on Army soldiers, marital satisfaction was also associated with satisfaction with the military (Burrell, Adams, Durand, & Castro, 2006).  The length, conditions, and perceived risks associated with deployments have been linked to increased stress on the marital relationship (Figley, 1993; Hogancamp & Figley, 1983; Negrusa et al., 2012; Riggs, 1990; Vormbrock, 1993).  Service members tend to marry younger than the general population and one in five junior enlisted couples report marital problems (DUDS, 2009).  In female spouses, the non-deployed spouse is likely to encounter a number of stressors, to include separation strain, loneliness, role overload, financial concerns, increased parenting demands, and frustration with the military bureaucracy (Vormbrock, 1993).  Statistics on male spouses was unknown.  Male service member may also experience an overload of feelings that may persist throughout the period of the separation and reunification (Hogancamp & Figley, 1983).  While reunions after deployment are often greatly anticipated and romanticized (Kelley, 1994; Riggs, 1990), problems can soon surface requiring renegotiation of boundaries and the adjustments to change.

Individual and Family Characteristics 

Military and demographic characteristics contribute to how individuals respond to stressors, receive assistance, and determine level of satisfaction with the military.  Research has examined a number of demographic characteristics related to military stressors and retention.  These demographics assist in identifying which subgroup may benefit from additional support.

Service Members Age

Approximately 40 percent of active duty and Reserve and Guard members are under the age of 25 (DOD, 2015).  With age, the percentage of married service members also increases.  This trend is consistent for enlisted and officers.  For female Officers, retention prospects appear to increase with each additional year of life (Mundell, 2016), so junior officers are at increased risk of attrition.  Service members who were younger and female have also been found to experience more depressive symptoms, anxiety and stress during deployment (McNulty, 2005; Ramchand et al., 2015) and are at a greater risk for a diagnosis of depression (Warner et al., 2009).  Younger spouses are more likely to be married to a deployed service member (Mansfield et al., 2010).  Fearing harm to their husbands’ careers, younger spouses are less likely to endorse help-seeking behavior (Warner et al., 2009), thus more likely to experience stressors compared to older spouses.

Service Members Race/Ethnicity

Research is mixed regarding the retention of minority women.  Asch, Miller, and Malchiodi (2012) found no statistical difference in retention among black service women compared to white males prior to the rank of O4, but the trend changes for later career The rate of depression in African-American females in the general population is statistically significant when compared to white females (8%; Pratt, 2008).  Unfortunately, the true mental health impact on African-American servicewomen, and service women in general, is unknown.  From research on the general population, we know that African American women experience the added burden of racial discrimination, which permeates every aspect of their daily lives (Dominguez, 2008). Racism and discrimination are stressful events that can directly lead to psychological distress and physiological changes affecting mental health (Kreiger et al., 2005). Perceived discrimination was related to diagnoses of generalized anxiety and depression in African Americans (Kessler et al., 1999).

The extent to which emerging health disparity among service members also affects the adjustment of their spouses has rarely been studied. Often comparisons could not be made due to insufficient sample sizes overall or between ethnic groups, or missing data on race/ethnicity (Allen et al., 2011; Mansfield et al., 2010; Renshaw et al., 2008; Warner et al., 2009).  Given that African American service members are more likely to experience psychological distress after exposure to a traumatic event during combat than White service members (Murdoch et al., 2005; Nayback, 2008), it is important to consider the potential for group differences based on race.

Service Members Education

The need for highly skilled and talented individuals to carry out national defense objectives makes education highly desirable.  Lower levels of education have been found to have a significantly negatively affect on the health and well-being of service members during deployment (McNulty, 2005).  Military spouses report feeling that they are overeducated and underemployed compared to their civilian peers (Hosek, et al., 2002.  Spouses with more years of education were significantly more likely to endorse health-promoting behaviors during deployment separation, such as exercising regularly, eating a healthy diet, and getting regular check-ups with a primary care physician (Padden et al., 2011).

Service Members Income

Service members are generally well paid compared to their civilian cohort, but some still experience financial stress, especially those in the junior enlisted ranks (Hosek & Wadsworth, 2013).  While most areas surrounding military installations require two-income households to live comfortably, the nomadic lifestyle service members often take a toll on the earnings of military spouses (Castaneda & Harrell, 2007).

Spouse Employment

Spouse employment is recognized as an important quality-of-life issue for military families (White House, 2011).  Combining the military lifestyle with a career is a daunting challenge for military spouses (Hall, 2008; Hosek, Asch, Fair, Martin, & Mattock, 2002).  According to the annual BSF survey, unemployment or underemployment of their spouse places the family at an added financial disadvantage (BSF, 2014).  Also, the frequent disruptions created by relocation can significantly disrupt career development (Eby, DeMatteo, & Russell, 1997).  Nonmilitary spouses may encounter employers who are reluctant to invest time or money training someone who may have to relocate.  Military spouses may also experience high rates of unemployment because of inadequate employment opportunities in and around some military bases. This is especially true with overseas locations, where female spouses may also face cultural bias against women working outside the home (Morrison et al.; Segal, 1986; Vercruysse & Chandler, 1992).  The challenge of balancing job demands and family demands can be magnified during deployments.  Families can have a financially tougher time during extended periods of separation.

Years Married

A solid marital foundation, often measured by the length of the marriage, provides a buffer to marital stress.  Evidence is strong that newly married male service members are at increased risk for post-deployment distress when compared to service members who have been married for more years (McNulty, 2005).

Service Member Pay Grade/Rank

The rank of service members has been highly correlated with military life satisfaction (Burrell, Adams, Durand, & Castro, 2006; Vernez & Zellman, 1987).  It was also correlated with the impact of military separations and psychological well being from the service member husband.  Prevalence of mental health symptoms are also strongly influenced by the rank of the active duty service member for both the service member himself as well as for his civilian spouse; with lower rank indicating greater risk (Lester et al., 2010; Phillips et al., 2010).  Enlisted service members reported significantly more posttraumatic distress than officers and a similar pattern, but not statistically significant, was observed between spouses of enlisted and officer service members (Heltemes et al., 2011).

Family Stress Theory: The ABC-X Model

Previous researchers have recognized the value of utilizing a family systems perspective in understanding the dynamic interactions of military families’ deployment experiences (DeVoe & Ross, 2012 ; MacDermid Wadsworth, 2013 ; Riggs & Riggs, 2011).  A family systems perspective assumes that (1) the family as a whole is greater than the sum of its parts; (2) individual family members have mutual impact on one another; and (3) individual members can be understood in the context of the larger family unit (Cox & Paley, 1997).  With this in mind, it is important to consider that any time one family member is affected by certain stressors, it is likely that other family members will also be affected.

Family Stress Theory presents a useful framework for understanding the complex relationships between military life stressors, personal resources, and military satisfaction among female active duty service members.  Using the ABC-X model in this study is unique in its evaluation of female service women as well as its focus on the relationships between the military and family stressors and satisfaction with the military.

Stressor events (A) are those experiences that provoke some degree of change in the family system (Price et al., 2010).  A stressor event can either change or not change a family’s level of functioning. Based on both the magnitude of the event and other moderating factors, stressors may lead to family crisis.  Stressors may be considered routine, in that they are expected based on a family’s circumstances (e.g., deployment).  These stressors are often considered normal for the family.  Other stressors are considered relatively uncommon and occur based on some unique situation that is unlikely to have been predicted (e.g., service-connected injury).  Stressors can also be categorized based on whether they occurred gradually or suddenly or whether the stressor is a short- or long-term concern.  In this model, the (A) factor represents the military and family stressors associated with military life.  The primary stressors evaluate the objective factors associated with the retention (i.e., time away from family, children under age 18, mental health outcomes, and work/family conflict).  Based on current research, it is recognized that it can be difficult to separate whether stressors are related to service women’s perception of military satisfaction.  Individually, stressors may all be manageable.  When combined, however, they create a situation that puts many military families at risk for crisis.  As the ABC-X model suggests, the accumulation of stressor events associated with adapting to military life may qualify as such a scenario.  Initial appraisal of the stressor would be determined by perceptions of susceptibility to and severity of the event.

Resources (B) available to and used by the family can moderate the relationship between stressors and retention outcomes. Resources encompass the family’s ability to access support or characteristics of the social network that can be used to meet the demands of the changes produced by the stressors.  External resources must be discovered, accessed, and utilized by the family effectively in order to reduce distress. The (B) factors are the family’s resources (i.e., social relationships and marital satisfaction),

In addition to accessing resources, a family’s perceptions of the stressor event (C) also moderate its effect on family outcomes (Price et al., 2010). Different families’ subjective definitions of the same stressor event fall on a continuum of meaning.  An event that finds one family optimistic and growing closer as a family can result in another family expressing feelings of hopelessness for an unmanageable situation.  Spirituality, values and beliefs, and cultural issues can impact the family’s perception of stressors.  Understanding whether a family embraces or dreads the changes brought about by stressor events is important to predict whether the family will successfully adapt to the change or experience crisis.  The current study did not operationalize the perception of the stressor event separately.  The items of the MCS and MCFS incorporate the respondent’s perception in the responses measured by these datasets.

The X factor of the ABC-X model is the family outcome.  The outcome signifies whether the family successfully adapts to the stressor event or whether the family experiences severe distress.  Stressors are not inherently bad for families, but may become problematic when family function becomes disrupted.  Demonstrating positive growth in the face of stressful life events is often referred to as resilience (Boss, 2002; Cozza et al., 2005; Walsh, 2003).   When a family is in crisis, family members are no longer able to function at optimal physical or psychological levels and experience high levels of distress.  Researchers should be clear that the X within the ABC-X model is conceptualized as a state of crisis (Boss, 2002), and measurement of dependent variables for their given studies should be consistent with that conceptualization.

Research using the ABC-X model has found that females are more likely to perceive stressor events (Price & McKenny, 2000). Service member who experience stressors also experience important changes through shifts in relationship roles (e.g., parent, wife) (Pincus et al., 2001).  The ABC-X model hypothesizes a linear relationship between stressor events and outcomes, moderated by family resources and perceptions of the event. In the context of the current study, each variable may be mapped onto the ABC-X model as depicted in Figure 1. The stressor events (A) is the military and family stressors experienced by service members during their career, including time away from family, the number of children under age 18, work-family conflict, and dual-military couple status. The concrete resources (B) accessed and utilized by the military family during the routine and emergency situations include support provided by family and friends.  The X factor describes either the successful adjustment to or crisis experienced from interaction with stressors and is operationalized by satisfaction with the military

Research questions

The current study investigated the relationships between military and family stressors (time away from family, work-family conflict, number of children under age 18, and dual-military couple status) and use of military and civilian resources (informal social support and marital satisfaction) on military satisfaction of female service members. That is, this study assessed the associations between stressors and military satisfaction, and it assessed the potential moderating effect of informal support systems and marital satisfaction on the direct relationship.  It is hypothesized that the use of specific resources will change the direction and/or strength of the relationship between stressors and military satisfaction.  Thus, this study had the following research questions:

RQ 1 To what extent are female service members’ military and family stressors (time away from family, dual-military couple, number of children under 18, mental health, and work-family conflict) associated with their military satisfaction, and how does these associations compare to those with male service members?

RQ 2 To what extent do personal resources (informal social support and marital satisfaction) moderate the relationship between female service members’ military and family stressors and their military satisfaction?

Based on the above research questions, it was hypothesized that service member couples who report higher military and family stressors (e.g., time away from family, dual-military couple, number of children under 18, mental health, and work-family conflict) will have lower levels of military satisfaction after adjusting for covariates. It was also hypothesized that association between military and family stressors and military satisfaction will be stronger for females service members than for male service members. Further, it was hypothesized that higher reported support from personal resources will have a stronger association on the relationship between military and family stressors and low military satisfaction in female service members.

CHAPTER 3: METHODS

Data: Description of the Data

The data for this study were drawn from the 2011 Millennium Cohort Study (MCS) and Millennium Cohort Family Study (MCFS).  The MCS study was designed to collectively represent all the men and women who served in the US military since 2000.  The MCS has enrolled four large panels of service members from the US military roster using a probability sample design.  The MCS was expanded in 2011 to include the Family Study, in order to understand the interrelated health and well-being effects of military service on families – service member, spouse, and children (Crum-Cianflone, Fairbank, Marmar, & Schlenger, 2014).  The MCFS baseline sample was randomly selected from service members of all service branches and components in October 2010.  Data for the fourth panel of the MCS and the baseline MCFS was collected between 2011 and 2013.  The military spouses enrolled in the MCFS were recruited from service members with 2–5 years of service enrolled in the MCS.  The spouse cohort was oversampled for opposite-sex married and female service members to ensure the enrollment of an adequate numbers of spouses for the Family Study (Crum-Cianflone et al., 2014).  As with the MCS, spouses in the MCFS study will be followed longitudinally, assessed at baseline with follow-up surveys completed approximately every three years (Crum-Cianflone et al., 2014).  Follow-up surveys will continue even if the service member and spouse experience a relationship status changes (i.e. separated, divorced, or widowed).

Enrollment of military spouses in the Family Study was done by the Naval Health Research Center (NHRC) and utilized a four-step enrollment process using both postal mailings and e-mails to encourage participation (Crum-Cianflone et al., 2014).  The MCFS employs a nested design model, indicating that service member in the MCS referred military spouses enrolled in the MCFS.  For married service members enrolled in the MCS who did not decline to have their spouse contacted, enrolled through direct invitation was utilized.  The first four mailings encouraged participation in the web-based survey, while the fifth mailing introduced the option of completing a paper questionnaire with a postage-paid return envelope (Crum-Cianflone et al., 2014).  Mailings were discontinued when the participant enrolled in the study, declined to participate, or at the end of the survey period.  Periodic reminders and pre-incentive items were incorporated into the recruitment process.  Every effort was made to minimize the temporal difference between service member’s completion of the MCS and spouse’s completion of the MCFS.

This study is a secondary data analysis of the Millennium Cohort Study and Millennium Cohort Family Study datasets.  A formal written proposal outlining the proposed research study and its alignment with the objectives of the MCS and MCFS was submitted to NHRC.  Once final approval from the oversight committee was provided, data de-identified was provided by NHRC.  Data was de-identified prior to distribution to ensure that the identities of research subjects could not be readily ascertained based on National Institutes of Health Safe Harbor procedures.

Survey Design

The MCS and MCFS questionnaires were comprised of approximately 100 questions.  Both questionnaires incorporated multiple components with associated skip patterns.  The questionnaires were divided into specific areas, allowing for the grouping of similar questions and time frames.  Standardized instruments were incorporated into the survey because of their reliability and validity, and to enable comparisons with other populations. Many of the standardized instruments in the MCS are mirrored in the MCFS to allow for comparison between the service member and spouse.  The questionnaires were designed to take between 30 minutes and 45 minutes with the ability to take it online or by hard copy mailed through the U.S. postal service (Crum-Cianflone et al., 2014).  Web-based access to the MCS and MCFS questionnaires by Cohort participants was maintain via highly secure web sites.  Both online and paper questionnaires offer the participants the ability to leave the questionnaire and return to where they left off.  Semiannual e-mails and postcards were used to track participants, maintain interest in continued study participation, and verify accuracy of contact information for this highly mobile population (Crum-Cianflone et al., 2014).

The MCS and MCFS utilized both web-based and paper surveys to assess a wide range of quality of life issues for service members and their families.  The specific questions within the survey are based on a conceptual model created with four main domains: (1) spouse physical health; (2) spouse mental health and adjustment; (3) spouses’ reports of their children’s mental/physical health and functioning; and (4) family functioning, and protective and vulnerability factors (Crum-Cianflone et al., 2014).  Due to the sensitive nature of some of the questions on the survey, spouses were assured confidentiality and security of all information provided.  In addition to self-reported survey responses, the datasets allow service member and spouse responses to be linked to physical, mental, and behavioral health information.  The link to military and VA records allow investigation of military-related experiences, including deployments, occupation, injuries, environmental exposure, and other military events (e.g. disciplinary actions, promotion, and separation).  Follow-up surveys also allow for longitudinal capture and temporal sequencing of the changing nature of the spouses’ experiences (e.g. relocation, separation, deployment, parenthood) and health symptoms, and their trajectories over time.

Oversight of the study is provided from the University of Maryland’s Institutional Review Board (UMD IRB) (UMD 1115127), NHRC IRB (NHRC 2000.0007), Office of Management and Budget (OMB Approval Number 0720-0029), and a Report Control Symbol number (RCS Number DD-HA (AR)2106) (Crum-Cianflone et al., 2014).

Study Design

Figure 1 identifies the major components of the family stress model and the hypothesized relationships between components.  It is predicted that satisfaction with the military will be directly and negatively affected by the military and family stressors encountered by the service member and his or her family.  It was also hypothesized that association between military and family stressors and military satisfaction will be stronger for females service members than for male service members.  In addition, it is hypothesized that the level of marital satisfaction with the spouse and social support from family and friends for the service member will change the direction and/or strength of the relationship between stressors and military satisfaction.

Participants

Completed surveys were received from 9,872 respondents.  Eligible participants for this study will include all MCS/MCFS study participants who are active-duty service members of the Army, Navy, Marine Corps, Air Force, and Coast Guard, and their spouses, including National Guard and Reserve member to account for dual military couples.  Sensitivity analyses were conducted for dual military, Reserve and National Guard couples to evaluate their inclusion into the sample.  The MCFS Team made great efforts to improve the representativeness of the sample.  Weighted populations variables were created to account for sampling design and non-response bias (Corry, William, Battaglia, McMaster, & Stander, 2017).

Analysis Plan

Quantitative data analysis was conducted to assess (1) the extent to which military and family stressors (time away from family, number of children under 18, dual-military couples, work-family conflict, and spouse/service member mental health) are associated with service members’ military satisfaction, and (2) the extent to which social support and spouses’ marital satisfaction moderate the relationship between those stressors and military satisfaction. Covariates (socio-demographic characteristics and military characteristics) that may influence satisfaction with the military will be included in the analyses.  First, the sample will be described on all variables of interest. Next, bivariate analyses will be conducted to assess the relationships between independent variables, moderating variables, covariates, and the dependent variable of military satisfaction.  Then, a series of multivariate regressions will be conducted to test the independent relationships between military and family stressors and military satisfaction.

The first linear regression model will test the total effect of military and family stressors on military satisfaction, while controlling for the covariates associated with the dependent variable in bivariate analyses.  We will assess the independent and overall effect of military life stressors on the outcome by examining the regression coefficients and performing a global F-test (Model 1).  The magnitude of the association between military and family stressors and their 95% confidence intervals will be estimated.  To formally test whether the relationships differ significantly between female and male service members, an interaction term between gender and specific military and family stressors will be assessed in the model.

Next, we will assess whether these relationships are moderated by social support and marital satisfaction (Model 2).  To do this, we will stratified the original models by gender, then include two-way interaction terms to the multiple regression models to test whether the relationship between stressors and service member military satisfaction differs significantly by lower and higher levels of social support and marital satisfaction.  All models will be weighted to account for sampling probability and nonresponse (Corry, Williams, Battaglia, McMaster, & Stander, 2017).  Sensitivity analyses will examine the outcome as a categorical exposure using ordinal or multinomial logistic regression models.  We recognize that these groups may have different experiences that may impact our analyses.  If the results differ, the groups may be analyzed and reported separately.  Statistical analyses will be performed using SAS software version 9.4.